Dinosaurs among us causing chaos and confusion

Abstract

The recent Hollywood blockbuster Jurassic World tells a story of how extinct species have returned to the present only to cause chaos and confusion. Unfortunately, this Hollywood fantasy is a reality within the world of physiotherapy with dinosaurs among us causing chaos and confusion.

The dinosaurs I am referring to are the many iconic, influential and idolised clinicians and researchers who, despite a new era in understanding pain and growing evidence of the biopsychosocial model, still stubbornly refuse to change their methods or mind-set, and continue to promote and teach outdated methods of assessment and treatment.

The dinosaurs, despite giving occasional lip service to the biopsychosocial paradigm, have no desire to support or promote it. They have vested interests in peddling snake oil treatments, and selling their courses and books that promise simple assessments and quick fixes, from realigning subluxed sacroiliac joints or twisted thoracic rings, to releasing psoas muscles or immobile kidneys.

The dinosaurs continue to worship predominantly at the altar of biomechanics and in the normalising of movement. They continue to teach the identification and correction of incomprehensibly subtle joint and muscle imbalances, …

Full text

Dinosaurs among us causing chaos
and confusion
Adam Meakins
The recent Hollywood blockbuster Jurassic
World tells a story of how extinct species
have returned to the present only to cause
chaos and confusion. Unfortunately, this
Hollywood fantasy is a reality within the
world of physiotherapy with dinosaurs
among us causing chaos and confusion.
The dinosaurs I am referring to are the
many iconic, influential and idolised clini-
cians and researchers who, despite a new
era in understanding pain and growing
evidence of the biopsychosocial model,
still stubbornly refuse to change their
methods or mind-set, and continue to
promote and teach outdated methods of
assessment and treatment.
MUCH MORE THAN BIOMECHANICS
The dinosaurs, despite giving occasional
lip service to the biopsychosocial para-
digm, have no desire to support or
promote it. They have vested interests in
peddling snake oil treatments, and selling
their courses and books that promise
simple assessments and quick fixes, from
realigning subluxed sacroiliac joints or
twisted thoracic rings, to releasing psoas
muscles or immobile kidneys.
The dinosaurs continue to worship pre-
dominantly at the altar of biomechanics
and in the normalising of movement.
They continue to teach the identification
and correction of incomprehensibly subtle
joint and muscle imbalances, in spite of
any robust evidence of reliability or valid-
ity. They continue to fail to consider the
many other non-mechanical factors that
can, and do, contribute to pain.
The dinosaurs always look to adjust and
fix so-called movement flaws and believe
this is fundamental in reducing pain in all
they see. They truly believe there is a
correct way for us all to move, they truly
believe they know what this is for every-
one and they truly believe they can, reli-
ably and at all times, identify this.
This prehistoric thinking fails to recog-
nise the growing evidence that many
common pains and pathologies correlate
poorly with biomechanics or so-called
movement flaws, and that many other
factors must be recognised.
1–5
This is not to say biomechanics is unim-
portant. Of course there are times when
biomechanics matter,
6
but just not as
many or as often as the dinosaurs would
have us believe.
CHALLENGING DINOSAURS
Dinosaurs often surround themselves with
loyal and devout followers, and command
authority from positions of almost unques-
tionable status and experience. This makes
any attempts to question or challenge
them daunting, intimidating and socially
awkward, with a fear of being seen as
inferior, or at risk of ridicule from peers.
This is perfectly understandable, as
dinosaurs do often quickly resort to their
authority with anyone who is brave
enough to challenge them. They will soon
state that, as an authority their views and
opinions carry more weight and validity
than do the views and opinions of those
who are not. This, as Carl Sagan tells us,
is baloney.
7
Those in authority have been
wrong and made mistakes in the past, and
will do so again.
In science, there are no authorities,
there are only experts. We need experts,
their role is indispensable, and the work
and effort to become an expert must be
recognised. However, it must also be
recognised that an expert is, by definition,
someone who knows more and more
about less and less.
8
Experts have a tendency to fail to see
the bigger picture. Non-experts, however,
tend to be very good at seeing the wood
for the trees, and as such can be better
placed at recognising the wider perspec-
tives and implications, such as clinical
relevance and practical utility. Being a
non-expert should not discourage the
challenging of an expert.
DISAGREEMENT IS NOT
DISRESPECTFUL
It can be challenging to confront dino-
saurs as they can also be fierce and fer-
ocious, roaming in packs, attacking, en
mass, anyone or anything that threatens
their position or status. The most
common tactic used is to change the
‘point at issue’, usually by reporting about
the tone of an opposing argument.
Dinosaurs often claim to have been
offended or insulted by the way a differ-
ing view has been presented or expressed.
They will then continue to focus the rest
of the argument on this rather than the
original point made. It is one of the main
reasons why a strong case presented by a
non-expert can lose its momentum, and
obvious logical flaws can be lost in a fog
of related but unnecessary issues.
We all have a choice of whether to be
offended or not; this choice varies from
person to person as to who or what does.
However, in any debate, being affronted
by someone’s views, opinions or com-
ments is not a counter argument.
END OF AN ERA
Dinosaurs should be extinct. However,
many are thriving because of outdated tra-
ditions that discourage challenges to
authority. Dinosaurs survive because too
many of us have a fear, a reluctance and
an apathy to not confront the old, weary
and obsolete ways.
Let me be clear, I am not saying all our
iconic, influential and idolised leaders are
dinosaurs. There are many highly experi-
enced leaders in our profession who are
fully open to suggestions, comments and
challenges, who are humble and honest,
and who do not pretend to bring com-
mandments down from on high, and it
seems that these icons do not have an
all-encompassing obsession with biomech-
anical analysis.
It is now time to end the era of the
dinosaur, and to put a stop to the chaos
and confusion they cause with their far-
fetched, poorly supported and improbable
methods. The only way this will occur is
if more of us move beyond fear and
apathy, and are prepared to question and
challenge them regularly, robustly but
respectfully.
Twitter Follow Adam Meakins at @adammeakins
Competing interests None declared.
Provenance and peer review Not commissioned;
internally peer reviewed.
To cite Meakins A. Br J Sports Med Published Online
First: [please include Day Month Year] doi:10.1136/
bjsports-2015-095282
Accepted 14 July 2015
Br J Sports Med 2015;0:1–2.
doi:10.1136/bjsports-2015-095282
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Department of Physiotherapy, Spire Bushey Hospital,
Herts, UK
Correspondence to Mr Adam Meakins, Department
of Physiotherapy, Spire Bushey Hospital, Heathbourne
Road, Bushey, Herts, UK; adammeakins@hotmail.com
Meakins A. Br J Sports Med Month 2015 Vol 0 No 0 1
Editorial
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confusion
Dinosaurs among us causing chaos and
Adam Meakins
published online August 3, 2015Br J Sports Med
http://bjsm.bmj.com/content/early/2015/08/03/bjsports-2015-095282
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