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11 Magnificient Rustic Farmhouse Furniture Collection – Vintage Indian trunks cladded with iron straps and brass medallions, farmhouse chic interiors update your style just by using outdated wooden hope chests made into useful coffee tables which have the added value of storage. Some are intricately detailed with elephants and horses carrying tales of the Spice Route and others are painted with rustic turquoise patina harking back to Jodhpur the Blue Metropolis. Distressed paint feels natural on the vintage rustic cabinets made out of recycled old doors, classic woods that are so fantastically aged and naturally varnished. Dining tables constructed from vintage doorways complete with latches and iron studs are accented perfectly with wrought iron chairs.
Classic rustic previous arches flip your kitchen mantel into an announcement, the inexperienced foliage in brass planters attracts consideration to the hand carved element and the pure washed patinas. Colorful textured tribal table runners will give your tables an elegant, classic bohemian worldly panache that works effectively with a multitude of colours. Choose up an previous planter and fill with beautiful cottage garden vegetation or herbs.Vintage bowls and rustic brass urns used as a centerpiece overflowing with seasonal pumpkins, pines and flowering twigs carry within the old fashioned cottage appeal. Add Rustic Farmhouse Furniture decorations, made at residence wreaths and floral arrangements that give a lovely personal contact. A rustic outdated chakra bookcase adds immediate allure, providing a spot to retailer books and your travel collections. Lengthy wooden blanket chests in distressed blues and greens used on the end of the mattress or as window console table placed within the nook, you possibly can enjoy the solar while studying your favourite guide.
farmhouse table with metal chairs – zhurnalifo source:zhurnali.info
Deliver within the farmhouse theme into the nursery by hanging an outdated jharokha window stuffed with child footage. The home windows get a cottage-chic enhance with handloom material throws weaved by artisans in pure cotton fibres and vibrant colours. Install previous rustic containers stuffed with colourful, seasonal blooms at the window sill. Sheer sari curtains are nice for kitchen home windows, breakfast nooks or other spaces the place pure mild adds charming model and some privateness with out stopping the sunshine.
Best Concepts to Decorate a Rustic Farmhouse Furniture
Farmhouse kitchen fashion will be good idea if you wish to have family gathering in your kitchen during meal time. There are a number of concepts in adorning this certain kitchen fantastically and attractively. Besides, kitchen on this sure type additionally is not going to make you spend some huge cash as a result of a lot of the equipment are offered in inexpensive worth. Listed below are some finest concepts in adorning your farmhouse kitchen attractively.
Color will probably be a fantastic concept to pick the theme of your kitchen. The commonest colours used in decorating kitchen in this certain model is purple, blue, apple green, honey gold, beige, and white. You should utilize of these colors or make a mixture of two match colors.
To tie the theme, you should utilize nation theme border in your kitchen. You could find lots of well-liked wall borders available in the market with several enticing designs. The most well-liked designs are including fruits such as apples, berries, floral baskets or nation plates. Some designs similar to stars and hearts are also quite standard as nicely. Or, you may choose a wall border with farm animal theme. Cows, horses, pigs, sheep or ducks shall be good border design on your Rustic Farmhouse Furniture.
Selecting A Farmhouse Eating Desk For A Nation Dwelling
For many who reside out within the nation in a ranch home, farm house, log cabin or any nation type house for that matter and are in search of a eating table to match the setting ought to strongly think about a Rustic Farmhouse Furniture eating table. This eating desk is perfect for people who need further room of their home for gatherings or for many who appreciate spacious dining arrangements. In addition to the ample space, the farmhouse desk additionally helps you capture the rustic essence that makes a house classic. A serious promoting level is the lasting endurance, plain and simple. The sturdiness of these tables allows them to be passed down many times in addition to their ability to climate the wear and tear they endure. Their incredible sturdiness is due in part to the material that’s used to construct them such as maple and oak, which also happens to have a phenomenal finish and appeal.
In case you are feeling artistic and have some further time in your palms, then establishing your individual desk is an idea price contemplating. Outdated barn wooden makes an incredible materials to assemble the desk with, which will certainly give the table a novel appearance that is not seen in shops too often.
Once you’ve got acquired a rustic kw eating table to your liking, it’s best to presumably contemplate other furnishings to fill out the remainder of the room like a solid oak espresso desk. Espresso tables are great accent items for a lounge as a result of they take up little space and have wonderful versatility the place you may store books, magazines, and place espresso mugs on top of.
farm chairs dining – costurasypatronesfo source:costurasypatrones.info
Rustic Black Farmhouse Dining Chairs Rocky Hedge Farm source:rockyhedgefarm.com
55 Gorgeous DIY Farmhouse Furniture and Decor Ideas For A source:diyncrafts.com
30" Rustic Farmhouse Nightstand in Brown source:mathisbrothers.com
45 Rustic Farmhouse Dining Room Table Design Ideas â The source:pinterest.com
Rustic farmhouse dining table source:shpock.com
farmhouse dining room table and chairs – spreza source:spreza.co


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Volume 17 Issue 2
Extension in big cities 1988
A Case Study for Assisting Food Business & Jobs
A blog post by Brian Raison, covering some of a local foods project being conducted in Columbus. Read the post here. ...
Volume 17 Issue 1
Volume 16 Issue 5
Urban Green Space Expert to Keynote Tri-State Green Industry Conference
A green space expert spoke in Cincinnati at the Tri-State Green Industry Conference, along with dozens of other relevant speakers. More information here. (Source: CFAES) ...
Urban Serving Universities Collaborate to Transform Higher Education, Strengthen Cities
Major universities in cities across the country have joined to spearhead a collaborative effort to build their cities from within. Read article here. (Source: The Coalition of Urban Serving Universities) ...
Volume 16 Issue 4
Volume 16 Issue 3


