The logical fallacy.
It rears its ugly head in any number of ways. Take, for example, the premise underlying the "logical" (yet arbitrary) concept of asymmetry and muscle imbalance. In our world today, there are countless examples of normal anatomic variability being "treated" as a problem when in fact they are, as I mentioned, normal for that individual.
Forget about what you think you witness in the clinic for a moment. Forget about what you were taught about asymmetry and imbalance. Let's step back and take a look.
Statistically speaking, asymmetry is the norm. Yet we continue to hammer away at how subtle anatomical variability - which has, perhaps, been there for life - is the root of all evil. We review MRI and x-rays after the onset of symptoms, yet we don't have a reasonable reference point pre-onset for comparison. Change? We would never know. There is a rapidly expanding scope of literature that reminds us that normal, asymptomatic people have anatomical issues like partial thickness rotator cuff tears, hip labrum tears, knee medial meniscal tears, and herniated lumbar intervertebral discs - and still have full pain-free function. Oh, and they don't necessarily serve as predictors of a future full of pain and suffering.
Yet how many of these have ended up in surgery? Or endless chiropractic treatments? Or interminable PT sessions that focus on the minutiae of the moment?
We assess asymmetry with tools that have poor reliability. Nobody can agree with what they see, but so what? Carry on and treat the anatomical variability nonetheless. And don't even mention that the human body, asymmetrical or otherwise, does wonders in adapting to the imposed demands of life on the planet without pain or loss of function.
Logical fallacy is a bigger problem than anything else in health care. It should constitute it's own syndrome, but for the clinician in question. It ends up in confirmation bias that oftentimes reflects the profit and loss statement of the practitioner more so than good clinical reasoning.
The worst part of all of this is that we actually have some valuable yet highly under-utilized tools for assessment. A consistent understanding of the responses to mechanical loading (be they symptomatic, mechanical, or functional) and concordant signs and symptoms pave the way to the development of an appropriate intervention strategy to increase the body's loading capacity.
In the meantime, we stabilize hyper-mobility and mobilize hypo-mobility, regardless of whether either is normal for the individual or not. Worse yet, neither may have any functional relevance to the problem at hand.
The problem isn't in our capacity for clinical reasoning and sound thinking. The problem is that we choose to deny ourselves the opportunity to do so, maintaining contradictions of thought in order to maintain our beliefs. Unfortunately, the patient - and health care as a whole - suffers in the process.
Photo credits: arenamontanus