So I had an interesting online ‘debate’ concerning a blog by a fellow physio Tom Goom aka the running physio which can be found here… http://runningphysio.wordpress.com/2012/07/20/research-isnt-everything/
His latest piece was on a recent documentary on the BBCs panorama programme called “The truth about Sports Science” in which they looked at the lack of scientific research that some sports companys use in the advertising and marketing claims they make around sports drinks, supplements and trainers etc.
The programme highlighted how selective (or rather biased) these company’s can be with research data to help ‘sell’ their products and back the claims they make, showing them to be far fetched and sometimes just untrue, but you have to be either a child or a complete naïve fool if you don’t think that any company or brand is not going to push the limits of any research to suit their needs and to promote and make their product more attractive to sell, that’s goes for all industry’s not just sports.
For example do you really think that a cream can reverse the ageing process and fill out your wrinkles…. those company’s stretch research so far that they practically claim they have found a cure for the ageing process.
But back on point, the debate last night was over Toms blog on not taking research to literally and sometimes we need to look behind the figures and analysis, as there is, especially in the medical world, a lot of conflict and contradiction in research
For example Tom again showed in another blog how the use of Glucosamine has had only two good independent studies one says it helps prevent arthritis, the other says it doesn’t. I come across this many times, like recently when I was looking into research on Isokinetic machines for testing professional football players leg muscle strength and ratios, the same contradiction in papers can be found, some studies show they can highlight a risk of injury, others don’t, this area really needs a systematic review by the way.
So where does this contradiction leave us the poor physio with the patient looking at us expecting us to make them better and give them the advise and the guidance they need when they are injured.
Well it can leave us in a very difficult position, but simply put we have to be guided by the research, but we also have to use our common sense, for instance my last blog on glute exercises, I know the research out there shows that the side lying exercises have been found by EMG electrode studies to get a stronger contraction of the glute medius muscle than the ones I recommend, but in my experience they aren’t as practical for a runner to do, thats common sense V’s research. My preferred exercises still work the glutes just not as much as the side lying versions, most my patients prefer them over the other ones and they get results.
I am a strong advocate for evidence based practice. I regularly read as much literature as my brain can handle on all things I do in my practice and follow the best practice guidelines,
For example I have abandoned practicing acupuncture after spending my own hard earned cash and investing my own time in training in it and using it for about a year, after some extensive background reading I have found the evidence to be extremely poor and unconvincing, and combine this with my own clinical experience of using it the vast majority of my patients had no positive outcomes, now some will argue that’s due to my poor technique or my lack of skill and experience in the art of acupuncture, it isn’t, it can’t be, it’s just putting a needle in, it doesn’t take that much skill and there’s no mystic art to it at all.
On the other side I have also changed my practice around treating tendionpathy, it was claimed that using exclusively eccentric loading exercise was superior, when we now know in early stages isometrics exercises seem to be more effective and then a combination of concentric and eccentric exercises that are carefully managing the levels of tendon loading gets better results, these are examples of evidence based practice.
Now a point about the use of anecdotal cases as research, as I’m sure someone will jump on this and start another debate claiming they have witnessed this and seen that in clinics etc etc, but it’s poor evidence and I’m afraid the plural of anecdote isn’t data, instead controlled un biased study and research is needed, yes I guess anecdotes do influence research, the ideas have to come from somewhere I guess, but until the research is done we cannot make any conclusions on them.
So that’s my ‘two penneth’ on research v’s common sense, in my opinion there has to be room for both in the physio and sports injury world, I will leave you with one of my favorite quotes…
Only in god we trust, all else must provide date
Now let’s see if this stimulates another lively debate