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Greatest White Male Singers of All Time
I saw that there was, "greatest black male singers" and "greatest Asian male singers" and "greatest Hispanic male singers" so to make sure there is racial equality, I made,"greatest white male singers" and then I will make,"greatest Indian male singers" (the second one might already exist) and if I can think of anymore I will make them
The Top Ten
1 Freddie Mercury
Freddie Mercury (5th September 1946 - 24th November 1991) was a Tanzanian-born British singer, songwriter and record producer, known as the lead vocalist and songwriter of the rock band Queen. He also became known for his flamboyant stage persona and four-octave vocal range. Before he became a singer ...read more.
Also not even in the same league as Luciano Pavarotti, Enrico Caruso, or Andrea Bocelli, though I would not expect that the average Top Tenner has ever heard of them. Of the names in the current top 20 here, both Frank Sinatra and Elvis Presley are quite a bit better.
Very over-rated, not even in the same league as Jim Morrison or Elvis Presley. Rolling Stone magazine has him rated #18 of all time, which is pretty generous even at that.
BEST ROCK SINGER OF ALL TIME.
2 Hansi Kürsch
Hansi Kürsch, born Hans Jürgen Kürsch, is the lead singer, lyricist, co-composer and bassist for German power metal band Blind Guardian . Heavily influenced by Freddie Mercury, he creates a huge choir effect by overdubbing his own voice multiple times in complex, overlapping vocal harmonies. He records ...read more.
Dio was an American heavy metal band formed in 1982 and led by vocalist Ronnie James Dio, after he left Black Sabbath with intentions to form a new band with fellow former Black Sabbath member, drummer Vinny Appice.
4 Chris Cornell
Chris Cornell was an American rock musician and singer-songwriter, best known as the lead vocalist, primary songwriter and rhythm guitarist for Seattle rock band Soundgarden and as former lead vocalist and songwriter for the supergroup Audioslave. He died on May 17, 2017.
5 Adam Lambert
Adam Mitchel Lambert is an American singer, songwriter and stage actor. Since 2009, he has sold over 2.5 million albums and 5 million singles worldwide.
6 Luciano Pavarotti
Luciano Pavarotti, Cavaliere di Gran Croce was an Italian operatic tenor who also crossed over into popular music, eventually becoming one of the most commercially successful tenors of all time.
7 Rob Halford
Robert John Arthur "Rob" Halford is an English singer and songwriter, who is best known as the lead vocalist for the Grammy Award-winning heavy metal band Judas Priest and famed for his powerful wide ranging operatic voice.
8 Elvis Presley
Elvis Presley was a American musician and actor. Known as "The King" He was mostly known for his number 1 singles including "Heartbreak Hotel" "Hound Dog" "Jailhouse Rock" "Love me Tender" Elvis debuted in the movie "Love me Tender" and focused less on his music and continued that way. ...read more.
Pretty funny that the biggest-selling solo artist of all time is not at #1.Elvis' total sales far exceed Michael Jackson's, and he is only behind the Beatles.
He IS IT! FOREVER & ALWAYS! XOXOXO
9 Jeff Buckley
Jeffrey Scott "Jeff" Buckley (November 17, 1966 – May 29, 1997) raised as Scott "Scottie" Moorhead, was an American singer-songwriter and guitarist. ...read more.
His father, Tim Buckley was even better.
10 Axl Rose
William Bruce Rose Jr., better known as 'Axl Rose', is an American singer born on February 6, 1962, in Lafayette, Indiana. He Is the founder and lead singer of the hard rock band Guns N' Roses. He is a celebrated but controversial figure in the world of rock.
He is king and he will always bee
11 John Farnham
John Peter Farnham, Jr., formerly billed as Johnny Farnham from his professional debut in 1967 until 1980, is an English-born Australian pop singer.
John Farnham's range is off this planet, he can sing the phone book and will still sound awesome.
The Voice! Enough said
12 Frank Sinatra
Francis Albert "Frank" Sinatra was an American singer, actor, and producer who was one of the most popular and influential musical artists of the 20th century.
13 Robert Plant
Robert Anthony Plant is an English musician, singer, and songwriter best known as the lead singer and lyricist of the rock band Led Zeppelin.
14 Michael McDonald
15 Bruce Dickinson
Paul Bruce Dickinson, known professionally as Bruce Dickinson, is an English musician, airline pilot, and broadcaster. He is most well known for being the lead singer in heavy metal band Iron Maiden and his solo career.
Why is Bruce not in the top 10, and Robbie Williams is?
16 Ozzy Osbourne
John Michael "Ozzy" Osbourne was born on December 3, 1948. He is also known as ''The Prince of Darkness''. Ozzy is an English singer, songwriter, and television personality. He rose to prominence in the early 1970s as the lead vocalist of the band Black Sabbath. Osbourne was fired from Black Sabbath ...read more.
I love Ozzy! He's got a great and distinctive voice and a fabulous vocal range. And even after leaving Black Sabbath, he's still done some amazing music. Ozzy is amazing!
17 Robbie Williams
18 Billy Joel
19 John Lennon
John Winston Ono Lennon, MBE was an English singer and songwriter who rose to worldwide fame as a co-founder of the Beatles, the most commercially successful band in the history of popular music. He was assassinated by Mark David Chapman on December 8, 1980 at age 40.
How is he not in the top three?! - FennikenFan9
20 Daryl Hall


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We all know that dating tradition has changed dramatically over the years, with an increase of women reaching and internet dating older men, or older women who date newer men. It has the interesting to make note of how much on the dating help and advice available now is normally directly aimed at these kinds of new wave of” Aged Women” or perhaps “OLTF” people. It seems that when ever society labeling something when dated, unsuitable or awful that we accept it as that, regardless of how fresh or old the person is. While we may nothing like to admit until this is happening, it is a problem within our culture.
Why is dating culture too bad? First, there is the age big difference itself. When you are dating somebody who is much mature than you, it can be hard to take a chance on get together up mainly because you obviously cannot be mainly because attractive to them as you will be if you were more youthful. This can trigger many concerns, especially if you do not realize that the simply reason that they want at this point you is due to your age difference – for anyone who is younger, chances are they will simply select someone who is much older. Certainly, if you are aged yourself, then you certainly are less prone to meet up with somebody who is more mature than you are.
Second, there is no for a longer time https://www.420psychomed.com/tips-on-finding-thai-women-meant-for-marriage/ the “age gap”. This used to be a key issue in the internet dating culture quite a while earlier, but now it really is becoming significantly less of an issue. Now, it is actually perfectly suitable for a man to date a lady who is much older than he could be (regardless of their age difference), because today he is considered “tougher”. So whilst it may not be socially acceptable, at work it is totally fine to date an individual way past your date’s age!
Third, it is not basically wrong to become interested in somebody outside the own their age. It may not be right to date various other women who will be younger than you, but it is definitely NOT the same as being interested in someone who is old. Many women consider themselves to get “tougher” than their age and so they still dined on a lot of younger males. It is possible to look for some excellent dates in case you are open-minded not limited by the own desire of age. Whenever http://www.umeda-iin.com/629/potential-benefits-to-dating-filipino-females-web-based/ you look hard enough, it is also possible as of yet someone who is normally older or younger columbia cupid than you are.
Next, the new “culture” of internet dating provides actually developed very positive situation pertaining to both men and women. There are now more aged and the younger people online than in the past, which provides men and women with a higher level of selection in finding a date. There are even some “Older Women Intended for Older Men” services on-line that allow you to get a date, in spite of your specific middle age! This has made available a whole ” new world ” for people in search of dates, as well as the “age gap” used to be described as a big hurdle. It is now turning into accepted for the purpose of both men and women to date inside their own a long time.
Overall, the “age gap” used to be described as a big problem in regards to dating, but today it is simply not an issue. Because of this men can time frame women much younger than they would manage to if that they used a “traditional” way of dating. Furthermore, the “dating culture” of your technology has created a healthier, entertaining atmosphere than ever before. In this way, it will be possible to meet someone of this opposite having sex who is also trying to find someone to night out.

domain: sociology


In my previous post i talked and explained what a nofollow tag is, here we will talk about how to check links with rel=”nofollow” tag on a particular page. I guess we all familiar with the fact that rel=”nofollow” tag prevent search engines from indexing the link, so it’s better to check the status of other links on that page before linking your page to it.
Think this, you just finished writing an awesome blog post but as usual it isn’t that popular in its initial stage. What’s next ? you pick a keyword to promote your blog post and you start building backlinks for it. You build 100′s of link but still your blog post is nowhere near first page of search results for your picked keyword.
We all know how frustrating link building can be and things like this happens, you are so busy in building backlinks for your article/blog post that you barely look at the webpages properly you are linking to. It leads only into frustration.
- To avoid this first be sure you are building some great backlinks, not just submission types of links because anything you are submitting to automated directories and blog commenting isn’t worth. Read Top 5 Link Building Mistakes you should avoid.
- Second, before linking your page or content always check whether that particular page has rel=”nofollow” attribute set to hyperlinks in that page or not.
How to check Nofollow links
There are several ways to find out whether your link on a given particular page has rel=”nofollow” tag in it or not. Easiest method which works on all browser is finding the nofollow tag in source of page. To do this all you need to do is select your anchor text in the page > right click > view selection source, a window will open and there you can see whether your link has nofollow tag in it or not. If this doesn’t works for you, you can also Right click in your browser and select page source to see nofollow tag in your link, this usually is a tedious method because do this you you will have to find your anchor text first in the page which makes it a bit hectic IMO.
Checking Nofollow links with add-ons
Who want’s to do manual work when there are tools available to do the same thing, right ? and that too at free of cost. There are two tools/add-ons which i personally like and use them all the time.
1st) SearchStatus :- SearchStatus is a toolbar from Quirk.biz which is available for Firefox and Seamonkey. Along with information about rel=”nofollow” links this toolbar will give you N number of information like Alexa ranking, google page rank, compete.com ranking, moz rank and lots more. Once you are done downloading and installing the toolbar it will appear on right-bottom of your browser (you can change the position later, also you need to restart the browser to take effect). Now, to see the number of nofollow links on a page right click on the searchstatus icon and click on Highlight nofollow links. See image below. Also you can see the diversity of option this toolbar gives. You can also keep the option active if you want to see the nofollow links on other pages which you may browse in future.
After doing this every link on that particular page which has rel=”nofollow” tag in it will appear in pinkish colour. See the attachment below, how nofollow link looks like when you activate this option.
You can download SearchStatus toolbar from here
2) NoDoFollow :- This is another awesome add-on available for firefox. Best thing about this add-on is you can check both nofollow and dofollow links at same time. I personally love this add-on because gives me exactly what i’m looking for. Once you have installed this add-on it’s pretty simple to check nofollow and dofollow links. To do this first let the page load completely, once the page is loaded, just right click on the page and select Nodofollow just like in the image given below.
What i like about this add-on is, it shows both dofollow and nofollow link in two different colour. Dofollow links will appear in light blue colour while nofollow links will appear in pinkish colour, same as searchstatus. It becomes easy for us to differentiate both dofollow and nofollow links.
You can install this addon from here.
So, which add-on or toolbar you are using in your SEO process ? Is it good or you find these tools/add-on better ? Do let us know your views on this, also if there’s any other way, addon or toolbar to find nofollow links (there’s plenty out there) which you think are better than these two, please share it with our readers.


