"Basic problems of representation are driving growing concerns about relying on published research to reflect the truth.  The end result is that the healthcare, biomedical research, and policy communities may end up drawing scientifically invalid conclusions based on only those parts of the evidence base they can see.  Recent studies have also shown that even when disclosure of study findings is mandated by law, results often remain invisible."  From the BMJ article discussed below

RIAT stands for "Restoring Invisible and Abandoned Trials".  Once you understand what Invisible & Abandoned studies are (HERE), you will agree that the companies in charge of purveying these sorts of practices on the public should be read the riot act (then fined, caned, and sent to Papillon's infamous 'Devil's Island').  Let me explain to you why "Invisible & Abandoned" studies are so deviously filthy.

As you know, when it comes to BIG PHARMA, there are billions and billions of dollars at stake, both through the private sector (insurance Companies and out-of-pocket) and public sector (Medicare, Medicaid, etc).  We already know that the pharmaceutical industry is frequently (routinely) charged with UNDER-REPORTING side-effects, OVER-TESTING, DATA FUDGING, "PRESS RELEASES" disguised as research, FINANCIAL CONFLICT-OF-INTEREST, HYPE, and OUTRIGHT FRAUD, while trying to either get their drugs approved by the FDA, or trying to gain market share --- and these are just for starters.  Another common way that research becomes untrustworthy is via Invisible and Abandoned studies.

These are the studies that are buried due to the fact that the results don't turn out the way the drug companies wanted.  In other words, one of the numerous dirty little secrets inside the pharmaceutical industry is that huge numbers of studies on any particular topic, never see the light of day if the manufacturers don't want them to.  The perfect example has to do with Anti-depression Drugs (HERE).  I will warn you that clicking on this link will both scare you and infuriate you if you or someone you love has been taking medication for DEPRESSION --- particularly if they are not an adult.   Where does this lead us?  To the RIAT Act.

The RIAT Act, as it is so lovingly referred to, is not some sort of official legislation, rule, or law.  It was an idea that was initiated by seven members of the scientific medical community, essentially calling out cheaters, and published in the June 28, 2013 issue of BMJ (Restoring Invisible and Abandoned Trials: A Call for People to Publish the Findings).  In essence, this was David calling out Goliath.  Let me give you an idea of how big this problem really is.  Just remember that what you are about to read is only the teeniest tiny tip of a very big iceberg --- obtained mostly through "disclosure" in lawsuits against drug manufacturers.

"We have access to around 178,000 pages of previously confidential company research documents. For drugs such as paroxetine, quetiapine, and gabapentin, litigation over illegal off-label marketing put thousands of pages of trial reports in the public domain. Other trial reports, such as for oseltamivir and clopidogrel, were obtained through new freedom of information policies at the European Medicines Agency (EMA) that have revolutionised the public’s ability to access trial data.  The documents are a substantial resource of information about trials. We expect that other independent groups will also have access to many additional trial reports.

The documents we have obtained include trial reports for studies that remain unpublished years after completion (such as Roche’s study M76001, the largest treatment trial of oseltamivir, and Pfizer’s study A945-1008, the largest trial of gabapentin for painful diabetic neuropathy). We also have thousands of pages of clinical study reports associated with trials that have been published in scientific journals but shown to contain inaccuracies, such as Roche’s oseltamivir study WV15671, GlaxoSmithKline’s paroxetine study 329, and Pfizer’s gabapentin study 945-291."

We should not be surprised that PFIZER & GSK are at the top of this list.   In fact, the drug we are going to talk about today is GSK's Paroxetine, otherwise known as the anti-depressant Paxil (Aropax, Brisdelle, Deroxat, Pexeva, Paxtine, Paraxyl, Sereupin and Seroxat).   Firstly, I have tons of information on my site about dealing with underlying causes of Depression naturally (HERE).   Secondly, the information in the highlighted section above is not new.  I wrote about this specific problem with antidepressants (Invisible and Abandoned) almost two years ago (HERE).  What is starting to happen is that people are redoing these studies or recalculating their conclusions  --- the latest being Paxil.

Paxil has been around since just after I got to Mountain View --- nearly 25 years ago.  A popular online encyclopedia states that, "It shares the common side effects and contraindications of other SSRIs, with higher rates of nausea, sleepiness, sexual side effects, and weight gain. Discontinuing paroxetine is associated with a high risk of withdrawal syndrome.  Paroxetine may be associated with a slightly increased risk of birth defects."   The problem is that we all know that adverse reactions to drugs are, at best, reported maybe 10% of the time (HERE). 

Between the years 1994 and 1998, GSK, in a study known as "329" (see the earlier highlighted quote) looked at the results of Paxil on 275 depressed teens as compared to a second antidepressant drug (Imipramine) and a placebo.  When the study was originally published back in 2001, you would have thought that Paroxetine was God's gift to teens with Major Depression --- at least according to the manufacturers.    

Earlier this month, the same journal that originally published RIAT (British Medical Journal) let fly with a study of their own Restoring Study 329: Efficacy and Harms of Paroxetine and Imipramine in Treatment of Major Depression in Adolescence.  Listen to these conclusions of the study where no new research was done; they simply looked at the results in an unbiased fashion.

"On 14 June 2013, the RIAT researchers asked GSK whether it had any intention to restore any of the trials it sponsored, including Study 329. GSK did not signal any intent to publish a corrected version of any of its trials. In later correspondence, GSK stated that the study by Keller and colleagues “accurately reflects the honestly-held views of the clinical investigator authors” and that GSK did “not agree that the article is false, fraudulent or misleading.”

The efficacy of paroxetine and imipramine was not statistically or clinically significantly different from placebo for any prespecified primary or secondary efficacy outcome. There were clinically significant increases in harms, including suicidal ideation and behaviour and other serious adverse events in the paroxetine group and cardiovascular problems in the imipramine group. The reanalysis of Study 329 illustrates the necessity of making primary trial data and protocols available to increase the rigour of the evidence base."

Look folks; I have been showing you for years that EVIDENCE-BASED MEDICINE is frequently nothing more than Orwellian double-speak --- a politically-correct charade --- the true definition of a "pipe dream" --- something that should be looked at both warily and critically.  Back in 2012 GSK was fined a whopping Three Billion dollars for this and other similar fiascoes with their drugs (HERE).  They did not even blink. 

