Fending off dinosaurs…

I should be doing something more productive instead of writing this blog but yet again I find myself embroiled in another online fiasco with accusations of being rude and disrespectful due to some comments I made. Now normally I don’t even acknowledge these things, but as a rather large and influential group of physios have decided to band together and have a pop at my character I feel the need to defend my corner and explain a few things more.

 

I recognise and accept that complaints and objections about m views and opinions are to be expected, and I don’t have an issue with most of them. Strong views will attract strong opinions in return, and I enjoy most of thr debates and discussions these bring. However, I get tired of some people taking offense at how I have expressed my views. Many use this as an excuse to complain or to make ‘official complaints’ in an effort to discredit or shame me into shutting up!

This will never happen!

The latest so called offensive thing I have said is that I think there are many ‘dinosaurs’ holding our profession back and that our profession will only truly progress when they have ‘fossilized’. To put this into context I said this to express my frustrations and feelings about a particular article I just read and I did purposely avoid mentioning names. However, some one asked what prompted this comment and so I shared the article which was an interview with Shirley Sahrmann that you can read here.

Now Shirley Sahrmann is a very well known and very well respected physio, with many advocates, and I do think she has done a lot to help our profession in the past. However I found her thoughts in this interview as well as other recent papers and books to be grossly flawed and inconsistent with the current evidence and lacking in an understanding of the recent advances in pain science. This is what lead me to express my views on dinosaurs. 

But this wasn’t a knee jerk reaction. I often see and hear the many other iconic therapy gurus, such as Sahrmann, Mulligan, Myers, Gray, Lee (both of them) Starret, etc promoting their overly complicated and inaccurate ideas and methods of assessment, treatment, and management, and yet they often go unchallenged and seem to be unquestionable. This annoys me. As I said at the start if you have strong views and opinions about stuff, be prepared to have others disagree with you strongly. Even if you are a well respected figure!

Controversial

But it appears my opinions are too offensive for some, and they riled a few of the Sahrmann disciples to take action. So I now find myself fending off their rebukes, rebuttals, and ad homs left, right and centre, due to complaints about my tone and language and not about the flawed article or out dated thinking. The point in issue has been lost as often happens.

This complaint was sent to me publicly via Twitter by a so called ‘progressive’ physio company called ‘Pure Sports Medicine’ and it was counter signed by over 20 other physios who all wanted to express their disdain at my comments. In this letter, they express their offence and try to shame me for the way I have expressed my views. See here for their letter and here for my reply.

But I suspect this is not really about offence. This is more about hierarchy, appeals to authority, and good old fashioned ‘who the hell do you think you are’I would also like to point on that ALL who have signed this letter have at some time or other crossed metaphorical swords with me before, and we all have at sometime or other disagreed in the past about something or other, usually the role of biomechanics or bloody manual therapy.

Now let me be clear, by calling someone a dinosaur I am not actually comparing them to a dinosaur, it is a metaphor to describe someone of out dated thinking and reasoning. By calling someone a dinosaur I accuse them of appealing to authority or even antiquity. I accuse them of failing to recognize others views, thinking they are always right, thinking that they are on top of the food chain, and too high and mighty to see alternative explanations, views, or opinions.

So if I call you a dinosaur let me be clear by saying I think you are stuck in the past stubbornly refusing to accept things have moved on. By calling you a dinosaur I think you believe your way is the only way, and that you don’t like to be challenged or questioned by anyone. By calling you dinosaur, I think you like to attack others who threaten your views and opinions rather than defend them following the rules of logical scientific debate. By calling you a dinosaur I see the lip service you give to the past decade of modern pain science, yet still worship at the alter of biomedical reasoning and biomechanics.

By calling you a dinosaur I am asking you to evolve, or become extinct… or fossilise!

Despite talking the talk, dinosaurs don’t walk the walk.

