We all want to believe that what is being done in our health care world is correct and for the right reasons. It is an issue of trust. For years, there has been a relative reverence for the role of health care providers (physicians in particular) in our community. And we have gone through history believing that health care providers act in our best interests.
If there is one area in which this trust may be betrayed, it is in the health care world.
The conspiracy of silence extends to our health care environment. The “silence” covers a broad scope – from evidence-based practice issues, to self-referral and “referral for profit”, and to over-utilization of services. And yes, these issues exist in virtually all communities in this country.
Let' s start off with the most basic element of health care – that of “evidence-based medicine” (also referred to as “evidence-based practice”). In simple terms, this refers to practice patterns (how patients are actually diagnosed and treated) that are consistent with the scientific literature and/or established clinical guidelines. Why do we care about “evidence”? Because our task as health care providers is quality of care – and science is required to establish what constitutes “effective care”. Clinical practice guidelines don't tell a provider what they can or cannot do - they simply provide the framework for effective clinical practice. We are long past the days of leeches and blood-letting – we now have science to guide us. Without it, long-term health care costs will be higher, and the overall health status of our community will dwindle.
"The inability to challenge our belief systems in the face of good scientific evidence is the primary limiting factor in the advancement of both health care and coaching, as well as human performance and injury prevention" (excerpt taken from "RunSmart" - 2008)
There is a conspiracy of silence in our community. It is evident in our health care, and it is evident in the world of fitness and coaching. It is a powerful undercurrent, a stealthy viral element that attacks us from all sides. Not a day goes by in which I don't witness it's effects. And the first step required to get down to the real issues in health care and fitness on a much broader scale, is to acknowledge and address it.
Much of what we experience in the context of health care and fitness is what I would term "Flat Earth Syndrome". Let me explain. For a great part of world history, civilization thought that the world was flat. It was part of the commonly-held belief system of the ages. It was actually part of the religious beliefs as well.
And then we discovered that - it wasn't. If you sailed a ship, you didn't fall off the edge of the world. You actually just kept on sailing. And suddenly, there was science to prove that the world was, indeed, spherical.
“Shhhhh, don't talk about this. We have empirical evidence – and that's all we have ever needed. We need to be careful with this science stuff, because if it takes hold, we might lose our power and control. So let's just be quiet about it. Maybe if we don't talk about it, it will go away."
It's finally cooling off in Austin. With cooler weather comes the start of all the marathon training programs in preparation for the Austin Marathon in February. And with cool fall weather and marathon training comes ... yes, the questions about stretching.
Stretching has become a panacea. So let's attempt to put a few things to rest with some good sports sciences evidence - though I suspect much of it may come as a surprise to many.
Let's start with a couple of interesting facts. Research on 5K runners has indicated that the fastest runners are the most inflexible. The increased passive muscle tension effectively gives the runner "free speed" because it's not requiring energy to produce it. Add to that the lack of research supporting the relationship between stretching and ---insert injury here --- [options include plantar fasciitis, achilles tendonitis, IT band syndrome, etc]. So we have to assess stretching by starting with the questions "why am I stretching in the first place?".
In the world of triathlon, it's all the rage.
Got aero?
It is a big trend in the triathlon community - the perceived benefits of aero tubing, aero helmets, aero bottle holders - you name it, aero is where it's at these days. Whether it's a more aerodynamic frame, or more aerodynamic bike fit/position, or a more aerodynamic helmet, "aero" is a huge catch phrase in the triathlon world. This focus on aero was once again brought to my attention at the Longhorn 70.3 half Ironman last weekend. As I was there supporting a number of athletes that were competing, I witnessed a lot of aero frames and helmets (or "coneheads" as one of my athletes calls them). In some ways, these struck me as frightening trends in that there is obviously a lot of talk and marketing dollars going into some of the beliefs held by triathletes these days.
And much of it revolves around the supposed benefits of aero on the cycling segment of the race.
At the end of July, I attended the McKenzie Conference of the Americas in Orlando, Florida. Though Orlando doesn't rate very highly on my short list of conference locales, the conference itself was well worth the time in the Land of Mickey. And though it may seem that a report of this is a little bit of "old news", I still think it's important to bring this to the attention of both clinicians and patients alike.
The McKenzie Institute conference has a rotating schedule. In alternate years, it is an International conference which moves throughout the global regions that have branches of the McKenzie Institute. On alternate years, the conference is a regional one - for example, our region being the Americas. I've been able to attend all of the North American/Americas McKenzie conferences since 1994 (8), and about half of the international conferences (3) . After my first McKenzie conference in La Jolla, I came to the realization that the McKenzie Institute are commited to excellence in conference programming. Through the amazing work of Ann Carlton and the U.S. office, we have continually been provided with exemplary conference speakers and workshops.
There are a couple of aspects of the McKenzie conferences that have always struck me as important. The first is that the speakers have been incredible. They are always individuals that are actively involved in either research or clinical involvement, and the information presented is current. Yes, current. That is a novelty in the world of conferences these days. I've been to far too many conferences and course that were out of touch with the issues that truly impact our profession. More often than not, the literature presented is current and relevant to clinical practice - if not truly cutting-edge.
Usain Bolt,
Michael Phelps.
Lance Armstrong.
What do they have in common? That should be an easy answer. It's certainly not their chosen sports - track and field, swimming, and cycling. These three fine athletes have shown us a glimpse of the levels of human performance that are possible. They have done things in their sports that many thought weren't possible.
Usain Bolt was running with arms spread wide for 30m of his 100m final - and still ran 9.69, a new world record. Then he arrives at what he calls "his event", the 200m, and runs 19.30 - then proceeds to mug with the camera and play to the crowd and run around like a little kid, so carefree and playful.
Having been in Atlanta to witness Michael Johnson's world record in the 200m in 1996, I can only say that I for one thought it would be a very long time before we witnessed another 200m world record. Bolt showed us it could be done.
The budget for the war in Iraq is, by many estimates, well on it's way to a trillion dollars.
That's a whole lot of zeros for anyone.
We can't fund a base level of health care for the people of the United States. Apparently the system can't afford it - not even basic emergent care.
Am I the only one that sees the hypocrisy in this?
Now this doesn't have to be an initiative to make all care free. No, we don't have to use the word "socialized" because Lord only knows that word does crazy things to people wearing red, white and blue. But how about we consider giving people some basic elements of care that can give them a springboard upon which to pursue the American Dream?
Up to 60% of runners will sustain an injury within any given year. Poor running mechanics, in conjunction with poor, ineffective and outdated training methods, can pose a significant injury risk. "RunSmart" was written to address these issues in the running community.
"Running Injuries: Etiology And Recovery- Based Treatment" (co-author Bridget Clark, PT) appears in the third edition and fourth editions of "Clinical Orthopaedic Rehabilitation: A Team Approach" by Charles Giangarra, MD and Robert C. Manske, PT.
Allan Besselink, PT, DPT, Ph.D., Dip.MDT has a unique voice in the world of sports, education, and health care. Read more about Allan here.
Top 5 finalist in three categories: "Best Overall Blog", "Best PT Blog" and "Best Advocacy Blog".
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