When the fine was announced, GSK held a press conference --- and afterwards, their stock actually went up.  They had already put the money for the fine aside in cash, and stated that it would not affect earnings.  In other words, a $3,000,000,000 fine was nothing more than the price of doing business.  And the clincher is that the drug was never taken off the market --- it is still around today, making money and killing children.  That's right; killing children.  If you really want a taste of how disgusting this whole sordid business has really been, read David Dobbs' recent article from The Atlantic; The Human Cost of a Misleading Drug-Safety Study (HERE).

"The scientific committee advising the US government has not used standard methods for most of its analyses and instead relies heavily on systematic reviews from professional bodies such as the American Heart Association and the American College of Cardiology, which are heavily supported by food and drug companies. The committee members, who are not required to list their potential conflicts of interest, also conducted ad hoc reviews of the literature, without defining criteria for identifying or evaluating studies."  From the study discussed below

"Medical Guidelines are tough to trust because all too often they are all about the money.  Always proceed with caution."  Dr. Russell Schierling

"You can't depend on your doctor."  Donnie Iris from 1981's Love is Like a Rock (King Cool)

Just one short year ago, Time Magazine boldly declared that our government's 'War on Dietary Fat' was finally over (HERE).  More recently I showed you the huge meta-analysis that revealed saturated fat is not the culprit in disease processes and weight gain (HERE).   Unfortunately, the more things change, the more they stay the same.  It really is difficult to teach an old dog a new trick --- especially if that dog is making a living off of doing the same old trick over and over and over again.

Day after day after day in my clinic, I treat and talk to patients who have been under the care of a cardiologist.  I always make it a point to ask them about diet recommendations.  Unfortunately for the patients, you'll almost always find the physicians making similar recommendations to what they would have made to their patients twenty five years ago.   The biggest of these --- I heard it again for the ten thousandth time just yesterday ---- is to avoid dietary fat (particularly saturated or animal fats), RED MEAT, SALT, EGGS, etc.  Enter Nina Teicholz.

Teicholz is a biologist / journalist (Stanford, Yale, Oxford) who is a regular contributor to any number of big-name publications, as well as being a reporter for NPR and on staff at Columbia University.  Teicholz is also the author of last year's runaway best seller, The Big Fat Surprise.   Most recently she garnered a new level of attention for her scathing report published last week in one of the oldest and most prestigious medical journals on the planet; the British Medical Journal or BMJ as it is most commonly known (The Scientific Report Guiding the US Dietary Guidelines: Is it Scientific?)

Every five years, government big wigs from organizations such as the National Institutes of Health and CDC, get together, have a few beers, look at the current research, and create the GUIDELINES that are supposed to be the shining beacon of light for American citizens to follow on our pathway to good health.  The only problem is, according to Teicholz, the current report....

"fails to reflect much relevant scientific literature in its reviews of crucial topics and therefore risks giving a misleading picture. The omissions seem to suggest a reluctance by the committee behind the report to consider any evidence that contradicts the last 35 years of nutritional advice.  The guidelines, which were first issued in 1980, have also driven nutrition policy globally, with most Western nations subsequently adopting similar advice."

It seems that while the people in charge of said guidelines might be drinking the beers, the evidence is incontrovertible that they are ignoring the current research.  The two highlighted sentences above basically sum up Teicholz's position --- something I have been trying to educate my patients about for the better part of the past two decades.  It's why the "evidence" in EVIDENCE-BASED MEDICINE must be checked, double-checked, and checked again before you even think about trusting it.  The same goes for medical guidelines.  HERE, HERE, HERE, and HERE are examples of the CHASM between the research side of medicine and the practice side of medicine. 

It should be noted that whoever controls these guidelines, essentially controls a huge segment of the economy (HERE is an example of this phenomenon from a post I wrote just the other day).  In fact, the BMJ article goes on to say that, "the report is vulnerable to internal bias as well as outside agendas."  In other words folks, we are talking here about financial conflicts-of-interest or COI (click the link if you think I am blowing hot air).

The drums Teicholz beats loudest are drums that I myself have beaten over and over again.  I have already mentioned the fact that contrary to mouthpieces like Dean Ornish, animal fats from good sources are not the 'Great Satan' they have been widely (almost universally) portrayed in the medical medical community and media to be.  The other drum has to do with LOW CARB DIETS (of which my favorite is PALEO). 

Teicholz shreds the committee's recommendations as far as what diets they think are best.  For years, our government promoted their deadly food pyramid, suggesting that we eat 7-11 servings of carbs (mostly grains) per day.  Once the pyramid was deep-sixed, they started promoting something that may have been even worse ---- THE DASH DIET (aka "Mixed Balanced" diet), which, as crazy as it sounds, actually suggested consuming up to 12 servings of carbs per day. 

MedPage Today's staff writer, Parker Brown, wrote a recent article about Teicholz's piece in BMJ.  In it he talked a bit about the reaction of Yale's Dr. David Katz (HERE, HERE, and HERE are articles where I have mentioned Dr. Katz).  Parker said that Katz was "rather stunned" by BMJ, and defended the team's work as, "promoting public health rather than favoring certain diets."  Katz went on to say that, "The DGAC report is excellent, and represents both the weight of evidence, and global consensus among experts.  It is entirely in line with the persuasive experience of Blue Zone populations."  What are 'Blue Zone' populations, you ask?   They are the parts of the world where people live longer.

The problem with this thought process is that much --- maybe the majority --- of the planet's population would be considered to be "Third World," or nearly so.   I have two daughters from Ethiopia.  Believe me when I tell you that inhabitants of the third world aren't the least bit concerned about any government's dietary guidelines.  Their only dietary concern is whether or not they are going to get something in their bellies today.  Of course Blue Zone populations are going to live longer --- IN SPITE OF THEIR CRAPPY DIETS.  They actually have houses to live in, medical care, clean water, and THREE SQUARES A DAY. 

Listen to the last two paragraphs of Teicholz's carefully documented article.  Better yet, if you want to get a better idea of how far off the recommendations are from the current 'science' take a look at the article itself (a five minute read).

"The overall lack of sound science and proper methods in the 2015 report could be seen as a reluctance to depart from existing dietary recommendations. Many experts, institutions, and industries have an interest in keeping the status quo advice, and these interests create a bias in its favor. Abandoning the NEL review methods, as the 2015 committee has done, opens the door not only for bias but also for influence from outside agendas and commercial interests, and all of these can be observed in the report.

