My Biggest Frustrations

I've been writing for Sports Injury Bulletin since it started back in 2000 and I was recently asked what is the biggest frustration still in your professional area of practice. 

I have two frustrations when it comes to injury rehab (in fact I think they probably spill over into the world of S&C) which are linked. 

1. 'Paralysis by analysis'. 

We have become obsessed with having evidence based practice and scientific research to support our training and rehabilitation strategies. 

 2. We are often trying to be too clever. 

I'm frustrated when I read endless reviews and research articles explaining in great detail risk factors that we can't really control. Whilst research is incredibly important I do feel that we are sometimes in danger of overanalysing everything, and ultimately miss what is obvious.  

We are obsessed with having to find an answer for everything and often can't come up with practical fixes based on hunches and experience. 

Let's look at one of the researchers favourites, the ACL. Whilst a significant amount of research has clearly gone into establishing the intrinsic and extrinsic risk factors associated with and contributing to ACL injuries I'm left wondering whether we can't see the wood for the trees. As a coach working with athletes it's unlikely that you are going to able to control all of the intrinsic and extrinsic factors (joint laxity, valgus collapse, pre- and post-landing activation patterns etc.) that are outlined in numerous studies. Forget thinking about this a male/female issue or worrying about intrinsic/extrinsic risk factors.  ACL's blow because fundamentally the musculoskeletal system can't cope with the demands being placed upon it. Maybe we should control the controllables and work on developing gross athleticism. It's just a hunch! 

When we speak to coaches and physiotherapists working on a daily basis with clients they can't always articulate why they performed a certain intervention. Alarm bells sound in our scientific minds. If they can't explain why, then how do they know it is working. It's simply not enough for them to refer to instinct or gut feel! 

In the book, Blink, Malcolm Gladwell points out that

“Our world requires that decisions be sourced and footnoted, and if we say how we feel, we must also be prepared to elaborate on why we feel that way”.

It is a lot easier to listen to the scientists, after all, as Malcolm Gladwell points out

  “...because the scientists could provide pages and pages of documentation supporting their conclusions.” 

What I've learnt during my career is that what we do is not an exact science. Yes we should always strive to understand why we are training in a certain way but we must also acknowledge the 'art' of what we do. Sometimes we just have a hunch, an instinct, a gut feel that what we are doing or seeing is the way to go. 

“We need to respect the fact that it is possible to know without knowing why we know and accept - that - sometimes we're better off that way.”


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