Ahead of President-elect Joe Biden’s $1.9tn stimulus announcement, Wall Street diverges with the Russell’s index settling at record highs whilst large cap and tech retreated. Small businesses are anticipated to be the main beneficiary of a new wave of spending, including expanding jobless benefits and vaccinations programs on top of more direct payments to American households. Meanwhile out-going President Trump struggles to assemble a legal team ahead of his 2nd impeachment and uncertainty still cloud when the trial will begin.
European benchmarks managed to notch higher on brighter re-evaluations in the face of social lockdowns that’s stifling economic recovery. Alongside the large U.S. relief package, Chinese trade balance data not only exceeded expectations but now stands at historic highs. An encouraging sign, especially after the EU and China signing a trade deal earlier this week.
Elsewhere US – China relations continues to sour as the Trump administration in the their finals days is set to impose sanctions on smartphone maker Xiaomi and oil company CNOOC, citing security risk for the former and punishing the later for their involvement in disputed South China Sea waters. Though news initially flustered the Hang Seng on open, the indices regained ground intra-day hitting an 11-month high. Australian shares rose on the back of Biden’s unveiling whilst Japan took a breather, slipping 0.78% thus far. Nevertheless, following a strong start to 2021, the Nikkei is now just 5% from the 30,000 level. Investors are anticipating a bumper earnings season despite prevailing headwinds. An outbreak still uncontained, an Olympic in doubt and a plunging approval rating for Prime Minister Suga.
The U.S. dollar index fluctuates around the 90 level as elevated Treasury yields stave off risk-appetite for alternative currencies. Gold steadies at 1,850, crude hits 53.00 on demand recovery and bitcoin back at 40,000.
Figure 1 (Source: IS Prime): AUS200 Daily : Aussie benchmark in a conundrum fraught with a pandemic of their own has left the S&P200 as one of the worst performing indices among developed countries.
Headliner to Review
- As of January 9, 2021, the number of people unemployment claims for the first time in the United States increased by 181,000 this week (the previous value increased by 2,000) to a total of 965,000 (the previous figure was down to 784,000), the highest since the week of August 22 last year (a total of 1.01 million), far exceeding market expectations of 795,000 people.
- The US import price index in December last year expanded to 0.9% month-on-month (the previous value was slightly revised up and rose by 0.2%), the largest increase in four months, higher than the market’s original expectation of a 0.6% rise.
- Natural gas storage in US dropped from -130 billion to -134 billion, which was worse than the expectation of -129 billion.
Headliner to Watch
- Retail sales out of the U.S. expected to improve but remain stagnant, whilst core sales continue to contract at -0.1%. Despite holiday seasons, Christmas spending was comparatively lackluster compared to previous years as COVID-19 deterred foot traffic.
Any opinions, news, research, analysis, prices, or other information contained on this website is provided as general market commentary, and does not constitute investment advice.


Tag Archives: Ross Ohlendorf
The Pittsburgh Pirates have placed right handed pitcher Ross Ohlendorf on the 15-day disabled list and have called up Brian Burres to take Ohlendorf’s place. That’s somewhat of a surprise,… Read more
Two big blows to the rotation as two of the best performing starters this year are dealing with injuries… -After exiting in the first inning after facing two batters, Ross… Read more
Delmarva Shorebirds (16-21, 48-59) at West Virginia Power (16-21, 47-60) Game 108 | August 3, 2010 | Appalachian Power Park | Charleston, WV Play-by-Play: Adam Marco Radio: Power Baseball Network… Read more
Ross Ohlendorf left tonight’s game after being struck in the side of the head by a Troy Tulowitzki line drive. Ohlendorf never lost consciousness, briefly dropping to a knee but returning to his feet within seconds. He appeared alert, and walked off the field under his own power. Ohlendorf was taken to a local hospital for precautionary measures.
As you may already know, I don’t believe that a baseball manager has a significant impact on a baseball team. I feel that the most important thing is talent, and… Read more
MLB Trade Rumors discovered today that the Super Two cutoff after the season will likely be at 2 years, 124 days, which is the lowest the cutoff has been in… Read more
A few notes before the game tonight… -Neil Walker has a concussion from his collision with Ryan Church yesterday. Walker will at least miss the rest of the Oakland series,… Read more


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domain: artistic


HARTFORD, Conn. (AP) — Connecticut lawmakers are being urged by needy parents to oppose Gov. Dannel P. Malloy’s plan to eliminate their state-sponsored health insurance coverage.
Malloy’s budget proposal ends coverage for adults who use the HUSKY A insurance program and if their income exceeds 133 percent of the federal poverty level. An estimated 37,500 people would be affected.
The change would take effect Jan. 1. That’s when federal subsidies become available, enabling parents to purchase insurance from the new health care exchange.
At a Capitol rally Wednesday, advocates for the poor and needy parents said many people will still be unable to afford the projected premiums and copayments.
The move is projected to save the state $5.9 million in the first year of the two-year, budget, and $59.5 million in the second.
Copyright 2013 The Associated Press.


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A day after Congress president Sonia Gandhi’s son-in-law Rober Vadra alleged victimisation, Union Minister M Venkaiah Naidu said the government is not vindictive but the law has to take its own course.
“I don't wish to comment on Robert Vadra. Law will take its course. We don’t discriminate against anybody. We have not harassed any political opponents since we came to power. The law must be allowed to take its course. I don’t want to make any personal comments about anybody,” Naidu said.
Vadra has alleged that he being subjected to political witch-hunt, a counter to the Enforcement Directorate and the Haryana government inquiring into his alleged suspicious land deals.Haryana Minister Anil Vij also jumped to defend the BJP government. “Whatever he has achieved till date is because of politics only. If he is talking about the inquiry, then we don’t have anything to do with it. There is no interference from our side.” “The commission is probing the matter and we have no role in that. It is between the commission and Vadra,” Anil Vij said.