Given the ever increasing toll of obesity, diabetes, and heart disease, and the failure of existing strategies to make inroads in fighting these diseases, there is an urgent need to provide nutritional advice based on sound science. It may be time to ask our authorities to convene an unbiased and balanced panel of scientists to undertake a comprehensive review, in order to ensure that selection of the dietary guidelines committee becomes more transparent, with better disclosure of the conflicts of interest, and that the most rigorous scientific evidence is reliably used to produce the best possible nutrition policy."

I remember the first time I met Wendy Rector.  It was literally the first week I was in practice in Mountain View (nearly 25 years ago), and she was extremely nervous about seeing a new Chiropractor --- especially one so young and green.  Needless to say, things worked out.   Among other things, I was eventually able to solve a chronic case of PIRIFORMIS SYNDROME for her, as well as having the privilege of coaching one of her daughters in soccer. 

The last time I saw Wendy, she told me that she had been diagnosed with FIBROMYALGIA.  After seeing doctors who had nothing to offer her other than drugs, she asked me what could be done about the problem.  Naturally, I sent her to my website.  I explained that Fibromyalgia is really a form of ADRENAL FATIGUE that tends to become progressively CENTRALIZED in the brain, causing the wide array of symptoms seen above.   I shared with her that there is actually an "EXIT STRATEGY" available for those suffering with Fibromyalgia (HERE'S another), and also warned her that it would likely be tough at first.

The very first thing she did was start the PALEO DIET.   She also began addressing other issues such as SLEEP as well --- something that is extremely difficult for those struggling with Fibro.  When I saw Wendy earlier this week, I could not believe how good she looked.  Her eyes were clear, and she said that since starting her new life 5 weeks ago, she not only felt completely different, but had lost a significant amount of weight --- without even trying.  It all has to do with her CONTROLLING INFLAMMATION.  As she was leaving she said to me, "Thank God there's someone looking out for our health.  I've poured over your website, and can't tell you how important it's been to my recovery."

Here's the thing folks; although I am certainly flattered by her kind words, I didn't really do anything other than point her in the right direction.  You can go that same direction if you want to.  You can do what she did.  The information is all RIGHT HERE.  No pre-pays.  Nothing to buy.  No bait-and-switch.  It's certainly not as easy as taking meds, but it's far more effective.  Even if you are a hardcore SUGAR ADDICT (many who struggle with Fibro are), you can do what Wendy did.  Wouldn't it be really cool to look back to this day one year from now as the day you started taking responsibility for your health, changed your life, and broke free from the chains of Fibro?

"He’s the ultimate industry insider."   Harvard Political Science Professor and expert on the FDA, Dr. Daniel Carpenter

"Dr. Califf ran a multimillion-dollar clinical research center at Duke University that received more than 60 percent of its funding from industry, where he founded and ran a $200 million center that manages clinical drug trials in more than 65 countries.  He has written scientific papers with pharmaceutical company researchers, and his financial disclosure form last year listed seven drug companies and a device maker that paid him for consulting and six others that partly supported his university salary, including Merck, Novartis and Eli Lilly. A conflict-of-interest section at the end of an article he wrote in the European Heart Journal last year declared financial support from more than 20 companies."   From Sabrina Tavernise's September 19 article in the New York Times (F.D.A. Nominee Califf’s Ties to Drug Makers Worry Some)

When it comes to "EVIDENCE-BASED MEDICINE" concerning drug research, the only thing we can be completely sure of is that you must be extremely cautious about trusting it.  This is particularly true with the absurd amount of financial conflicts-of-interest present between the medical research community and the pharmaceutical industry.  Dr. Marcia Angell found this out the hard way when was forced out after two decades as the editor or the New England Journal of Medicine, after running a scathing editorial (expose might be a better word) about this problem back in 1998 (HERE).  Suffice it to say that in the nearly two decades since, the problem has not gotten any better --- it's simply becoming "mainstream" --- the 'norm' if you will.  If you want proof of this, just click the first link on the page and start scrolling.

The FDA has likewise been shown to be untrustworthy (HERE).  And now we find out that Dr. Robert Califf, a research cardiologist who is renowned for his financial ties to BIG PHARMA as much as his innovation in the pharmaceutical industry, has been nominated by our President to be the new head of the agency designated to protect us from such things --- the Food & Drug Administration.  Like I said, the foxes continue to guard the hen houses.

From all indications, Califf is a great guy --- someone that I would likely enjoy spending a day with on the CURRENT RIVER.  In fact, when MedPage Today's Molly Walker wrote a recent article (Friday Feedback: Robert Califf's Potential Impact on the FDA --- What to Expect from the New Commissioner) where she interviewed three people considered to be big wheels in the medical and pharmaceutical fields, as well as a past vice president of the FDA, they simply gushed about him.  Listen to what one of these individuals, Peter Pitts, formerly of the FDA, had to say.

"President Obama has made the most important healthcare decision of his administration. The nomination of Rob Califf to be the next Commissioner of the FDA signals the beginning of a new era at the agency that regulates more than a quarter of the U.S. economy. Califf knows the issues and the players...   It's more than time for the FDA to take its place in the center of the healthcare ecosystem....   Welcome to the era of entrepreneurial regulation. Entrepreneurial regulation means that the FDA can be both regulator of industry and its colleague in innovation."

But is Pitts' statement correct?  Some of it is.  Califf certainly knows the players --- he's received a boatload of cash from them over the course of his professional career.  But can someone who is so financially attached at the hip to the pharmaceutical industry really be unbiased when it comes to controlling and regulating one fourth of our economy ("Entrepreneurial Regulation" was the oxymoron that was used).  Just read the first link in the second paragraph about the FDA and you'll quickly see what a pie-in-the-sky pipe dream this idea of entrepreneurial neutrality really is --- not according to me, but according to the most current peer-reviewed scientific literature.

Bear in mind that conflict of interest does not mean that Califf is necessarily doing something or has done something wrong.  Financial COI is simply the appearance that something improper could be going on.  It's why nepotism is frowned on so greatly.  Lo & Field defines COI as, "a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest." 

Just in case you aren't sure what it's like to see hardcore scientific financial COI in black and white; HERE, HERE, HERE, HERE, HERE, HERE, HERE, and HERE are a few examples.  Just make sure you are in the bathroom or have a barf bag ready while you are reading.  As I have already shown you; even though people claim that they are not affected by these sorts of conflicted interests, studies show us otherwise (HERE is a biggie).   So do the lives of career politicians.

As a side-note to this issue, word has it that one of the big things he will be going after is DANGEROUS ALTERNATIVE MEDICINE.