Dinosaurs believe they are immune from questioning or criticism, and many are placed high on pedestals by their disciples, due to their status, reputation and past work and they also believe that no one should question them, and are quick to attack those that do. But no one is immune from criticism, you, me, them. In fact, I think those who teach, write, publish, or even blog should be critically criticised more, including me. Simply put, if you are bold and brave enough to give your opinions and views, you should also be bold and brave enough to have others question and disagree with them.

Despite saying otherwise many dinosaurs place the task of identifying and correcting posture, structure, and imbalances as THE priority in the management of painful conditions. They focus on fixing so called movement flaws, and they truly believe that there is a correct way to move, and that they know what this is. This is not to say biomechanics are irrelevant or not important. That’s a false dichotomy, and another infuriating logical fallacy I often get accused of. Of course there are times when biomechanics matter, but just not as much or as often as believed by the dinosaurs!

Unfortunately the logical fallacy of appealing to authority is often used when a dinosaur is questioned. It is a belief that we should all know our place and that some are simply right because they are in positions of authority. This is simply ridiculous. Those in authority have made mistakes in the past, and they will do so again. When did having a position of authority, or title such as a PhD or Professor automatically make you correct all the time? Of course we should acknowledge and respect the work and effort used to achieve these qualifications. But they are, at the end of the day just qualifications.

It is worth remembering that the more qualified you become, the narrower your field of vision gets, as beautifully demonstrated in the picture below. A dinosaur tends to know a lot, in fact they tend to know more and more, but unfortunately about less and less.

More concerning is how the dinosaurs and their followers attempt to restrict others right to express their views and opinions against them. This is almost censorship and this is what really annoys me the most.

The right to express a view and an opinion is a basic human right, many have fought long and hard and even died for this right. Ok so disagreements over physiotherapy is not on par with those fighting oppression, corruptness or imperialism, but the same rights exist for all. This means we are all able to express our views how we like, and where we like, it also allows us to be direct, controversial, blunt, even abrasive and annoying if we choose too be. This may seem unfair but that’s life, it’s unfair, deal with it.

Good.

So in my opinion the recent outrage about my so called disrespectful behavior is nothing more than an attempt to shut me up by those in supposed authority. And basically in a nutshell they want me to ‘wind my neck in’ because I challenge them and their opinions and I tend to rock their boats often. If I make them or you feel uncomfortable, good, maybe you should ask yourself why. Is it really my ‘tone’ or ‘disrespect’? Or is it that you just don’t like to be challenged, and that your position and premise is beginning too look shaky.

There is also a suggestion that I have some ‘great responsibility’ or duty to curb and restrain my thoughts due to some ‘pseudo popularity’ on social media. This also annoys me greatly. Lets be honest, the only reason I have some ‘pseudo popularity’ on social media, is because I tend to ask the difficult, awkward questions to these dinosaurs, gurus and authority figures that no one else does (yet many want to). Lets also remember that being popular on social media means very, very little. It’s like owning a lot of property in a game of monopoly!

Finally I am not forcing anyone to read my blogs or follow my twitter activity. Remember you have a choice what you read, and it does still amaze me how many people get upset and annoyed at things they CHOOSE to read. 

 

Cheers

Adam

31 thoughts on “Fending off dinosaurs…

  1. Keep up the good work, you have expanded my knowledge but am not am not guru worshipping either. We need different opinions and should respect other views but be able to challenge them, and perhaps more importantly be challenged ourselves.

  2. Every industry needs a bit of critique as it brings out the truth, hinders the quacks and drives progression. Without knowing this kerfuffle was going on, I was only thinking today how reviving your unmuzzled views are to physiotherapy!

    Very helpful to students, essential to professionals and practitioners. Please keep your pyroclastic opinions public, and thanks for all the effort put in your blog posts.

