Thursday Thoughts: Where's the Evidence?

If you've ever attended an Eclectic Approach course, you'll know one of my "E" points is being Evidence Lead, and not Evidenced Based.


EPB to me, means the Evidenced Based Police... people who troll blogs and social media, start up arguments based on theoretical mechanisms, most of which are entirely plausible and most likely true but their delivery is terrible. Most of us in social media have encountered them, and then they go back to wherever it is they came from and all high five each other on being more informed.

A few quotes from my buddy Charlie Weingroff succinctly state my thoughts on this supposed controversy.

• The result of your work is the evidence.
• I subscribe to the Journal of Common Sense
• You measure something, introduce a variable, and then remeasure to see if a change is made. That's the scientific method in a nutshell - (last one is paraphrased)

Take MDT for example; it is proven to be a reliable method of assessment for the cervical and lumbar spines. Using a repeated motion exam can quickly predict outcomes of a patient via centralization. It also fits into all the evidenced based guidelines on teaching patients self care, independence from passive treatments, and gives some rudimentary pain science education. 

However, it is not proven for the thoracic spine, has only been proven in a few case reports for the shoulder and the knee, yet it works all over the body, makes sense, and teaches our patients to be independent. Who the heck is not going to use it after receiving training in it?

"The result of your work is the evidence"

The EPB are "against" postural correction as well. You may even say vehement... why? Who knows, maybe they're too lazy to sit upright reading all of those journals. Posture is not a root cause of all neuromusculoskeletal complaints, but it matters when it changes a patient's presentation.

I saw a patient last year, with chronic lateral epicondylalgia from her repetitive lab work. After taking her history, the first thing I did was try some posture correction and then overcorrection. The cervical retraction with posture overcorrection eliminated all elbow pain with grip, wrist extension, etc... So despite the "evidence" stating poor posture does not lead to complaints, it is relevant to the case in front of you when you can correct/overcorrect it, and it makes a change in the way the patient feels and moves. It's one of the most simple, empowering things you can teach a patient. With thousands of MDT trained therapists all around the world making similar changes, is not that proof enough?

What happens when you argue with a EBP troll

One piece of advice, do not get into arguments with the EBP, they are myopic and like most internet arguments (or is it all arguments), you'll never convince them.

"Does it make sense?"

Yes, despite what you're told, it can go both ways. You can, and should pick and choose what research you use to enhance your clinical decision making and also still do "non" EB treatments. However, who is to say some technique that works frequently, does not hurt patients, and helps them become independent of you (say, like Mulligan techniques), should be avoided due to the lack of RCTs on it? Remember, according to Chad Cook, most RCTs, at the validation stage (repeated experiment) are not significant the next time around.

A parting thought....Is a personable old school manual therapy clinician who believes in repositioning the SIJ with manipulation and MET, capsule and fascia deformation, "stretching" the nervous system, and still has amazing outcomes, doing a bad job?

Keeping it Eclectic...