CANCER is bad news, and Lung Cancer is especially bad because survival rates are not what people have been led to believe they are.  Wikipedia tells us that, "Worldwide, lung cancer is the most common cause of cancer-related death in men and women, and was responsible for 1.56 million deaths annually, as of 2012".  And according to our own government's National Caner Institutes (SEER Stat Fact Sheets: Lung and Bronchus Cancer) the five-year survival rate is only about 17% --- certainly not as severe as PANCREATIC CANCER, but poor nonetheless.   Although the moral of the story is "DON'T SMOKE", that is not what this post is about. 

Do you remember when I showed you, via the peer-reviewed scientific literature, that the side-effects of medications and procedures are under-reported by somewhere between 90 and 99% (HERE)?  This simply should not be happening in our 'enlightened' age of "EVIDENCE-BASED MEDICINE" --- and certainly not to this magnitude or extent.   Unfortunately for patients, clicking the previous link will reveal incidence after incidence after incidence of Under-reporting, OVER-TESTING, DATA FUDGING, INVISIBLE & ABANDONED STUDIES, "PRESS RELEASES" disguised to look like science, FINANCIAL CONFLICT-OF-INTEREST, HYPE, and OUTRIGHT FRAUD within the scientific medical community.

The study, published in the latest edition of JAMA Oncology (Hospitalizations During Systemic Therapy for Metastatic Lung Cancer: A Systematic Review of Real World vs Clinical Trial Outcomes) by a team of medical oncologists, led by Dr. Dr. Monika Krzyzanowska of Princess Margaret Cancer Center in Toronto, let us know that the more things change, the more they stay the same.  After searching medical databases for studies that met criteria, they compared five clinical trials (clinical trials are where you are reporting to the FDA to get your drug approved) to five studies that involved giving chemo in a "real world" setting.  The results can be seen in the red highlighted statement at the top of the page. 

Dr. K's takeaway?  "I think the low-hanging fruit is that clinical trials should start reporting hospitalizations."    With billions of dollars at stake, don't expect things to change any time soon --- except to get worse.  As is always the case, make sure you are LOOKING OUT FOR YOURSELF AND YOUR FAMILY, and doing your own research when it comes to health-related matters.

Unfortunately, I could not be at the funeral due to work conflicts, but I felt I needed to be there for Rick.  I left Imperial at 4:00 am on Monday morning to avoid the crazy 100 degree heat we'd been having, made my way to I-70, and headed west.   I rode through some torrential rains in the KC area, arrived in Emporia in time for breakfast; spending the day hanging out with the Burris clan before leaving at 4:00 am on Tuesday. 

Although there was certainly sadness for the passing of the family matriarch, ILENE, the day was really a celebration of her and Paul's life together.  For instance; one of the kids (Jonah?) found an old slide projector and slides --- all of them four to five decades old.  It was an incredible time watching everyone's reactions to the slides and listening to their stories. 

That afternoon, Rick approached me about taking care of someone's shoulder.  After working on one person, it sort of snowballed.  Several people told me of chronic (long-standing) problems they had been struggling with, and I spent a couple of hours working on anyone who needed.  I felt honored to be able to give something back to a few of the people who have become a second family to me.  Below is an email I received from DREONA'S husband -- a law enforcement officer in PA.

Following an incident that occurred while conducting an arrest, I had severe neck and upper back pain that kept me up at night and inhibited my movements during my work day.  While at a recent family function, Dr. Russ Schierling performed Scar tissue remodeling treatment on me. After the procedure, I instantly felt the pain release from my neck and upper back. That night I slept for the first time in months without waking, and I am now able go through my workday pain free.    - Jeremy Breton

TESTIMONIALS are certainly cool, but what was doubly cool is that Rick was able to stop by Mountain View for a couple of days on his way back to South Carolina.  Naturally, we spent yesterday on the CURRENT RIVER, running all the way up to Blue Springs, cooking, eating, jawing, and of course, snorkeling.  It was about as good a day as you will find, with clear blue skies, warm temps (84 degrees), and water with a clarity and color that rival the Caribbean.   As always, I'm looking forward to doing it again --- next time with your whole family.  If you are interested in seeing some of the pics, just click the previous link.

Although the tide is slowly turning (particularly in the RESEARCH COMMUNITY), the vast majority of today's practicing physicians still view fascia as they always have --- a sheath that works like a support sleeve, girdle, or stocking to bind together the body's other much more "important" tissues (MUSCLES, LIGAMENTS, TENDONS, etc).  There are even a few doctors out there who understand that fascia is the tissue that connects the lymphatic system, circulatory system, and other organ systems together --- but not many. 

Fortunately, fascia is shedding its reputation as the "redheaded stepchild" of Anatomy & Physiology, and is slowly claiming its rightful place at the forefront of the study of the structure and function of the human body (HERE'S a recent example).  When I talk about "function" I am speaking of things much greater than simple joint motion or tissue support.  There is actually research showing that facial function is intimately related to the proper function of various organ systems, the nervous system, and even the immune system. 

In fact, we are seeing that fascia is not just a tissue, but a Tissue System, which, like the nervous system, connects every part of your body to every other part of your body (HERE).   This means that anything that disrupts the fascia is bad news --- potentially really bad news.  The most up-to-date fascial research is showing us that FASCIAL ADHESIONS can cause the body to dysfunction in a wide variety of ways ---- ways that not only cause pain, but can cause sickness as well.  Unfortunately, to the untrained practitioner, the two problems ---- Fascial Restrictions and the various systemic illnesses they are associated with ----- are all too often "seemingly unrelated problems" (HERE).

We have recently learned that fascia can contract on its own --- similar to muscle tissue (HERE). Besides this, research has shown that both stress and systemic acidity can cause fascia to go into a perpetual state of contraction.  On top of all this, the fascia is also known to be embedded with nerve fibers from the Sympathetic Nerve System (FIGHT OR FLIGHT).   Put all of this information together and it is not difficult to grasp that POOR DIETS, improper (or not enough) EXERCISE, HIGH STRESS LEVELS, etc can play a huge part in the development of fascial problems --- or more particularly, in the inability of many people to be able to defeat their underlying fasical injury and dysfunction (HERE). 

One of the things that I have been talking about for years is the fact that despite the amazing advancements in high tech imaging techniques, our current models bring us no closer to being able to tell people exactly what is causing their low back pain than we were 50 ---- or even 100 years ago (HERE and HERE are example of this).  This is because people have a misconception that current advanced imaging technologies like MRI or CT will actually show you what is causing your pain (HERE). 