    Jason

  3. Hi Adam

    I’ve been ‘lurking’ on Twitter for some time and thoroughly enjoy your contributions to our profession! It’s not been until reading tonight’s feed though that I’ve felt compelled to contribute. The notion of you as some kind of physiotherapeutic heretic is absurd and only lends support to the argument of how flawed the physiotherapy establishment is. Why would anyone wish to repress scientific debate and discussion with ‘ground rules’ and censorship? Every opinion is valid, and every question helps to further our understanding.

    I, probably like you, have sat through enough days of kinetic control courses to earn the right to have an opinion on it, and mine isnt great. People on Twitter seem to be suggesting though that it’s the same as getting your kids to eat new things……….they can’t say they don’t like it until they’ve tried it themselves. And as such you shouldn’t be warping the fragile minds of the more junior, and many senior, members of our profession with your influence and criticism of the likes of Shirley Sahrmann, let them make their own minds up.It’s absolute rubbish. Critical analysis within our profession is something that has been sadly lacking for too long. Keep up the good work. If only the CSP could focus a bit more on issues like pay freezes they’d find they didn’t have to worry so much about social media…….cos we’d all be out enjoying ourselves rather than looking at Twitter all night!! Hope to continue this at BESS. Cheers.

    Joe

    • Hi Joe

      Thanks for your comments, and I will look forward to talking more at BESS

      I also come across the same excuses you mention often. The frustrating thinking that all physios have to try the known dubious or even disproven assessment or treatment techniques even though evidence doesn’t support them, SIJ Ax being the most common example. This is as you say, almost seen as a traditional right of passage, and is complete nonsense. How can we as a profession move forward if we are consistently doing what we have always done and teaching what we have always taught to the new generation.

      The other excuse I here a lot is you cant knock it until you’ve tried it, which again is nonsense. If a technique or method has no plausibility in any sound robust science or even good old common sense then I dont need to try it.

      Thanks again

      Adam

  4. Wow, talk about panties in a knot! A lot of this unwillingness to consider stopping doing things that are untenable, half baked, silly and just stupid is very well described in this book: Mistakes Were Made (But Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts. I highly recommend it.

  5. Ah, Adam… You do make me laugh! Surely you ought to expect this kind of backlash; what else is going to happen when you rattle the cage? I’d have hoped this is exactly the sort of response you’d have wanted!

    Still, letters after your name or not, as Mr Thacker suggests, balanced critiques are much more profitable. How’s your balance working, mate? ;0)

  6. I just graduated last year from DPT school, you have influenced my thinking more than anyone aside from my favorite professor that held many of your views. We have since had a few beers and he kept his comments to himself out of respect for his colleagues who are forced to teach this dogma do be accredited.Thank you and all that you do.

  7. I first saw the article that generated your comments elsewhere on Twitter. It was referred to as a “fantasy piece” requiring more “dragons and heroines” as well as being full of “howlers.” Interestingly enough no similar public backlash seems to have been directed there. Perhaps balance needs to be found but not by failing to question ideas we should have moved past. “Good behaviour” seldom changes things for the better. Carry on, Sir.

  8. Adam,
    I admire the honesty and lateral thinking you bring to the stereotypical growth curve the profession has accepted as norm and this article and the graphic is an excellent pointer too. I deeply admire physicians, surgeons and physiotherapists who have no agenda and stay true to their guts and act on it without fear. I did post a couple of pics on twitter yesterday and tagged you into it (Dr. Ben Kibler and Dr. Mary Magarey) and in the words and stands of these colleagues- I was pleasantly surprised that although they achieved a doctoral worldview of the shoulder from 30 years of work they yet kept their hearts focused and minds open to an entirely new view on the scapula. I wish we had many more of this rare breed.

    • Thanks for the comments Simon, and yes its a rare breed indeed thst can dedicate some much time and effort in one direction only to realise that you need to change direction, i have utmost respect for anyone who can do that

      But it must be remember the fundemental rule of all science is, trying to prove yourself wrong, and not to get fooled along the way. Its a shame many see to forget these bascis!

      Thanks again

  9. Hi Adam,

    Keep fending them off mate. I wouldn’t worry about finding your balance. I think you have the right balance.

