published 2/14/09
Never, Ever Trust “Common Sense”!
The fallibility of seemingly sensible ideas about physical therapy
by Paul Ingraham, Vancouver, Canada MOREclose
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
There are a hundred ways that an idea can seem reasonable even when it’s dead wrong.
Recently the Lancet published a new paper showing that common practices in the treatment of severe ankle sprains are misguided — they should be put in a cast and given a chance to stabilize, rather than rushed back into action as quickly as possible. Getting people to use injured body parts as soon as possible is an important concept in rehabilitation, but it’s not a license to force injured body parts to function before they are ready for it. This new experiment clearly shows that the widely practiced method of minimal bracing simply doesn’t work.
“This elegant study highlights the need for trials to address common problems,” the editors commented. In other words, we need to test all assumptions.
We need scientific experiments to test anything notion that we think is obvious or common sensical — they are as likely to be wrong as any other idea, maybe more. In my professional experience since 1997, physical therapy is rife with “common sense” that is either dubious or already mostly disproven. What seems like common sense is usually fashion and dogma and assumptions based on inadequate evidence.
Even when there is good evidence proving that the conventional wisdom is wrong … the conventional wisdom will still persist for years or even decades.
Calling for a little humility in health care is hardly original. But I think professionals need to go farther than a little humility. I think we need to get really comfortable — really, really comfortable — with saying “I don’t know” about practically everything. Contrary to what we’d all like to believe, the physical therapies are still pretty primitive. After all, we’re still just finding out how to treat an ankle sprain! How long do you think it’s going to take for every doctor and physiotherapist to find out about this research and apply it?
Meanwhile, how many millions of people will be told that it is “common sense” to get that sprained ankle working again as fast as possible?
I don’t know!