domain: news


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text: b'The Shoe Game is a trending wedding staple that will have you and your guests laughing to tears.Traditions & alternatives BOUQUET TOSS head table where guests can GIDEON PHOTOGRAPHYNICHOLAS GORE WEDDINGS This is the classic movie make a donation! For eachmoment we all know so well donation, the couple has tobut what if the bride wants tolock lips.hang on to her bouquet? Kidnap the bride Who has the key?Have the groomsmen kid-Lock up your bouquet or a giftnap the bride and hold her for in a box. Pass out keys to yourransom. The groom has to run guests and whoever unlocks thearound the reception collecting box gets the prize!money from guests in order to Fun-sized bouquetget her back!Have your florist craft aAuction a dance mini-bouquet specifically forHave your DJ host an auction the bouquet toss. It will be waywhere the highest bidder gets easier to throw!to share a dance with the bride Gift tossand/or groom. Make a bouquet of scratch- DANCINGoff tickets, dollar bills, candy,If you or your fianc arentor any other creative ideas youbig fans of dancing, then come can think of. Both the bride andup with a different way to cele-the groom can toss one to thebrate! Heres a list of some of crowd! our favorite alternative recep-GARTER TOSS tion ideas.Garter toss a little to scandalousHave a brunchEMILY MILLAY PHOTOGRAPHY for your taste? Try these instead:A morning ceremony with a cel-Dance-off ebratory brunch is a great way Invite the men out to the danceto enjoy time with your friends floor for a dance-off. The groomand family.stands as judge with the trophyYard game (garter) and decides who hasOffering yard games like bean-the best moves.bag toss, ladder golf, giant DOLLAR DANCE Jenga, Bocce Ball, and Croquet The dollar dance is a fun tradi- are fun and unique options to tion, but too many donationsentertain your guests.could keep the bride from herVideo games groom all night! Consider theseConsider renting old arcade instead:games like Pac Man or a pinball Pay for a kissmachine, or set up a gaming Instead of clinking their glassesconsul for Wii champions,to get the newlyweds to kiss,Guitar Hero battles, and epic have a jar near the entrance orMario Kart racing. KILLIAN ROSE PHOTOGRAPHYNICHOLAS GORE WEDDINGS100TODAYS BRIDE|8-12 MONTHS UNTIL I DO|ENTERTAINMENT'

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The ‘Terroir Moselle wine and architecture route’ is a ‘preparatory’ cooperation project gathering six LEADER areas, five wine growing areas from four regions and three countries.
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A restoration project of an old railway station became a model of energy-efficient renovation work and set the grounds for creating a eco cluster of specialised companies and technicians.

domain: agronomy


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The Texas Medical Center accelerator (TMCx) program announced its 2016 graduate companies, demonstrating broad innovation born in Houston and ready to be unleashed on the health care industry. TMCx couples the resources of the world’s largest medical center to facilitate the development of early-stage digital health and medical device companies.
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We followed events, news, and tweets about the Cancer Moonshot Summit held on June 29th and created a collection of highlights. Vice President Biden puts hope at center of cancer ‘moonshot’ summit. Read our story.
For the tenth year, U.S. News and World Report (@usnews) released the #BestChildrensHospitals list. The 2016-17 rankings include children’s hospitals...
The American Diabetes Association and IBM Watson Health announced a long-term collaboration to bring together the cognitive computing power of Watson and the Association’s vast repository of clinical and research data. Collaboration Will Include Developer Challenge to Catalyze the Creation of Cognitive Apps.
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A lot has been happening since the Cancer Moonshot 2020 Program was launched this past January. From gaining the support of millionaires to meetings with the Pope check out the latest Cancer Moonshot news with Our Story.
Climate change will have devastating consequences for public and individual health unless aggressive, global action is taken now to curb greenhouse gas emissions, the American College of Physicians (ACP) says in a new policy paper published in Annals of Internal Medicine.