    I have read that article in question now and think the words “dinosaur” and “fossil” are quite polite given the nonsense written.

    I found the the following article in 2013, on 25 years of the Biopsychosocial Model, sadly enlightening:

    http://www.ncbi.nlm.nih.gov/pubmed/23970112

    Conclusion being: “The utility of the biopsychosocial framework cannot be fully assessed until we truly adopt and apply it in research and clinical practice”.

    25 years of the BSP model and it still hasn’t been truly adopted. Too many researchers and clinicians stuck in the dogmatic biomedical and biomechanical models refusing to move on. Far too many vested interests.

    I would use the term “dinosaur” but I don’t want to get a nasty letter……

    Cheers
    Gibbo

  10. Great blog Adam. I have not attended a physio course for 5 years due to these gurus and their disciples. Too many charlatans with their mechanically calibrated hands and high-tech imaging eyes for my liking. I decided to do post-grad studies in sports medicine and pain management instead as i feel these areas are at least moving forward instead of being locked in the jurassic period. Keep up the good work.

    • Thanks Gerard for the find comments, I am really flattered and humbled at the amount of messages of support and encourgement I have received, it does make all the aggro and BS worth it! Thanks!

  11. I didn’t actually see the big quarrel (I was actually watching Jurassic World…) but I don’t get why people get so pissed off with some one voicing their genuine concerns. Concerns which in my opinion are well founded.

    Recently I had a debate with a colleague regarding pain and how things have moved on so much. The debate ran and ran until my colleague said ‘you’re very sure about what you say, what happens if the evidence changes?’ And a look of *Ha, I’ve got you now you know it all tit…* I simply replied ‘I would change…’

    To me that’s simple, it’s logical. But my comment was met with confusion and annoyance. I used to worry that evidence was too hard to follow because of accessibility, I’m now worried it’s hard because change is too hard to make it worth while.

  12. Adam,

    I applaud you for pointing out the flawed thinking in the PT profession.

    “If you make people think they’re thinking, they’ll love you; but if you really make them think, they’ll hate you.” Don Marquis

    Evan Burke, DPT

  13. Well as a Canadian trained Physiotherapist, I am certainly not surprised to see Diane Lee pen her name to that bizarre letter.

    By and large, Canadian Physiotherapists appear to be among the worst at holding near and dear antiquated patho-anatomical models of assessment and treatment. It’s almost laughable some of the post graduate manuals I have perused in recent years. It sure does make me wonder about the quality of new graduates who seem unable to critically analyze even in the slightest because if they could…many Canadian post graduate courses would drown in a pool of laughter.

    Anyway Adam, water off a ducks back my friend. Carry on…appeals to authority have no place in scientific inquiry. Shame on them.

  14. At the tender age of 56.and still a dedicated sports person I have been on the receiving end of some dreadful physio. Your attitude and approach are like a beacon to me. Keep pushing the boundaries – you are an essential component to change 😊

  15. I laughed so hard at that letter from Pure Sports medicine that I nearly pulled a deep neck flexor. I then looked at the names who agreed and signed it petition like….. I seriously have put my 5th rib out.
    I attended a shoulder course with an acclaimed international shoulder specialist who did nothing but criticise/slag off a lot of other researchers and professionals….. Pot kettle and black come to mind.

    • Hi, I need some advice please.  No problem if you can’t. I am 57 yrs old and have been in various sports from karate at international level and body building (at failure level – didn’t do steroids). I now do competitive indoor rowing and came 5th in the world in my age group. As you would expect I have collected a number of chronic and minor physical issues over the years. Physio support has been pretty poor (lots of smoke and mirrors). I have learnt a lot in my 40 years of sport! Hence my attraction to your blog. I am getting ready for the British Championships in Dec an need some assistance. I am based in Preston Lands – do you recommend? Apologies for the long email. Best regards Philip 😊

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