A Tale of Two Nails

Scenario one:

I presume that many of you have heard the famous story, written up in the British Medical Journal, about the man who jumped onto a large nail and was immediately in agony. An animated Ted-ED on the subject has been circulating recently. As the story goes, when they eventually removed the boot, they found that no injury had occurred, the nail having passed between the toes. On this revelation the pain dispersed….

Scenario two:

As a teenager, whilst helping out on a building site, I jumped off a wall with several bricks in my hand, onto a protruding 15cm nail which went straight through my mid foot. At this stage there was no pain. I thought that it was not a good idea to leave the nail in, so I stood on the piece of wood it was nailed through and pulled my foot off the piece of wood. Still no pain. I went into the house, slightly limping because I thought I should I suppose, but no pain, to tell my Dad of the incident. He took some forceps and proceeded to fish around in the wound to see if there was any debris. Still, I felt no pain, just a little sore. The only treatment and care was a tetanus injection.


What’s the difference Doc?

The difference is context, that is to say, the temporary environment of the event. I would imagine that my colleague in self harm was horrified that his reinforced boot had allowed the nail to penetrate. Wow that must be bad! Everyone around might have panicked adding to the importance of the damage. An ambulance was called, sirens rang, a hospital at the other end. The smells and sights of A&E all compounding the importance of the damage and danger. Antigenic responses having a party.

In my case, I was alone. No care, no sympathy, no ambulance and no hospital. A tyrannical father was waiting for me to blame my stupidity for the accident and the inconvenience to him that work had been interrupted and a perfectly good pair of boots ruined!

It’s all about Context

It’s all about context at the end of the day. In my case, it was not to my advantage to add pain to an already bad situation. I did not require the additional protection that a pain construction can provide, my cognitions and metacognitions ‘overriding’ any associated molecular patterns (AMPs) produced in my body.

Next time you see someone who is – or who is not – suffering in proportion to what you might believe is normal, have you just been judgemental as to their character? Or have you really cared and dug deeper into their story and their context?

Would you like to know more?

Check out page 58 in Explain Pain Supercharged for the latest on the AMP’s family.


– David Bolton, London 

The Mysterious Science of Pain

You’ve often heard me talk about pain as an experience rather than a feeling and, as an experience, it is very dependant on context. This poor gentleman (a true story) saw the context of a massive nail through his foot and concluded the worst……

Have a listen to his story and be amazed….….

Wear and Repair

From time to time I like to share the “Golden Nugget” moments of my dear friend and colleague David Butler. Many of you have experienced the “clumsy” language used by some medical professionals and been disturbed by the images that they conjure up.

Have a listen and be reassured……….

Motion is Lotion

It’s one of the mantras of NOI and we use it all the time; “Motion is Lotion”. But why do we say this to patients? What is the thinking behind it? Just to add a little scientific knowledge, to give the phrase more meaning, let’s have a look at the term “thixotropic behaviour”. According to Wikipedia, the term Thixotropy was first used by Pettefi in 1927 from the Greek word Thixis- to stir or shake- and Trepo- turning or changing.

Taking this knowledge into everyday life, most of us have probably experienced that moment of hedonism when we feel the need to spoil ourselves and be indulgent, throwing our healthy habits to the wind. On that double decker burger what better addition than a dollop of ketchup – a glass of shiraz doesn’t go a miss either. The frustration when we tip the bottle up and nothing happens! What do we do, instinctively we shake the bottle and, low and behold the ketchup flows. What has actually happened in that moment is  “thixotropic” behaviour. The action of activating the liquid by shearing the molecules of the ketchup and, the kinetic energy causes the liquid to be less viscous, more liquid and easier to flow.

The Big Question
But is this what is really going on within our patients? Are the lubricants of the joints really responding to the movement in a thixotropic manner? Maybe and maybe not but it is a wonderful image to give the patient, assuring them that they it is safe to move.

Maybe the truth of the matter lies more in protective pain mechanisms that kick in to protect us at the outset of movement and recede as the brain feels that it is safe to move more vigorously. Maybe the lotion is more the “Juices of the brain” rather than the joints. Either way I find it a beautiful mantra “Motion is Lotion”. Maybe a little knowledge  gets the juices flowing too…

Summer Holidays 2019

It’s that time of year again, hopefully off on your holidays for a well earned REST.

Yes time to relax and recharge emotionally but equally physically.

Give your body a break too rather than filling the day with all those sporting activities that you DON’T do the rest of the year. If you can’t resist then ease in gently and remember, fitness in one sport doesn’t translate into fitness in another.

Hopefully I won’t be seeing you soon.....

Enjoy 😎


The Light of Knowledge

The “Pain Revolution” is well underway in many countries with Australia and maybe the UK leading the wave of change. Progress is pitifully slow among the medical professionals. I believe that it is the patient that can bring about speedy change by “Knowing” their pain and seeking the appropriate help, shaming those who are ignorant.  Hopefully this encourages those professionals to up grade their thinking and do away with expensive and ineffective treatments. 

Just 20 minutes of your time spent listening to Lorimer, a dear colleague of mine, can change your life and you’ll probably know more than the majority of health professionals World Wide.......