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The influence of structure on back pain is a discussion I have had twice in the last 3 days.
I would not describe myself as an expert in this area but this area of discussion does leave me a little confused and I do take an interest in it, especially with the whole ‘forgetting the bio in the BPS’ thing.
These are just some thoughts and data, this is certainly not a comprehensive literature review, just information I have been exposed to and to be honest leave me more uncertain than certain.
Undoubtably the disc can be a source of nociception and relevant in back pain. The plausability is not in question here.
My key questions (not really answered yet) are:
1) How do we reliably identify discogenic back pain clinically?
2) How does this influence our management?
WARNING - the data below is likely to leave things much murkier than clear!!!
Prevalence of disc related factors in LBP
So firstly we see that disc degeneration is more prevalent in those with back pain.
We also see that more findings (3 or more) on an MRI report were more strongly associated with LBP than a single finding.
Here we see those with acute back pain are more likely to have disc herniations
But we also see lots of the same signs in those with no pain
Again a high prevalence of the same signs in asymptomatic populations.
People with previous back pain also had increased MRI findings but no current pain.
MRI findings also do not seem to be predictive of back pain.
Changes in MRI are also similar in symptomatic and asymptomatic populations
So maybe we need to think more about relevance than prevalence here? If both groups can have MRI findings then we cannot just assume.
Do symptoms of lower back pain correlate with structure?
These papers below would suggest it is not that simple to correlate the symptoms that people experience compared to imaging. Again this suggests that if there is nociception from the disc it is not the only factor at play.
It does appear to be difficult to diagnose discogenic pain with 90% being labelled as non specific. So we know it can be prevalent but it is difficult to find if it is relevant for your patient. Ultimately we need to be able to identify clinically to make the link in my opinion.
These are some recent clinical classification guidelines.
There is some support for centralisation in identifying discogenic pain.
This paper is pretty certain in being able to identify discogenic pain
This paper suggests that internal disc disruption is not a real thing!
How does this change management?
It was suggested to me that we would treat an annular sprain much the same as we would a sprained ankle. This would be through the concept of optimal or tolerable loading and could be done both via the magnitude of load and manipulating the load different movements might place on the disc through spinal kinematics.
I think this sounds fair however it brings us to the second point I raised of does this information make a big change in the management of LBP. We could treat a non specific LBP in a similar way so again I am left a little confused.
Over the longer term for conditions such as disc degeneration the famous Battie twin study would suggest loading has limited influence.
We can't draw to many conclusions from these two papers below, as they are observational, but perhaps they tell us that activity is not detrimental and MIGHT BE beneficial.
So the real question should be, how specific should we be with our exercise prescription?
(Now this could have turned into an epic blog, but I have decided to keep it brief and readable!)
In my opinion WE SHOULD ALWAYS BE SPECIFIC.
Now that’s a pretty emphatic statement so I should probably add a bit of nuance to that.
For some people the term specific means that we should use a SPECIFIC exercise for a SPECIFIC problem.
The world of therapy is littered with exercises that have been held up as the ‘best’ exercise to fix a certain issue and not achieved that status, think TvA activation exercises for back pain or VMO exercise for knee pain. Being specific in this way does not appear to be warranted with the current evidence base we have.
We could also be specific to some form of physical quality like strength or range of movement. We see that in many cases when it comes to MSK pain going after a specific physical quality also does not seem to yield better results, there ARE a couple of examples of when being specific is important and I will discuss those later.
I might be bold and stick my neck out and say that non specific pain (meaning we cannot pinpoint the source), of which we seem to have a bunch of around the body, probably needs a non specific approach to exercise. This means that we cannot strongly suggest a singular exercise or a type of exercise that focuses on a physical/biomotor quality.
So why the need for Specificity?
So everything I have said so far may seem to point towards there being no real need to be specific. Does that mean that we can just give someone any old exercise and expect to see a positive result from it?
I don’t think so.
Any application of exercise should come with some form of reasoning and we should start with the end in mind.
What SPECIFIC effect do we want from our exercise?
This will be SPECIFIC to the person and their current issue or goal. This means that the reasoning approach is always specific but the application may not always be the same.
So rather than be SPECIFIC to a type of exercise or presentation we are being SPECIFIC to the PERSON standing in front of us.
WHAT do we want?
There are many different outcomes that we may want to achieve from our application of exercise and we find we can influence lots of different elements of human function.
To make things a bit simpler and more organised we could make some broad categories.
This could be tolerance of a specific tissue such as a tendon or muscle although we still have not quite worked out the relationship between pathology and pain here.
There may also be clearly defined scenarios where we do see the need for specific biomotor qualities, such as strength needing to be addressed post operatively.
Pain relief maybe another specific outcome that you want to achieve from your exercise prescription.
It seems here that lots of types of exercise may create analgesic effects. Isometrics are the flavour of the month at the moment but both strength training and cardio training also have the potential to create analgesic responses.
I am still slightly on the fence about the usefulness of short term responses for all but I can see a clinical need with some groups of patients.
As we start to move away from a tissue focused view of exercise and movement the concept of beliefs around exercise become much more important
Concepts such as fear avoidance and exposure based therapies are starting to gain traction, and rightly so, especially as their role in actually getting people moving is starting to be appreciated more and more.
We might have to be very SPECIFIC to a movement but that movement is probably very SPECIFC to the individual as well.
It might not matter what the exercise or its aims are if it doesn’t get done in the first place.
This is a great example of when non specific is really quite specific.
We may have to be specific in
- Type of equipment
- Preferences & enjoyment
To get someone moving again.
It has been hard to pin down many SPECIFIC movement ‘problems’ that we reliably see as a cause for pain.
Our understanding of the mechanisms behind the pain experience are broadening and we see modern concepts such as the decoupling of SPECIFIC movements from pain responses as a plausible reason for using a movement based approach but again these seem to be quite SPECIFIC to the individual.
Variability that is either too high OR too low might be relevant to pain, maintenance of pain and injury. Or not! Who knows.
It might be that just MOVING is what many people need!
Being specific – Where’s your data!
This does not mean that there are NO specifics we should aim for across people but they DO need to be clearly defined. An example here might be return to play for ACLR rehab. Better outcomes have been shown if patients achieve RTP markers of almost equal, within 10%, of quadriceps strength and also hop performance. We also see the specific use of eccentric contractions with the prevention of hamstring injuries over concentric strength work.
The key here is if you ARE being specific that you have some form of data to back it up.
Remain vigilant to the specific response
All exercise gives individual responses, its not just fire and forget. Lots of exercise research is based around comparing the means of two different groups to look for a statistical significant difference or variation between the two groups.
While this type of analysis does point towards a trend for an effect, in reality it gives us little idea about individual responses to exercise so it is important to monitor someone’s response rather than just expect your reasoning process to have a successful outcome.
An exercise could make someone better, worse or simply have no difference. It is important to know that many exercise interventions don’t achieve spectacular results. The actual effect is often around the minimal clinically important difference (MCID). The MCID is smallest difference that a patient is likely to see as important to them. Although this number varies across studies is generally around 2 points on a 11 point 0-10 VAS scale.
We must always be prepared to adjust the exercise type or dosage based on the SPECIFIC response from the patient.
- We always need to be SPECIFIC
- Not always in the same way
- Always ask "what do we want?" from the exercise
- Lots of different effects across the BPS spectrum
- Want to be specific? Have data!
- Always remain vigilant to the effectiveness of your exercise
Exercise is great, we know this, right?
Well sort of.
Many people know exercise is good for us on a general level, but the question is, do they know it’s right for them on an individual level and is it the right fix for their problem?
This is an entirely different proposition, applying that general information to the person. This idea that these things are good for us can be quite vague, one of those things we may have glanced over in a newspaper or half heard on the news whilst eating our cornflakes.
People also build up ideas about what is the correct treatment for them. This can be from their own in depth research on the internet (right!), what they have picked up from friends and family or from previous treatment with a therapist. This can lead to some pretty strong ideas about what should and perhaps should not be done to help them.
These beliefs don’t always align with the best available data we have about interventions. A prime example of this is the belief that exercise risks out weight the benefits with back pain (55% of folk in New Zealand). This stat was taken from this Darlow paper in 2016 HERE.
We know that exercise can be effective with back pain, certainly not a magic bullet, but one of the best things we have at our disposable within a comprehensive treatment plan, especially as it is low cost and low risk too.
Beliefs and expectations
Our beliefs drive our expectations and actions. Predicted expectations are gaining weight as a prognostic factor in recovery over the past decade. They may influence my participation and behaviour in a treatment plan that will ultimately affect the outcome. If I don’t believe in something I am much less likely to do it.
How can we combat this? Well in my opinion the best tool we have is good quality information we can use to combat the beliefs that may hold people back. A key to start affecting beliefs, again in my opinion, is not to challenge to firmly but inform people using well-evidenced information.One of my favourite one liners is “ That’s what we used to think but we are learning new things all the time, the latest research suggests….”
Here are some small titbits of information that we can use to start informing our patients and clients about the role of exercise in pain AND health, which of course ultimately affects pain too!
Remember that giving people information is really designed to change behaviour rather than just show how smart you are so monitoring what happens is pretty important.
1. Exercise is one of the BEST well EVIDENCE interventions we have for MSK pain
This paper HERE from 2017 in PLOS one shows moderate to strong effectiveness of exercise as an intervention for many MSK issues. This is in contrast to the belief that things need to be zapped, needled or popped back into place.
My therapist only gave me some exercises. Yep. Because they followed the evidence!
2. Exercise won’t make your body WORSE
So many people see the body as a bit of machinery. The more it works the more the parts need replacing. Is this true? Absolutely NOT. The body is an organic organism that adapts both positively and negatively to stimulus. The more active we are (within reason) the stronger we become. The less active, well…..
A classic common belief is that our invertible discs wear out the more we use them. This classic study from Battie HERE (2009) looked at twins to determine the major contributors to disc degeneration. They suggest that the “commonly held view that disc degeneration is primarily a result of ageing and "wear and tear" from mechanical insults and injuries was not supported by this series of studies”
This study HERE from 2017 found that if you have a rotator cuff tear, the tear getting worse did not appear to be simply related to activity levels. In fact they suggest pain development is actually associated with LOWER activity levels.
