The debate over limitations in human performance has been waged for decades. In the endurance sports world, the commonly-held perception is that the cardiovascular system is the primary limiting factor. The belief expressed by many endurance sports coaches is that maximum VO2 and lactate threshold are the primary culprits - and thus, we need to track and scrutinize the appropriate training parameters - namely, heart rate.
But here are some thoughts to refute those claims - to take our focus away from the past and turn it towards the future.
There seems to be a growing aversion to the medical system in recent times. Why are people so hesitant and apprehensive about accessing medical care for anything other than chronic or life-threatening conditions? I certainly see it regularly when interacting with active people. Why is this so?
I am not sure I have that answer completely - but let me propose a few potential reasons.
Just like any other enterprise, there needs to be a value added benefit to going to a clinician for care. The "customer experience" starts from the moment they contact the office. You're on hold waiting for the next customer service representative. A frustrating start, for sure. Let's say you get lucky - and don't have to wait to schedule an appointment. Is the provider of your choice on your insurance plan? Or will this be an (oftentimes exhorbitant and inflated) out-of-pocket expense? Now I have to balance the potential cost-to-benefit ratio of the experience.
The Ivory Tower of Academia. If you've been involved with the educational system in any way, shape, or form, you've at least seen it off in the distance. Perhaps you've occupied it's courtyard, or maybe even resided inside it's walls.
The Ivory Tower - is tarnished.
Last time I looked, academia and education were about teaching and learning. There is plenty of good research literature to indicate that adults learn primarily by interaction, by doing, by being actively involved in their own learning process. In effect, it is much the same way that children learn most effectively. As Bob Pike would say, adults are just babies with big bodies.
This week marks the 13th anniversary of my first McKenzie course. I would bet that your first thought would be "why remember something so seemingly trivial - it was just a course"! But in our lives, we remember moments in time that shaped us and our perspective on the world. That four days in February 1994 was one such weekend.
What made it so? In the span of four days I was presented with a large volume of research - that contradicted much of what I'd been taught in school. This was, at first, unsettling - but the "scientist" in me decided that you can't simply discount the literature and that if it was all about "being a better PT" then I better sit down and do some homework to understand how all these issues fit together. It pushed my "comfort zone" ... and started me down a path that changed not only my career but my personal life perspective as well.
I've found myself considering the concept of "balance" a lot recently - not so much in the "maintain a vertical posture in space" realm, but more so with regards to "muscle imbalance". The idea of muscle imbalance isn't what causes me great consternation so much as the perceptual reality defined by someone who has "it".
Allow me to explain.
Patients will generally come into our offices with three primary issues - I am in pain, I am unable to move as I normally would, and I have lost some level of function because of one (or both) of these issues. At this time, the perspective is essentially one of "help me understand this problem so I can move on with life".
The talk of the town (in Anytown, USA) is "Evidence-Based Medicine". If you're in the health professions, I am sure you've become familiar with the phrase. The same holds for those in health insurance - and clinical research. "The evidence" is driving everything these days.
For the record - I am a true believer in the power of good clinical research. I do think that as clinicians we need to provide care based on true evidence-based medicine. We must hold ourselves to high standards of practice, and we must continue to challenge our thought processes and clinical reasoning skills - as uncomfortable a process as this may be. It involves reflection on our practice patterns and perhaps even challenging our belief systems - about our role in patient care or the methods we advocate.
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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