Although most doctors are adept at convincing patients they have found the source of the pain, the research tells a much different story.  I have chronicled this fact in the Blog Posts in the previous paragraph.  Suffice it to say that the majority of the adult American population is walking around with disc bulges, degenerative discs, rotator cuff tears, and heaven only knows what other issues (CANCER for instance), are completely unaware because they have not yet developed pain or overt symptoms.  In plain English; MRI's are not predictive of whether or not you will have back pain or how long it is going to last.

The renowned biomechanist Dr. Manohar Panjabi, who along with Dr. Augustus White wrote the classic 1990 textbook, "Clinical Biomechanics of the Spine" published a paper in the prestigious medical journal, European Spine, suggesting that we need to think about a whole new model of back pain.  Dr. Schleip and his team of researchers of Germany's Ulm University Fascia Research Team verified what Dr. Panjabi was saying, going as far as stating that.......

"Subfailure injuries in spinal ligamentous tissues can lead to chronic low back via related muscle control dysfunction and resulting tissue changes including subsequent neural inflammation. Based on the positioning of the lumbar fascia and several other indicators we subsequently published a response in the same journal, in which we suggested that micro injuries in the posterior layer of the human lumbar fascia should be included in that model as a potential back pain generator."

They then backed the statement up with studies by Vermont University's famed fascia / TENSEGRITY researcher, Helen Langevin, M.D., and Nagoya University's Dr. Toru Taguchi.  Their research indicates that microscopic fascial injuries can trigger an entire cascade of altered physiological responses that are thought to play a major role in the development of both acute and chronic low back pain.  It seems though that most clinicians do not grasp the all-encompassing effects of injured fascia, and seem to have only a cursory understanding of what it really is, what it really does, how to asses it, and how to effectively treat it (HERE is an example concerning low back pain --- make sure you watch the 5 second videos).

"The Use of the Membranes is, to wrap up and cover the parts, to strengthen them, to defend several of them from being hurt by the subjacent bones, to sustain the vessels that are ramified upon them, to keep the parts united; and ‘tis wroth our observation, that the admirable sympathy, or consent of the parts one with another, depends in a great measure upon their fibrous connexions."  A definition of fascia from 1707's Anatomy Textbook, Myographiae Comparatae Specimen

Although it was terribly misunderstood and often all but ignored as unimportant, you can see from the above quote that anatomists have been discussing fascia for hundreds of years.  You yourself have learned a little bit about this amazing tissue and may be starting to wonder if your pain and / or health problems might possibly be related to problems with your fascia. 

"Fascia Proper" is not difficult to understand.  These are the the fascial "bands" or "sheaths" that cover muscles.  However, this is only the beginning of really understanding fascia.  You must be aware that when you see any of these terms listed below (from Drs. Langevin & Huijing), you are almost certainly talking about fascia.  This list, by the way, will help you understand why fascia is said to be the most abundant Connective Tissue in the body!

• Dense Connective Tissue (This is tissue that is made up of collagen fibers.  Dense connective tissue forms strong, rope-like structures such as tendons and ligaments, as well as the lower layers of the skin.)
• Areolar Connective Tissue (These tissues hold the organs in place and attache the lower layers of the skin to deeper underlying tissues (HERE).
• Superficial Fascia (This is the fascial layer lying directly underneath the skin.  It contains both Dense and Areolar Connective Tissue, as well as fat --- see previous link.)
• Deep Fascia (This is what most of us think of when we think of fascia.  The Deep Fascia is often called, "Investing Fascia" and is a layer of fascia which can surround individual muscles, and divide groups of muscles into compartments. This is the dense fibrous connective tissue that interpenetrates and surrounds the muscles, bones, nerves and blood vessels of the body.   It provides connection and communication in the form of ligaments, tendons, RETINACULUM, joint capsules, and septa. The Deep Fascia covers all bone (periosteum and endosteum); cartilage (perichondrium), and blood vessels (tunica externa).  It also becomes highly specialized in MUSCLES (epimysium, perimysium, and endomysium) and nerves (epineurium, perineurium, and endoneurium). The high density of COLLAGEN FIBERS is what gives the Deep Fascia its strength and integrity, not to mention its elasticity.  Make sure to look at it's relationship to STRETCHMARKS as well.
• Intermuscular Septa (These are the sheaths of fascia that separate individual muscles from other individual muscles that might be working opposite each other.  These work in concert with the Epimysium.)
• Interosseal Membrane (Interosseous Membranes are broad and thin planes of fascia that separate certain bones from certain other bones.  For instance, these fascial membranes can be found between the tibia and fibula of the lower leg, as well as between the radius and ulna of the lower arm.)
• Periosteum  (This is the thin layer of membrane that is the outermost tissue of all bones.  You can see it if you pick at a chicken bone.)
• Neurovascular Tract  (Often called the Neurovascular Bundle, this fascial tissue surrounds and envelops nerves, arteries, veins and lymphatics that tend to travel together in the body.)
• Epimysium   (This is is a layer of connective tissue, which surrounds the entire muscle like a sheath.  It is composed of dense irregular connective tissue. It is continuous with fascia and other connective tissue wrappings of muscle including the endomysium, and perimysium. It is also continuous with tendons where it becomes thicker and collagenous. The epimysium also protects muscles from friction against other muscles and bones.)
• Aponeurosis   (APONEUROSES are layers of flat broad tendons. They have a shiny, whitish-silvery color, are actually considered to be tendons.  The primary regions with thick aponeurosis are in the abdominal area, the lower back, and in the PALM OF THE HAND and the PLANTAR FASCIA. Their primary function is to join muscles and the body parts the muscles act upon, whether it be bone or muscle.)
• Perimysium    (In a muscle --- the biceps, for instance --- there are thousands of bundles of individual muscle fibers that are bound by sheaths of fasica.  These fascial sheaths called Perimysium wrap groups of these muscle fibers (anywhere between 10 to 100 or more) into bundles.)
• Endomysium   (This is where things get crazy.  We just saw where the Perimysium surrounds bundles of muscle fibers.  The Endomyisum is the fascia that ensheaths each individual muscle fiber. 