If I had a pound for every time it has been suggested to me that running damages the knees then I would be a rich man. A study of marathon runners HERE showed that they had LESS meniscal abnormalities than non runners.
3. Exercise might actually make the discs in your back healthier!
Two recent studies have shown a POSITIVE effect of activity on intervertebral discs. Firstly this study HERE from 2017 showed that MORE vigorous activity was associated with BETTER disc health on MRI.
Secondly, in this paper from 2016 HERE. Runners were shown to have intervertebral discs that had increase hypertrophy compared to the non athletic group. The authors suggest that running actually strengthens the discs, whether we can infer a causal relationship here is unclear but this goes against activity causing wear and tear which is a common belief.
4. Activity is a pain killer
This study HERE showed that older adults who were MORE active also had better endogenous pain inhibitory mechanisms when their conditioned pain modulation (CPM) was tested. Simply put : ) this means the more active the better their natural pain killing mechanisms were. Which of course is super cool.
5. Exercise is an anti inflammatory
This study HERE showed that regular physical activity caused an increase in interlukin -10 which is an anti inflammatory cytokine that can reduce nociceptor sensitisation.
Now the caveat here is this study was performed in an animal population but as we know that there are associations between inactivity and both acute and chronic pain in humans it is a linked that potentially needs to be better explored.
6. Lack of exercise is associated with chronic pain
This large study HERE looked at the relationship between recreational exercise and chronic pain. Both older and younger folk were studied and the researchers found that for both groups exercise participation was associated with reduced chronic pain. A relationship was also present for the frequency, duration and intensity of that exercise.
7. Lack of exercise as a major cause of chronic diseases.
This comprehensive paper HERE makes a case for a lack of exercise being a primary prevention against 35 chronic conditions suffered by us poor humans. This goes beyond what most of us involved in the musculoskeletal field would have to deal with but also shows the importance of exercise for systemic health too.
8. Its involved in mental health as well.
We are understanding more and more that the mind and the body cannot really be separated. Physical health and mental health are interlinked in the human being and guess what…..exercise plays a role in improving mental health too. This paper HERE explores the mechanisms that may relate to mental health and exercise.
This randomised control trial looked at aerobic exercise and a variety of measures of psychological health HERE. The authors found significant group differences that favoured the exercise group.
9. You want to live longer right?
Strength training in this paper HERE was found to have a significant association with decreased mortality in adults over 65. BUT only a minority of this age group actually meet the current guidelines.
10. Have a healthier heart
This prospective study of 15 years duration HERE found that physical activity was a predictor of cardiovascular disease.
There are a whole bunch of others studies that relate to these topics but I just picked a few. I think it demonstrates that physical activity and exercise have an effect on us on a number of different levels, from the heart to the head to pain as well.
- Do it
- Do it
- Do it
- Do it
Here is a short video I did on the Rethinking physiotherapy Facebook page on Applying pain science education. ENJOY!!!!
Pain education is a valuable tool for some, but certainly not all, patients. It can help to provide a narrative or explanation for problems that may remain unexplained by ‘traditional’ medicine or therapy.
This paper HERE regarding chronic lower back pain explores what people are looking for from a visit to a therapist.
“more than 90% of patients expected a physical examination, tests or investigations, a diagnosis, reassurance and advice, and clear explanations of causation, symptom management”
How tough is this in many instances with no clear diagnosis or causation available?
Up to 90% of back pain is described as ‘non specific’ for this very reason. We know that uncertainty is a big deal for many patients. Mishel first proposed this in the “theory of uncertainty of illness” HERE.
Carroll's paper HERE “How Well Do You Expect to Recover, and What Does Recovery Mean, Anyway? Qualitative Study of Expectations After a Musculoskeletal Injury” also discusses the process of diagnosis, uncertainty and the subsequent effect on expectations of recovery.
But although data suggests pain education can help it can also be very tough to deliver.
This quote from Louis Gifford sums it up nicely.
"The patient that learned from their pain explaining therapist that their pain didn't really mean anything, who suddenly got out of the chair, went home and went riding their bike for the first time in 5 years...just doesn't really exist!”
So how can we improve the delivery of pain education?
A question I often ponder is have we replaced anatomy with neurobiology? Do we now bombard people with complex processes involving brains, nerves and receptors rather than complex biomechanical stories? How much neurobiology or neuroscience is actually required?
In some cases certainly it will be useful, but in many cases maybe it could actually hinder. This does not mean that some of the key concepts such as plasticity, sensitization and the brains role in pain are not important but maybe the minutia of information that can be focused on is unnecessary.
Perhaps we can apply some of the information in this paper HERE. Simplifying MRI reports appears to have a positive effect on how they are received. This may also apply to the delivery of pain education. What does nociception or Ion channel mean to a patient? It could end up very similar to VOMIT (Victims of Medical Imaging Technology) HERE if poorly delivered.
Should the focus now be on the delivery and context of information rather than the information itself?
I thought it might be nice to get some other opinions on some of the key elements that go into making successful pain education and reached out to colleagues from around the world, using social media, to pitch in.
Some of the key components I already advocate, but I must admit some others I had not considered and provide valuable food for thought for myself and perhaps also the wider therapeutic community.
I was pleasantly surprised by the elements discussed, almost none related to the actual information itself but instead on the delivery and thought process involved.
Here they are!
The most consistent point made by the contributors as a whole was listening.
Listening is a key clinical tool. Although pain education is often thought of as the delivery of information, it should start with listening. I think this is advocated on many fronts but as we know patients can often be interrupted pretty quickly HERE and this is always worth keeping in mind.
The desire to be listened to also appears to be valued from a patient perspective and helps to build therapeutic alliance HERE. This is probably vital for those receiving and processing the information. delivered.
This is a good paper on ‘listening as therapy’ HERE
A couple of patients also contributed to the discussion and they felt that someone listening to and validating their experiences was a big part of their recovery. This also ties into the paper above regarding a patient’s perspective. If symptoms cannot be ‘medically’ explained or solved by traditional interventions, then patients may feel that they are being seen to ‘make it up’ or exaggerate their painful experience. All pain is real and although it can often be hard to describe it is also exactly the way that someone says it is. It cannot be anything else!
Another of the key points consistently put forward was about individualizing the delivery and placing into a relevant context. Now I personally have a bias for placing pain education in context with someone’s current situation. By weaving it into their story and using their painful examples to tie in some of the key concepts I think we are more likely to get some elements of comprehension.
This fits well with the key component of listening. Without listening we cannot place the information in the context of the patients narrative.
The question is, is this more effective than information generically delivered? I just don’t know. I think this would be an interesting comparison to study.
One thing I must admit to NOT asking was simply “do you want to know more about pain?” This was brought up by a number of people. This may avoid the very real problem of ramming pain science where it is not wanted. Pain science should be judiciously applied where it is needed AND wanted rather than a therapist dropping knowledge bombs expecting an instant epiphany.
It is not a passive exchange
Remember there are two equal people involved in this. It is not simply a teacher pupil relationship. Patients lived experiences are also important. The therapist can also learn from the patient, especially when it comes to the patient experiences. Perhaps it should be seen as a journey by two people to find mutual meaning in a negative situation rather than simply an educational experience.
Pain science is a way of thinking not an intervention
One of the criticisms that I have seen recently of the application of pain education is that it is seen as a standalone intervention. So rather than bombarding people with statements or analogies that have been previously heard for explaining pain, the concepts and ideas should affect the way we reason, interact, explain and apply the treatment provided.
Experiences are as powerful as talking
It’s not just about talking; doing is also a powerful educator. Perhaps sometimes talking is needed before and after the doing, but without the actual doing we cannot ‘prove’ the point. Beliefs about the body are a good example of this. Without SEEING or FEELING a different, positive outcome to that expected, potentially a number of times, a belief may remain in place.
Again listening is key. What are the key experiences that need to be reconceptualised in a physical sense as well as a cognitive sense.
Find out HOW your education has been interpreted
As with any part of the therapy process, pain education has the potential to have a NEGATIVE outcome as well as a positive one. We may well baffle people with talk of brains and outputs etc and HOW they interpret this information is the arbiter of success, however well meaning or comprehensive the input by the therapist.
This may boil down to wording, health literacy and therapeutic alliance. The list of potential influencers is endless, but essentially the ability to mitigate any negative effects could be dependent on simply asking!
We may be able to influence this interpretation by being clear and concise, using bite sized chunks of information, avoiding confrontation regarding beliefs and also avoiding negative or long winded medical or anatomical jargon and terms.
Don't just providing statements, also use reflective questioning. This may help to facilitate understanding and apply this new information to their own personal experiences and think critically about some of the beliefs they may hold.
Lets say someone has a negative belief regarding about their back because of a slipped disk a number of years ago. We could suggest that structure and symptoms don’t always display a consistent relationship. We could follow this up by asking if their symptoms come and go (as long term back pain generally does) and would this be a sole cause if the ‘slipped’ disc remained a constant.
Of course this is just some opinion/s but collectively they could be valuable!
- People are looking for answers
- Uncertainty makes things worse
- Pain education may provide some explanation
- It is tough and often fails
Some things may make it more effective
- Asking If it is wanted/needed
- It is not a passive exchange
- Pain science is a way of thinking not an intervention
- Experience is as powerful as talking.
- Find out HOW your education has been interpreted
- Reflective questioning
Here is another webinar! This time for the Pain Masterminds Network.
The subject is 'Exercise and clinical reasoning - More than sets and reps'
I am taking a look at moving beyond the tissue and capacity model of therapeutic exercise.
Below is the PDF of the presentation!
If I had a £ for everybody that mentioned posture on social media or when they had a pain problem…… well lets just say I would be a pretty rich guy.
POSTURE has literally become engrained in peoples thoughts when talking about back, shoulder or neck pain even though we have a shit ton of studies that compare the postures of pain free people with those with back, shoulder or neck pain and find no real differences, this information gets regularly IGNORED.
NEVER let science get in the way of a good story, especially if it’s on the interwebs!
In fact I have written about posture a few times before : )
But just to kick off with a bit of science, this paper HERE from 2016 found NO significant difference in lumbar lordosis (spinal curve) between people with back pain and those without.
This is super important. HOW can we blame something that we see in people WITHOUT pain as a cause of pain for those that do?
I will just let that sink in……
What are you measuring?
So in this blog we are going to explore a few questions related to how we assess posture and if they are actually scientifically VALID, because if you don't have a good measure to begin with then it is pretty tough to blame something for the problem.
