Reducing Research to the Whole

I've been in practice for not so many as others in my field, but when I take a look at where I started things are quite different. In school, we were very focused on evidenced based medicine, which has become a rather warmly debated topic among medical professions (go ahead and 'Google' it). Researchers are regularly pushing out articles that are relevant to practice...some gaining more traction than others. Research often gives us insight about certain conditions related to something abnormal in a population or about a specific treatment on a condition. These pieces of information provide simple and clean exam questions and continuing education material. The example I'll use here is abdominal, aka "core", weakness in people with low back pain. 

It has been fairly well documented that people with low back pain tend to have atrophy and weakness of the multifidus and transverse abdominus muscles. That discovery set us in search of the best exercises for those specific muscles. What can, and in many cases has, happened in looking to research articles is that we get so zoomed in on a deficit or treatment, and the clinicians providing treatment to patients forget to zoom back out and ask 'how' or 'why' this has happened. It might make sense that someone with abdominal weakness does some "core" exercises, which is often prescribed by doctors...I've heard it relayed plenty of times from patients.

The problem is that they have narrowed their view of their problem and solution to abdominal weakness and abdominal exercise. This thought process doesn't lead to asking, 'what is it about my body or about my life that has lead me to have abdominal weakness?' That person could be weak because these muscles haven't had reason to work due to lack of moving...not necessarily amount of exercise, but quality and variety of movement...or because your brain doesn't think it's best or know how to use it right now, possibly related to past injury? 

Doing these core exercises can make muscles stronger, but if the stronger muscle doesn't work efficiently, you may not be better off in the long term because you haven't changed any of your movement habits during the time you aren't doing the core exercises.  

What I'm aiming at is that there are the lifestyle choices and life events that may have lead to feeling back pain and abdominal weakness, and we need to ask what can be done to unwind that process. Research can provide some insight, but can't replace our own investigations. These studies include a large group of people, thus making it difficult to apply to an individual that brings with them their own variables from their own unique lives. 

I started my career in the evidence based focused care, but soon saw that it had some very clear limitations. Searching for a more complete understanding of the human body is one of the best things I've done for my career and my clients.