Although the "Father of Osteopathy", DR ANDREW TAYLOR STILL touted fascia as being one of the most significant tissues in the body clear back in the late 1800's, there was no scientific evidence to back up his claims.  Mind you; there was plenty of evidence ---- it was just that it was not in the form of double blinded, placebo controlled studies (it was "anecdotal" --- aka TESTIMONIAL).  The explosion of two brand new branches of healing (Chiropractic and Osteopathy), created huge amounts of experiential evidence. However, until very recently, this type of evidence was not accepted by mainstream medicine.   They wanted research, studies (RCT's), and hard empirical facts.  Now that there is ample amounts of research, we find that much of it is largely ignored, despite the recent emphasis on something called "EVIDENCE-BASED MEDICINE"). 

And although these early practitioners ---- pioneers in the field of manipulation and body work ---- made it clear that that fascia was not just a tissue scrap left over from last week's anatomy dissection, they did not have the evidence to prove scientifically that what they were discovering with their patients was in any way connected to fascia despite the fact that very passing day brought new evidence that fascia plays a much bigger part than its obvious supporting role.  Think about it, Dr. Still was touting fascia as not only the most abundant Connective Tissue in the body, but one that is intimately involved in its structure, function, neurology, immunology, and metabolism ---- well over a century before some of these things could be "proven".

Although most of the Medical Community does not take a position on this one way or another (hey, IF IT DOES NOT SHOW UP ON AN MRI, it can't be too important can it?), the current research has made it painfully obvious that practitioners can no longer look at muscles, joints, and numerous other tissues as something different and unrelated to fascia, because they are so intimately connected.   According to the most current available fascial research today, we know that Fascia does far more than was ever imagined by even some of those who are "in the know".  According to brilliant scientists like Harvard's Donald Ingber (M.D. Ph.D) and Dr. Tom Meyers, founder of Anatomy Trains (links provided earlier), we are becoming increasingly aware of the amazing relationship between the structural and functional integrity of the body's soft tissues.   And it is fascia that seems to be the common denominator in all of this.

Although it is often difficult for people in pain to grasp the fact; local problems do not exist in isolation.  The Kinetic Chain is just that ---- a chain of structure and motion.  Not to sound New-Agey here, but the new breed of healers --- the successful healers of tomorrow --- will grasp the fact that science can no longer look at the body as it currently does; simply as a bunch of individual parts that are related to each other.   As the great Greek philosopher Aristotle taught, the whole organism is much greater than the sum of its individual parts.  We must begin to recognize the musculoskeletal system for what it is ---- an almost unfathomably complicated group of inter-related tissues, working in unison (HERE).  And as we are increasingly seeing from Fascia Research, the failure of these tissues to work together in harmony, causes not only chronic pain but sickness and dis-ease.

• Renowned Endocrinologist / Neurologist, Dr. Helene Langevin (M.D.) of the University of Vermont's College of Medicine has been studying acupuncture since 1986.  In a recent study she showed that new technology has made it possible to actually visualize fascia as layers slide over each other.  This is done by using diagnostic ultrasound and elastography.  Videos taken using this technique show unhindered movement of the Thoracolumbar Fascia in people with no back pain (these are the videos I mentioned earlier in the post).  However, people with back pain typically exhibit restriction and adhesion of their Thoracolumbar Fascia.

 

• I have spoken at length about the fact that SCAR TISSUE is neurologically very different from normal tissue.  Interestingly enough, some of this information is becoming mainstream.  Dr. Alena Kobesova (M.D.) is a neurologist and physiatrist at the Rehabilitation Department of Charles University's School of Medicine, Prague, Czech Republic.    According to some of her most recent work, scars that are neurologically active (father of Applied Kinesiology, Dr. George Goodheart, spoke extensively about this decades ago) can subtly alter or inhibit spinal motion.  Many patients perceive this abnormal joint motion as low back pain.  She has shown that pain of this nature can often be relieved by treating neurologically active scars in the abdominal and pubic region (think surgeries here; particularly C-scections).  A prime example of this in our clinic can be seen HERE.

 

• Italian P.T. Luigi Stecco's family (his children Carla and Antonio are both M.D.'s who carry on his work), have made some incredible breakthroughs in our knowledge of fascia.  Their work with fresh, unembalmed cadavers has shown that when fascia is mechanically overstressed, irritated, or immobile; the collagen matrix becomes inflamed and disorganized.  The result is something they refer to as "FASCIAL DENSIFICATION" --- a thickening, FIBROSIS, and adhesed tissue.  South African P.T., Willie Fourie, has shown that this process of fascial thickening and adhesion causes abnormal joint motion, abnormal muscle function, and ABNORMAL PROPRIOCEPTION.  As function is impaired, motor control is lost.  Fascia expert, Tom Myers (who studied with some of the heavy hitters in the bodywork field such as Dr. Ida Rolf, Dr. Moshe Feldenkrais, and Dr. Buckminster Fuller), has shown how local adhesion, tissue fibrosis, scar tissue, and restriction, cause patterns of aberrant motion that can adversely affect the whole body (see the links in this paragraph).

 

• Fascia is the "new" Nerve system.  It allows every part of the body to communicate with every other part of the body in a manner similar to, but different than nerve conduction.  Interestingly enough, nerve impulses travel between 150-175 miles per hour.  However, Fascia transmits messages at approximately 750 miles per hour ---- the speed of sound in water!  Expert on Fascia, Tom Myers recently stated in an interview with Susan Maier-Moul, "Fact: there are ten nerve endings in the fascia for every one nerve ending in the muscles. I’m talking about sensory nerve endings here.  In the normal course of things....  your nervous system is constantly listening to your fascial system."

 

• Recent research by Dr. Tomasek (a cell biologist at the University of Oklahoma), Dr. Schleip (a professor at the Institute of Applied Physiology in Ulm, Germany), and others has shown that Fascia can actually contract on its own --- in similar fashion to muscles.  This is not brand new information (Dr. A. Cathie in 1974), but is just starting to be embraced by the Fascia Research Community.

One more thing to be aware of.  Fascia is subject to INFLAMMATION in similar fashion to most other tissues of the body.  This is not simply due to overuse or injury, but any number of issues, including poor lifestyle choices.  Because I don't find one in a thousand people who really grasps the importance of Systemic Inflammation's relationship to pain and ill health, I would suggest you take a look at the link if you are dealing with any sort of Chronic Pain or CHRONIC ILLNESS issues.  To learn more about solving this important piece of the puzzle, HERE are some links for you.  You might also be interested in taking a look at some of our TESTIMONIALS as well.