The first piece of ACTUAL EVIDENCE, something often missing in the posture debate, looks at the measurement of STANDING LUMBAR LORDOSIS (the curve in the back often blamed for back pain) and this assessment is something that is performed in treatment rooms and gyms the world over.
The idea is that an increase (and sometimes decrease) in lumbar curve increases back pain and is often coupled with the idea that the tilt of the pelvis has an influence on the size of the lumbar curve, even though lumbar curves do not seem to be much of a factor in lower back pain anyway (see the SCIENCE above : )
Way back in 1990 this was explored by Heino et al HERE and they found that the angle of someones pelvic tilt and their lumbar curve do not simply correlate! So looking at the position of the pelvis tells us very little about what is occurring at the lumbar spine, which is much harder to measure. A very similar study HERE from before this in 1987 also threw up the same result but this BS is still being taught today.
Anyway, back to the standing measurement paper HERE. The authors explored the variability in standing posture of 400 people, 332 without pain and 83 with low back pain, and they found that each time we stand we do it in a slightly different way.
The authors in their words state “standing is highly individual and poorly reproducible”.
So why does this matter?
Well simply put, which posture are you ACTUALLY measuring with your postural assessment. One may show an increase in lordosis, another less so.
I have some questions related to how we interpret postural assessments in light of this information.
- Which of these postures is related to the problem?
- How many times do you measure and do you average?
- What are you comparing against to determine if the curve is too much or not enough?
The authors highlight a good point that the lack of consistency in standing posture may actually lead to the “wrong diagnosis and possibly unnecessary treatment”.
If you focus on something that is not an issue you do not focus on something else that might be or be blinded to the fact that it is not working or only works transiently (potentially why so much back pain is persistent).
What people actually use in their everyday lives might also be different to what is measured in the clinic or gym. A clinic or gym measure could be described as a ‘snapshot’ and this study HERE compared this ‘snapshot’ to what was actually used on a daily basis by the study participants.
The authors found that on average whilst standing, as most postural assessments are, there was a 33.3° lumbar lordosis but the average used over a 24hr period was only 8°, a huge difference!
So the ‘snapshot’ postural assessment would not really inform us very well about how much lordosis was REALLY being used and we could overestimate the extent of the imaginary problem : )
We also have to remember these were radiological measurements and this is the clinical ‘gold standard’. Often a lordosis is measured in a much more rudimentary fashion by looking at the relationship of landmarks at the pelvis indicating a pelvic tilt and therefore change in lumbar curve, which we have already discussed as not being well related to lumbar curve! This in itself is a problem as demonstrated by Preece in 2008 HERE as pelvic morphology is also VARIABLE leading to incorrect measures.
“These results suggest that variations in pelvic morphology may significantly influence measures of pelvic tilt and innominate rotational asymmetry”
Here is the distribution of side to side difference of the ASIS-PSIS relationship (used to assess pelvic tilt), we can see it is skewed to the right side meaning it is more anteriorly tilted at a BONY level.
So it might be that we are really bad at measuring something that doesn’t matter that much. OUCH
Are you biased?
Another important question for those that assess posture is……are you MORE inclined to see an ‘abnormality’ in posture when you know pain is present?
This paper HERE would suggest so Here the authors looked at scapular dyskinesis or abnormal posture and movement of the shoulder blade, which is often proposed as a CAUSE of shoulder pain.
They compared 67 people with shoulder pain and 68 without and firstly found that there was no difference in shoulder posture or motion between those with pain and those without.
Fascinatingly though when the assessors were aware that they were assessing someone IN PAIN, they reported a greater prevalence of a postural or movement problem. This shows a bias towards to finding an ‘abnormality’ to blame when there is pain, even though there was NO MORE ‘abnormality’ in those with pain than without.
The authors also suggest that scapular dyskinesis actually represents normal variability between humans! Perhaps if they assessed it multiple times it would throw up different measures each time?! It is important to remember we have no scientifically defined ‘good posture’ to base deviations from in the first place.
How do healthy people sit?
Another question is how do people without back pain actually behave? They must have great daily posture right? Well actually NO.
This paper HERE shows that asymptomatic folk , 50 of them, when seating actually SLUMP. In 10-min sitting, spinal angles flexed 24 deg at lumbar and 12 deg at thoracolumbar regions relative to standing posture. But this slumping does not seem to cause them problems.
So changes in our spinal curves seem to be fairly unrelated to pain as we can see below.
So if posture does not really correlate with pain, what does it correlate with?
Well this paper HERE shows that cervical spine alignment changes actually correlate with age. This study split the participants into 4 groups determined by age. They found that the measures of the angles of the neck all correlated with the increasing age range of the 4 groups.
Key point to remember here is that all the participants, 120 of them, had no pain. In fact the exclusion criteria here was pretty rigorous and the authors actually excluded 64 people, so 1/3 of the original sample, for having current or previous pain.
So simply put, as we get older our posture becomes ‘worse’ or perhaps better put our posture increases....BUT and a this a big BUT, this does not seem to cause MORE pain.
To sum up it does not seem as simple as ‘bad’ posture = pain whatever you read or are told in a bar, gym or clinic room.
Key take homes
- People IN pain DON’T have different postures to those that don’t have pain
- Posture displays variability just like movement
- This means your assessment may not tell you what you think it does
- Your assessment could be biased to finding a postural ‘problem’
- Postures used throughout the day are probably different to those being assessed
- As we get older our posture change and this happens to people NOT in pain too
Here is a FB live lecture on adherence with lots of research discussed around this topic and a sprinkling of opinion too!
Here are the slides too! Adherence (1)
So I got my virtual buddy Paul Lagerman AKA the naked physio to come in and contribute to this post and below is our bastard lovechild offspring of a blog post : )
The video above on whales and their contribution to our planet is not only informative and enlightening but also serves as a great metaphor for our understanding of the human body.
Confused? Read on.
An argument for the continuation of whale hunting is that whales are predators that sit at the top of the food chain and consume fish. One school of thought would be if we reduce the number of predators then there will be more fish for the smart Humans to eat. Sounds simple right?
Well, actually….not so much!
The video nicely highlights the complex interaction between the whales and other inhabitants of the sea such as fish, krill and plankton. In fact what has been found is that as we reduce the number of whales so has the number of fish reduced, disturbing the homeostatic balance of the ecosystem. Interestingly, causation is not a simple correlation of reducing numbers of one thing will increase the numbers of the other.
Well as usual what seems like a simple relationship turns out to not be so simple, and the reasoning model used to come to this conclusion is well….. simply wrong.
The whales as it turns out have a much more complex interaction with the environment so there are things that have simply NOT been considered in the simplistic model.
The whales actually bring nutrients up to the surface in the form of whale poo that are much scarcer in the upper waters and in turn help to fertilise plant plankton. They also create changes in the vertical water flow by moving up and down the water column that also has an effect on the plank plankton and enables them to thrive.
The animal plankton feed on the plant plankton that in turn feeds the smaller fish and krill and so the food chain flourishes, it moves and it flows.
So simply put more whales equals MORE fish and krill, not LESS.
Thinking about the impact of just one system in the biological world where more than one system interacts is just well plain STUPID even if it is simple and makes sense to some people. The aquatic ecosystem is multidimensional, approaching it with a unidimensional reasoning model will always have trade offs.
Remind you of another model?
The parallels with the human body are quite stark. The body is a complex system made up of many systems that interact such as the mechanical, biological and psychological. We can break it down further into the cardio vascular, muscular endocrine etc etc and all of these systems interact. The body depends on a homeostatic balance and interaction between systems similar to that of the aquatic ecosystem.
When we view the body simply as a mechanical system operating in a linear fashion, it makes complete sense that if we keep moving in a specific or repetitive way we will produce increase stress to muscles and bones that eventually will fail and cause pain, or that the knock on effect of excessive or decrease movement will cause a problem somewhere else.
Is this a bit like thinking less whales equals more fish?
Well here’s the problem, maybe we have applied the wrong model that does not consider other factors involved with being a human just like the whale guys.
Firstly, human beings are not simply a mechanical system, they are a biological system that displays both variance and adaptability.
This means that one part does not have a simple knock on effect to another. The body DOES display interdependence but also independence and it does this in a very individual way that simple all encompassing models do not really reflect.
- Humans are adaptable. If we load the body in a variety of dimensions (physical, psychological, social, environmental) it has the ability to get stronger and adapt rather than just wear out like a piece of metal would. How do we know this? Going to the gym and weight training is a great example, or exposing yourself gradually to stimuli such as temperature or a bed of nails.
- It has redundancy and variability. This simply means the body has a whole bunch of ways of achieving the same task that can reduce repetitive loads that might have a detrimental effect. This is a key defining feature of a biological system.
- The human body has individual tolerances. Some people can compete in iron men triathlons whilst others struggle to run 5K. Just because you apply a load to a tissue does not mean it will be beyond its tolerance, especially if it has successfully adapted to the load.
We also have to consider the impact on other co existing systems such as the psychological or social.
If you tell a person moving is bad then they may form a belief that moving is bad and stop moving, or perhaps your workplace has specific rules about lifting technique and this influences the way you protect your back. We are very impressionable creatures after all.
Stopping people from flexing their spines is a great example of a simple mechanical view having an effect on the psychosocial perception of movement or activity and a potential detrimental outcome.
If I do not flex my spine due to the belief that this is BAD, its tolerance to moving and flexing might actually DECREASE as it is not being loaded. Astronauts do not load their bodies as much due to decreased gravity. Their bodies and bone mass adapt negatively, a process of atrophy (remember adaptation happens both ways). This can also happen after immobilisation of a limb following a fracture or a sprain, consider the long term effects of complex regional pain syndrome.
So in essence one system, the psychological or social has had an effect on another system - the biological, all of this originating from a mechanical viewpoint. A familiar image of categorical thinking and reductionism is depicted in this image.
So even though things seem simple and make sense, consider that simple may not always explain the cause.
Be more WHALE and less HUMAN.
- FREE webinar recordingSeptember 15, 2020 - 6:09 am
- Sorry, there is NO SUCH thing as low self-efficacyJuly 28, 2020 - 3:09 pm
- How OFTEN should my patient do their exercises?June 23, 2020 - 2:38 pm
- Applying the BioPsychoSocial model in clinical practice!June 11, 2020 - 6:39 am
- Does exercise ‘WORK’ for pain? – Scrutinising the question!April 22, 2020 - 2:39 pm
- The most important thing people with back pain want – INFORMATION (especially as not much else has a large effect)March 10, 2020 - 11:56 am
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As it was announced that the Marks & Spencer (M&S) store in Basildon could close as part of the company’s bid to modernise its business model, thoughts turn to the 91 employees who could soon be facing unemployment.
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An Employment Tribunal has ruled that a senior teacher who showed a violent Halloween film to a group of teenage students, had suffered disability discrimination.


