Back in January 2010, the NY Times published an article entitled “Treat Me, But No Tricks Please”. It got a lot of physical therapists fired up, and it even prompted a response from the American Physical Therapy Association. And it made me chuckle about many things I have known for a very long time.
The firestorm of debate started when Dr. James J. Irrgang, a researcher in the Department of Orthopedic Surgery at the University of Pittsburgh and President of the Orthopedic section of the American Physical Therapy Association at the time, noted that “there is a growing body of evidence that supports what physical therapists do, but there is a lot of voodoo out there, too”. He also noted that “You can waste a lot of time and money on things that aren’t very helpful”.
Fast forward to 2011. I am now in the midst of preparing a 3 hour presentation entitled “Mechanisms Of Therapeutic Exercise Progression” for the Texas Physical Therapy Association’s Annual Conference in October. This will be my third consecutive appearance at their Annual Conference. What I have been reminded of – as I have reviewed a topic high on evidence-based cellular physiology research and low on practical application by clinicians – is that Irrgang was indeed correct. Sadly, not much has changed in our profession since this article was published, even with the responses and outrage it generated.
Note: This is an update on a post from 2007. Read the original post here.
The system of health in this country is faced with some significant problems. First of all, it is not a system of health at all – it is a system of illness. Our current system emphasizes "prevention" and yet we still have an increasing rate of chronic medical conditions. For example, 57% of adults are overweight, with 1 in 4 having a body mass index of 30 - a level that is considered obese. We would like to believe that our medical system is the best in the world – but we spend 50 percent more on health care than any other country in the world and yet rank only 15th in preventable death, 24th in life expectancy, and 28th in infant mortality.
I’d say that is sufficient testimony to the failure of the system of “health” we currently have in place in the United States.
How many health-related issues do we experience that can be readily dealt with on the basis of self-care strategies alone? And does an effective system of health require a bunch of providers applying interventions, or can patients apply many of those strategies themselves?
There is a solution that will involve not only systemic change, but cultural change as well. It’s name is Competent Self Care. What is Competent Self Care, and why should any of us care?
The mechanisms of exercise physiology have been described in great detail over the past 30 years. The sports medicine and sports sciences research is growing in leaps and bounds. So why is it that with all the “advances” in the science, athletes continue to sustain training-related injuries at an alarming rate?
Is it because coaches continue to advocate traditional training approaches based on old research or anecdote? Or is it because very few attempts have been made to synthesize and integrate it into a unified “big picture” approach to human performance? In a system such as the human body, how could there be so much disparity between approaches to training? Why has so much attention been given to “genetics” and so little to “consistent training principles”?
After many years of reviewing the sports sciences and sports medicine research, I began integrating the research into a more unified approach. This started with a focus on the running and cycling literature. But it also expanded to some reading on systems thinking and chaos theory, fields of study far removed from the sports sciences realm.
By 1999, I had synthesized many diverse avenues of thought into what I have termed “Recovery-Centered Training”, a new model of human performance.
Almost as soon as President Obama passed a rather diluted version of health care reform, there were claims of it being unconstitutional. With that said, a number of lawsuits were filed. Just this past week, a judge dismissed two of Virginia’s legal challenges to the new health care law. Apparently, at this time, health care reform is within the bounds of the Constitution. I am sure this battle will continue.
What happened when Medicare was put in place? Was it considered unconstitutional as well?
This behavior tends to be apparent when people (and lobbyists) simply don’t agree with policy and legislation. Go ahead, file a lawsuit. Place the blame on a breach of the constitution. Lawsuits have a great way of holding up the process or even preventing the law from ever seeing the light of day.
Is health care reform truly unconstitutional?
Today, I am presenting the first in a series of RunSmart videos. The series will be on-going and a new video will be released on a monthly basis. These videos will complement the material presented in the book “RunSmart: A Comprehensive Approach To Injury-Free Running”. The full series of videos can be found here.
For those of you that are interested in a more interactive learning environment, consider attending a four hour RunSmart Level One program. You can further your education with the Level Two and Level Three programs which will focus on the application of RunSmart principles to both coaching and training program development and running injury recovery.
A transcription of the video will also be available with each post.
I hope you enjoy the video series. If you would like me to address any specific aspect of the RunSmart approach, drop me an email or add a comment to this article.
We see the effect of our self image and comfort zone reflected in our behaviors on a daily basis. Our self talk becomes a significant factor in our self image. Should our self image be low, and our self talk be negative, we will also partake in self-sabotaging behaviors to maintain our comfort zone.
We are all faced with a challenge to growth. How do we effectively acknowledge our self perceptions and self image and, in doing so, consciously raise the upper limit of our comfort zone? We have the ability – or the response-ability, as Stephen Covey notes - to expand our internal locus of control if we so choose. We have the ability to refine and control our self talk, again if we so choose.
Here are three common examples of self image, self sabotage, and comfort zones in action.
Somewhere in the midst of the 100+ degree temperatures in Central Texas, runners are finding inspiration to begin the journey that is marathon training. For many, it is time to start training for the Livestrong Austin Marathon in February 2012.
Many will decide to participate in the Austin Distance Challenge, a series of 5 races that lead up to the Austin Marathon.
Sadly, the start of marathon training in Austin also means that there will be an unfortunate rise in running injuries over the course of the next 6 months. Anywhere from 60 to 90% of runners will sustain an injury while training for a marathon – depending on which studies you read. 'Tis the season to be injured, fa-la-la-la-la … la-la-la-la.
The frustrating part is that many of these injuries could be prevented. Injury does not have to be the accepted reality of marathon training. Most injuries can be directly related to poorly developed training programs. Many Austin-area training programs are no different from the accepted norm and continue to emphasize aspects of run training that increase the risk of injury - regardless of the sports medicine and science evidence to the contrary.
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.