I well remember an incident that happened while in Anatomy Class back when I was in Chiropractic School in St. Louis.  The instructor was talking about the periosteum in relationship to a bone-bruise, referring to it as, "the single most pain-sensitive tissue in the body."  I didn't really think much of this statement until I started studying FASCIA.  You see, Fascia (periosteum included) is the mucousy, cellophane-like membrane that covers almost every tissue in your body.  Below are some examples.

• SUPERFICIAL FASCIA:    This is the fascial layer lying directly underneath the skin (HERE) that contains both Connective Tissue and fat.
  
• DEEP FASCIA:  The Deep Fascia (sometimes referred to as 'Investing Fascia') surrounds your organs as well as muscles, dividing muscles into compartments.  Deep Fascia is the tissue that ALLOWS COMMUNICATION with other tissues, sort of like having an extra nervous system.  It also provides support, kind of like a spring-loaded skeletal system (HERE).   It is the covering for any number of tissues, which are named according to their location.
  

                FASCIA THAT COVERS BONE:  Periosteum and Endosteum
                FASCIA THAT COVERS CARTILAGE:   Perichondrium
                FASCIA THAT COVERS BLOOD VESSELS:  Tunica Externa
                FASCIA THAT COVERS MUSCLE TISSUE:  Epimysium, Perimysium, and Endomysium
                FASCIA THAT COVERS NERVE TISSUE:  Epineurium, Perineurium, and Endoneurium

Believe me when I tell you that I barely scratched the surface (HERE).  As you should be starting to see, Fascia is continuous.  In other words, it is a membrane that winds its way through your entire body as it surrounds and supports any number of tissues and organs.  Not surprisingly, it is the most abundant connective tissue in the body.

Why is the Fascia around the muscles so commonly injured?  For one, it is an external tissue.  As I have shown you before, one of the ways to cause the Fascial Adhesions that I refer to as "SCAR TISSUE" is to bang or hit a body part hard (HERE).   What is far more common, however, are overstretching or tearing type injuries --- think MVA's, SPORTS INJURIES, or CONCUSSIONS here --- which can result in this same microscopic Scar Tissue.  But it's the chronic overuse type of injuries that are probably the most common -- with research saying that repetitive injuries are the hardest to deal with (HERE).

Chronic, repetitive actions can lead to a build up of this Scar Tissue (some will argue that it is not really a Scar Tissue per se, but a "DENSIFICATION" of the fascia).   I frankly don't care if you call it banana boat, it's dealt with in the SAME FASHION.  This might be a great time to also mention that STUDY after STUDY after STUDY has shown us that INFLAMMATION always leads to Scar Tissue (HERE).  Another reason that you need to understand THIS POST.

The more external "Deep Fascia" around the muscles is prone to injury not only because its external or superficial nature leaves it vulnerable to getting hit or impacted in some fashion, but because it is vulnerable to tremendous torquing or shearing forces.  Think of it in terms of what happens on a merry-go-round.  If you are standing in the center of a merry-go-round that is being pushed intensely, although you are spinning in a circle, there's very little force on you.  However, move out toward the edge, and it's all you can do to hold on tight enough to keep yourself from flying off into space (probably the reason you don't see these relics of a bygone era anywhere anymore).

Regardless of how the adhesion of the Fascia occurs, here's the dilemma.  The tissue that is arguably the single most pain-sensitive tissue in your body, CANNOT BE IMAGED via standard tests such as MRI.  What does this mean to you?  It means that even though you might be struggling with any number of CHRONIC PAIN SYNDROMES, don't be surprised if there's nothing to show for it as far as positive medical tests. Because of this, it is likely that you will be treated as a drug-seeker --- or given a prescription for one or more of "THE BIG FIVE" and essentially told that there is nothing more that can be done for you other than pain management.  Or maybe you'll be sent to a specialist who will do the same things.   Because I HAVE LIVED IT MYSELF, I feel for those of you struggling with Chronic Pain. 

If you think your pain might be the result of Fascial Adhesions, you've got NOTHING TO LOSE BY SEEING IF TISSUE REMODELING COULD HELP YOU.  As far as tackling some of the chief sources of inflammation is concerned, I've got that covered for you as well.  HERE is a simple little post that explains how to get started.

"The obesity epidemic and the consequent development of metabolic syndrome are an increasingly significant health problem, associated with reduced life span and quality of life. Metabolic syndrome is a term given to a condition associated with the collection of a series of risk predictors that are associated with metabolic diseases including obesity, cardiovascular disease, diabetes, and more recently dementia.  Obesity and metabolic syndrome are correlated metabolic diseases associated with chronic low-grade inflammation. Insulin resistance is an important health issue since it flourishes silently much before the onset of such metabolic manifestations. Insulin resistance refers to impaired or failed intracellular transduction of the insulin-mediated signalling cascade in sensitive tissues, especially the liver, skeletal muscle, and adipose tissue."  Cherry-picked from the June 2015 issue of Oxidative Medicine and Cellular Longevity (Molecular Events Linking Oxidative Stress and Inflammation to Insulin Resistance and β-Cell Dysfunction)

A study published in this week's issue of Science Transnational Medicine (Excessive Caloric Intake Acutely Causes Oxidative Stress, GLUT4 Carbonylation, and Insulin Resistance in Healthy Men), built on what we learned from Morgan Spurlock's 2004 documentary, Supersize Me --- it does not take very long to get fat and sick when eating a crappy diet.   Below are a few cherry-picked sentences from a popular online encyclopedia concerning the movie.

"Spurlock ate at McDonald's restaurants three times per day, eating every item on the chain's menu at least once. He consumed an average of 5,000 calories per day (the equivalent of 9.26 Big Macs) during the experiment.  As a result, the then-32-year-old Spurlock gained 24 lb, a 13% body mass increase, increased his cholesterol, and experienced mood swings, sexual dysfunction, and fat accumulation in his liver (at one point he gained 17 lbs in 12 days).  It took Spurlock fourteen months to lose the weight gained from his experiment by using a diet supervised by his then-girlfriend (now ex-wife), a chef who specializes in gourmet vegan dishes."

In other words, by the end of the thirty days, Spurlock was both physically and mentally messed up.  This recent study is even more shocking in it's revelation of just how fast WEIGHT GAIN and INSULIN RESISTANCE can actually occur.  Have you ever been on a vacation or holiday where you lay around watching old movies or one football game after the next, while eating ample amounts of junk food (think about a Christmas break where you are snowed / iced in)?  According to this latest peer-reviewed research from Dr. Guenther Boden's team from Philadelphia's Temple University, the price you will pay for a sedentary "binge" of this sort is going to be steep.