Saints fell behind after two early tries from Joe Westerman and Carlos Tuimavave, but responded and ran away with the game scoring 11 tries thanks to four tries from Kevin Naiqama, a hat-trick from the returning Adam Swift, plus two from the excellent Jonny Lomax on his 200th career appearance as well as scores from young Jack Welsby and Lachlan Coote.
Justin Holbrook made four changes following the win over Wigan, as Adam Swift came with Tommy Makinson in at centre with Mark Percival out injured. Matty Lees and Joseph Paulo both started and there was a Saints debut for Joe Batchelor with Jack Welsby on the bench.
A fast start from the visitors saw them race into a 10-0 lead inside the opening 12 minutes after Westerman latched onto a kick through from Jake Connor for the opening try. Minutes later following a 40/20 from Marc Sneyd the ball was thrown out wide and Tuimavave touched down in the corner to give Hull a 10-0 point lead.
Saints hit back minutes later after back to back penalties put us in prime position and Lomax was over after receiving the pass from Joseph Paulo. Coote added the extras.
On the very next set Saints were in again and this time it was all about Lomax. The England international threw the dummy and then stepped back inside three Hull defenders to walk under the posts. Coote adding the two giving Saints a 12-10 lead after just 20 minutes.
Saints were now in full control and two tries followed in three minutes. Naiqama with the first of his four after Lomax put him away down the line and the centre backed himself to score in the corner.
Then Swift, making his first start of the season, was over in the corner after excellent handling from Paulo and Lomax allowed Coote to find the flying winger.
The scoring in the first half didn’t stop there. In the final minute of the first half Paulo put Coote through a gap and the elusive full back stepped past Connor to score under the sticks as Saints headed into the break 30 points to 10 ahead.
The second half started like the first with Hull on top. Inside the opening minutes of the second half they pulled a try back. After keeping the ball alive, Jez Litten was first to the loose ball to pick up and score. Sneyd adding the extras.
It didn’t take Saints long to hit back though as Naiqama fed the ball out wide to Swift and the winger finished spectacularly in the corner.
Swift was in again for his hat-trick on the hour mark after a diving finish in the corner, Naiqama again putting the winger away. Coote converting off the touch line bringing the score to Saints 40-16 Hull FC.
Saints were now in full flight and after excellent footwork from Lomax he found the gap and on his way down somehow found an offload to Naiqama to go under the posts for his second of the game.
Welsby was next to go over as the ball went from left to right and back again before the youngster claimed the long pass to score and bring up the 50 points.
In the final five minutes Naiqama grabbed his hat-trick, flying over in the corner before he bundled his way over again for his fourth and Saints eleventh try of the game to bring up the impressive 60 point victory for Saints.
Tries: Jonny Lomax (18, 21), Kevin Naiqama (29, 64, 75, 78), Adam Swift (32, 53, 59), Lachlan Coote (39), Jack Welsby (70).
Goals: Coote 8 from 10 and Richardson 1 from 2.
Starting 13: Lachlan Coote, Adam Swift, Kevin Naiqama, Tommy Makinson, Regan Grace, Jonny Lomax, Danny Richardson, Matty Lees, James Roby, Luke Thompson, Joe Batchelor, Morgan Knowles, Joseph Paulo.
Interchanges: Kyle Amor, Dom Peyroux, Jack Ashworth, Jack Welsby.
Tries: Joe Westerman (7), Carlos Tuimavave (11), Jez Litten (48).
Goals: Marc Sneyd 2 from 3.
Starting 13: Jake Connor, Bureta Faraimo, Cameron Scott, Carlos Tuimavave, Ratu Naulago, Albert Kelly, Marc Sneyd, Scott Taylor, Dean Handley, Masi Matongo, Mark Minichiello, Sika Manu, Joe Westerman.
Interchanges: Jordan Thompson, Christopher Green, Jez Litten, Bradley Fash.