Rabbit Holes Recognizing the rabbit holes of bias
I‘ ve become fond of writing of rabbit holes . I use the concept in many of my workshop presentations , as well as on a few of my recent blog posts . For those of you who have followed my writings or teachings , you know that I speak often of the overlap between our many ways of treating and engagement with patients , both in terms of the way we hold our bodies and move our hands . If viewed from a distance , most people may not be able to discern any major differences between what all of us do for a living . Sure , some of our hands are moving / massaging while others are more still , some of us work dry while others work wet . Some of our patients are quiet and passive during a session , while others may be active , moving or allowing themselves to be moved by the therapists . But there are only so many ways to touch and most of us are touching skin , even though we feel we are reaching and impacting many different tissues , structures , and pathologies .
There is always information that seems to conflict in every line of education and within each profession and manual therapy is no different . For instance , in my profession , physical therapy , the benefits of movement are seen as universal , but movement is often co-opted by those with a movement = strengthening bias , where weakness is seen to be the reason why pain exists . That bias is reinforced by improvements in pain when their chosen form of movement ( strengthen-
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By Walt FrITZ , PT
ing ) is applied . Strength is often hindered when pain is present , as movement or resisted movement will hurt ; inhibiting the strength shown on testing and making the patient seem weak . Movement , in the form of strengthening , is then applied / dosed and pain diminishes . When the PT retests strength , the patient will typically test as stronger . The patient no longer hurts to move so there is no hindrance to movement . Movement is a very common , nearly universal asset to the reduction in pain and discomfort (“ I was stiff / painful when I first got out of bed , but after moving around a bit I felt a lot better ”). Strengthening is one form of movement , but so is walking , swimming , dancing , yoga , Pilates , etc . All are simply different rabbit holes taken to relieve pain or improve movement ability . If you were to be stuffed down one of these holes , where gains are seen in pain when applying your principles and beliefs , be it through strengthening , swimming , etc ., it gets very easy to assume that you are one of the chosen ones ; using the best form of intervention , with your biases confirmed . But peek out of your rabbit hole and see what others are doing . Chances are they are having some pretty good outcomes as well . Watch it , though , as confirmation bias tends to make us more than a bit smug . Who needs to look down other rabbit holes when we are having such good success ?
Our education , continuing education , and personal experience in the clinic will often lead us down similar rabbit holes of bias . Schooling tends to be broader in scope , with various methods used to explain pain and the effects of our interventions . Not having attended a massage program , I can only repeat stories I ’ ve been told by massage therapists I ’ ve encountered over the years , who relate that massage training varies ( often greatly ) from school to school . One school may be more neuromuscular in approach , while others may be more Swedish massage oriented . You may encounter an instructor who completed in-depth continuing education ( CE ) training after graduation and they bring this information back into their classroom , passing along the trigger point or myofascial belief system to all of you . It becomes quite easy to play off of the enthusiasm for such an instructor to believe that their chosen form of intervention is indeed superior to others . But with so many different CE choices , how can one know which , if any , are really the best ?
Fights are easily started over discussions such as this , but I am a firm believer that all manual therapy , massage , and related modalities / approaches get very good outcomes . I am saying this as a CE provider who makes a living off of teaching my version of MFR to others . I know that I should be banging the drum of superiority to all of you , but I know this to be untrue . All manual interventions tend to have outcomes that are viewed as positive . Part of this outcome comes