Our government's own National Academy of Medicine says that the average sedentary, middle aged male (30 to 50) should be consuming about 2,200 calories a day.  In this particular study, six "healthy" men were made to lay in a hospital bed for one week, eating almost three times that number of calories (6,200 to be exact) --- mostly in the form of high carb / high fat junk (PIZZA, COOKIES, white bread, etc, etc).  The results?  They gained an average of eight pounds each; a bit over one pound a day --- on par with Spurlock's gain of 25 lbs in a month --- most of it as BELLY FAT. 

Remember, however, that due to the totally sedentary nature of the men in this study, it's almost certain that they actually lost several pounds of muscle mass, meaning that the weight gain (all fat) was even more pronounced than it appeared.  But weight gain was not the only problem revealed by this study --- not by a long shot.  Make sure you are sitting down when you read this next sentence.  It only took 2 days for these men to develop a resistance to the hormone Insulin (Insulin Resistance --- a part of the METABOLIC SYNDROME, which, along with HYPOGLYCEMIA, is a precursor to DIABETES).  According to the authors, by day two there were, "severe systemic and adipose [fat] tissue insulin resistance in every one of six study subjects."

Along with the chemicals we collectively refer to as INFLAMMATION, oxidative stress (oxidation is what causes unprotected iron to rust) was determined to cause the biggest changes to GLUT4 --- a protein regulated by Insulin that actually transports BLOOD SUGAR --- glucose --- out of the blood and into the cells.  Several studies have shown that people who lack the gene for making GLUT4 in certain parts of their brain end up with DEPRESSION and cognitive impairment ("DEMENTIA"); symptoms that certainly jibe with what we saw on Supersize Me.

The authors of this study argue that it is oxidative stress and not inflammation that first triggers the weight gain and insulin resistance.  As far as I am concerned, the point is moot because not only are both essentially caused in the SAME FASHION, you deal with both dietarily the same way as well (HERE).  Because this study showed that oxidative stress is involved, it would naturally follow that a DIET RICH IN ANTIOXIDANTS could be beneficial.  Just remember, however, that research has shown that high doses of chemically synthesized individual antioxidants are not always the best approach.  I bring this up because this is always what researchers are looking for --- some sort of chemical or drug that can be patented and sold.  

Studies such as this one produce tons of hype about the potential for that "miracle product" that will solve your Diabetes (or PRE-DIABETES) without any effort on your part.  You'll not need to change your diet or address the underlying Inflammation.   It's the false hope of drugs and supplements --- that there is something out there WITH ZERO SIDE EFFECTS that will allow us to keep living our same old self-indulgent lifestyles, but prevent us from gaining weight or getting sick; or "cure" us when we do.  Products like this are a staple of late night TV advertising.

The body and the foods we eat need to be viewed as a whole.  It's why I am such a stickler for WHOLE FOODS & WHOLE FOOD SUPPLEMENTS.   Prescribing people an isolated molecule can do amazing things ---- for awhile.  But you upset the body's homeostasis, leading to an array of potential problems.  CORTISONE is one such molecule --- ask anyone that's been on it.  Amazing results; brutal side effects.   If you follow medical logic, we should just be able to give folks GLUT4 and solve their Insulin Resistance problem.  The problem with this approach is that according to a study published in the May, 2002 issue of the Journal of Biological Chemistry (The Insulin-Sensitive Glucose Transporter, GLUT4, Interacts Physically with Daxx), this could potentially produce deadly results.  Daxx is another name for Death-Associated Protein VI --- a chemical whose purpose is, among other things, to cause pre-programmed cellular apotosis (death).

I certainly did not set out to be the "PIRIFORMIS SYNDROME GUY".  But due to the results we've gotten with great numbers of sufferers (HERE are some of them), it just sort of happened.  PIRIFORMIS SYNDROME has any number of causes, including ADHESIONS OF THE FASCIA, which are extremely common.   After treating patients, I give them STRETCHES.  I have recently changed my protocol for the recommended stretching post-treatment --- at least as far as stretching the piriformis / hip is concerned.

I used to simply have people do the stretches --- every half hour for three days and every hour for the next week --- after working on them.  I still use the same schedule, but with the following caveat; don't overstretch.  I have recently (within the past few months) had two different patients who each got nearly 100% results as far as their pain was concerned --- at least initially.   The first individual for several days, and the other person for one day.  They both felt things start to go south after a session of intense stretching first thing in the morning.  In both cases, the pain settled back down to pre-treatment levels (one of them is significantly better). 

I have also seen any number of cases of Piriformis Syndrome caused --- or at least contributed to --- by heavy duty stretching.  Case in point, an email I had in my inbox this morning.

"It is my belief that I must have sustained an overuse injury of sorts because this all came about after about 4 months of partaking in crossfit classes. There was never a moment when I felt I injured myself, the symptoms just sort of started in my left hip and leg......    Two months of physical therapy with minimal relief. (I continued the stretching program at home on my own but stopped when I developed the unbearable buttocks pain.) "

How do you know if you are one of those people who are going to develop Piriformis Syndrome?  That's just it; you don't.  This is why I, although I still recommend stretching of the hip / piriformis area, I want folks to know that the stretches need to be less intense / more controlled.  Interestingly enough, I have not found this to be the case with other areas of the body.  Not sure I have ever seen anyone over-stretch their NECK or SHOULDER after we work on them.  I believe that the mechanism has to do with THE NATURE OF SCAR TISSUE and the fact that by its very nature, it has a "tethering" action that can be very deep.   Below is something I wrote a few years back (HERE is a recent article on the topic).

"I would liken the kind of stretching you have been doing, to trying to undo a loose knot by pulling on both ends of the rope:  No matter how hard you pull, you only make the knot tighter!  Sound familiar?   Think about it logically; if Scar Tissue is a significant part of your problem, stretching is simply tightening the noose!"

The moral of this story is, if you are dealing with PS or hardcore myofascial tightness of the buttock / hip area, stretch but don't over-stretch.  What does this really mean?  Honestly, I'm not completely sure myself.  Certainly, for those struggling with PS it can be a fine line.  Especially for those of you who are motivated to do whatever it takes to get better (lots and lots of intense stretching) ---- especially here in America; the land of, "if a little is good, a lot must be better."