(Please click the above image to go to his podcast - Lorimer Moseley/noijam.com)

(Please click the above image to go to his podcast - Lorimer Moseley/noijam.com)

It won't happen overnight, but it will happen

A question that often crops up in surgery is "How long will it Take to get better?”. A valid and justifiable question indeed. We are all individuals and therapeutic intervention can only create the best possible environment for healing but cannot speed it up. That is your beautiful bodies' job to heal you. A dear friend and colleague of mine, David Butler,  sums it up well...

Click the above image to go through to the article

Click the above image to go through to the article

Motion is the Lotion

Sometimes, in our complex physical and emotional lives, it can take very little to tip the balance creating a disastrous negative domino effect, when not caught in time. A hug at the right moment, a listening non judgemental ear, a hand held out to aid is often all it takes to avoid a landslide of emotional and or physical consequences.

Xmas is a time when many of us are at our most vulnerable so maybe, take a moment to check on and listen to the person next to you. Maybe, with very little, you can save a soul too……

Pain & Altered Movement

People with pain movement differently.

That much is well known. But why do people with pain change the way they move? Prof Paul Hodges presents some new findings of his research into muscle adaptations in people with pain.

Please click the image below to play Paul's video:

Normal Abnormal or Abnormal Normals?

It has been said that if we could take away measurement and comparison, we would be much more content in life.


This is particularly true, in certain areas of medicine, when the conclusions drawn from the imaging findings of MRIs have little to no relationship with the patients pain and disabilities "The truth about Pain” -  this is important for those patients who might have lost hope of any recovery due to false conclusions drawn from their apparent disabilities....

Time Out

It's that time of year when we take our well earned summer break. With the pace of todays World, rest seems to be a thing of the past when on holiday. Our heads are often still filled with work and our time taken up with activities and, whether family commitments, sporting or cultural, we are emotionally and physically on the move constantly.


Would it be so terrible to give our minds and our bodies “ Time Out” to just daydream and recharge? To organise down time and grab a moment for ourselves without feeling guilty? Give it a go and see if you can find that place to go and “Daydream”.

If you can manage it, I will be less busy this Autumn…..;-) 

Serenity in chaos

Serenity in chaos

A moment of insanity
Whilst holidaying here in Thailand, I had the craziest idea to rent a scooter to get around site seeing. Having already experienced the chaos of the traffic and total lack of any Highway Code by taxi, I must have had a moment of insanity.

They drive on the left, MOST of the time……….

A combined, gracious movement forward…  

Venturing off, a little apprehensive, I found myself on a dual carriageway surrounded by traffic of all imaginable kinds: over taking, undertaking, everyone manoeuvring into the best position to move forwards. A large coach sitting literally on my taillight. However, unlike say London, there was not one sound of a horn, zero road rage, no rude hand gestures, it was a combined gracious movement forward to our individual destinations, each respectful of the other. ‘If you go here, I’ll go there’‘you take this space I’ll take that’. In essence this is their Highway Code!

The chaos of chronic pain  

It reminded me a little of the behaviour of my own chronic pain state. An ongoing mixed flow of peripheral and central traffic, each signal having a specific destination. My Highway Code is pain knowledge, and metaphors such as hurt does not mean harm, motion is lotion etc. With this code I arrive safely at my destination, in pain but not suffering, safe in my knowledge that, at the end of the day, I can achieve my aims and reach my goals within my own and others limitations, trusting that I will not be harmed.

-David Bolton



Crinkles in your Wrinkles

Twinkles in your Wrinkles

Inevitably, one day we all arrive at a point where we think, as we reach with a groan, for another paracetamol “ Where did the time go”. How we might deal with our mature years is so well expressed by one of the greatest influences in my professional career and a dear friend David Butler. I would encourage you to take time to read his article that moved me deeply. 

Oldies are Goldies  

Most of us are living longer! Sixty is the new 40, 80 the new 60 so we hear. Phew! Living longer is usually a good thing but ageism is in the air. Ageism is a negative perception of getting older and of older people. It’s a really big personal and societal DIM (Danger in Me neurotag) and it needs to be challenged. Young and old people can be ageist, older people can be ageist about themselves, health professionals and sometimes government departments and companies are ageist. Let’s challenge it, first by obliterating some myths about pain and ageing.

Read the full David Butler noijam article here


Motion is Lotion

Its that time of year again when we can become more indulgent in those delights that we enjoy and, as such less physically active. 

When we’ve worked together, in the past to improve on your well being, education has always been the king pin of the treatment plan. Within that education you’ve often heard me say “Motion is Lotion”. 


Move it or lose it relates to the fact that the body is designed to move. It is our means of transport and expression. A brain sitting on the kitchen table without a body has neither ability!

Movement improves all body functions, promoting improved physical and mental health by stimulating fluid exchanges, not only in the joints, but in all the inner organs such as the brain, heart, liver and kidneys.

I wish you a very Merry festive time of year irrespective of your religion, as it is an opportunity to share love and friendship. However, don’t forget to take some regular exercise and get those fluids flowing.

Remember motion is lotion…..cheers

© 1997 - 2017 David Bolton Physiotherapy London