There’s been a recurring theme in many of my blogposts this year, and a Facebook post by Adam Meakins on Wednesday summed it up beautifully.
In the post (here), Adam was responding to an earlier post by Brent Brookbush promoting a new educational video of a muscle tissue release technique, to which Adam made this comment;
The continued illusion or delusion of therapists thinking they can find ‘nodules’ ‘trigger points’ ‘knots’ ‘taut bands’ ‘scar tissue’ ”gristly bits’ ‘snotty shit’ ‘gammy areas’ still astounds me in 2016… these are just soft tissue sore spots of an unknown origin… Meakins (2015) http://bjsm.bmj.com/content/49/6/348.full.pdf
The issue that I’ve been grappling with repeatedly this year is that we have been using our physical therapy techniques for over a century now, and yet what we really know about them is really, really limited. But that this isn’t necessarily a bad thing.
If we take Adam’s comment above as an example, Cyriax was talking about trigger points in the 1940s, and hundreds of thousands of physiotherapists and other practitioners have learned the techniques since.
Has the lack of empirical evidence of their existence or the efficacy of the therapeutic technique reduced people’s use of the term or the treatment? Has the fact that we can’t differentiate between a sore spot and some ‘gristly bits’ harmed the profession? Is our lack of sophisticated neuro-biological determinants altered what we teach students or write in our textbooks? I haven’t seen any evidence of it.
To my mind most if not all of physiotherapy is socially constructed. Call them trigger points if you want. What matters in the end is not what you do, but what it means, for your clients/patients, for you, and for the people who fund your service.
We have always treated ‘sore spots of unknown origin’ and someone, perhaps physiotherapists, always will. But I’d like to bet it’s not because we finally find proof of what Cyriax told us about 80 years ago.
To dismiss the value of a practice that has been omnipresent (albeit unscientifically) on the the open market of human service for aeons, may be considered myopic and disharmonious of thought. The technician bone setters from the first century, up until today’s regulated professionals, have million fold verbal and written, observational first-order evidence of their positive health status results, evidence both scientific and non-scientific. The a posteriori knowledge gained through direct experience is often times downgraded, classified as unscientific, with a resulting failure to see the merits and values of MT intervention. Therefore, to view MT’s success as coincidence, could be considered a factor that was left over from the application of a bad theory. Any suggestion it is “poorly supported” identifies a smattering of cognitive dissonance and appears to be a logically fallacious argument. Insofar as, an argumentum ex silentio, where the conclusion is based on the absence of ‘scientific’ evidence, rather than the existence of evidence that MT does not ‘work’.