Tuesday, November 24, 2015

Well, it worked for me. - No, it didn't.

This showed up again on Facebook recently. The idea that because somebody thinks something worked it must have. It's a common misunderstanding and it is caused by the limitations of human brains.

This particular story was a response to someone posting on the HEMA Alliance page about their impending knee surgery. And it's ensuing rehabilitation needs.

The first response was, "see a doctor". This response wins.

Many people encouraged the OP to get physical therapy. And more importantly to find a PT who has experience with vigorous athletes. After all, most PT is sedentary folks, so they just don't have as many opportunities to work with folks like us.

Then somebody else said, try "tui na". I'd seen the term before, but I had to look it up. It's a traditional Chinese medicine practice (TCM) involving manipulation and massage.

There is nothing wrong with manipulation or massage in and of themselves. They have been covered in my PT program so far. However, because it is TCM these treatments are not guided by the physical reality of what's inside a human body. They are instead guided by unsubstantiated beliefs about structures and energy that have never been shown to exist.

Furthermore, the TCM process for determining what manipulation and massage is necessary are not based on the reality of human physiological processes. I know how manipulation works because I've dissected a human cadaver. And because others have done so for five centuries accumulating knowledge of all the details. TCM does not have this information.

But It Worked for Him

I understand why he thinks this. But the mere fact that he got better does not prove that he got better because of the Tui Na.

The poster describes having undertaken both PT and tui na. And I'll assume that he also rested. So his rehabilitation plan looks like this:
  1. Rest
  2. Physical Therapy
  3. Tui Na
We know, from extensive research and experience, that the first two are sufficient. He didn't need to do anything else to get better. The most parsimonious explanation of his improvement is that he undertook the first two items and so he got better. And that the tui na was simply not relevant.

But this is typical. This person undertook both a medical treatment and an alternative treatment and he credits his improvement to the alternative treatment. Instead of acknowledging the way that PT addressed his rehab needs

Of course, when you've paid money for the treatment and taken time out of your life to get it done, you have a subconscious drive to believe that you didn't waste your time and money. The human brain is incredibly good at rationalization. And that's the better explanation for this person's personal experience.

I'm not saying this person didn't experience what they experienced. I want them to understand which narrative explains their experiences best. We all have our own narratives that we use to interpret the world. But our narratives are not reliable.

It is imperative for humans to acknowledge the limitations and illusions of our mind. Daniel Simons extensively documents this in the book, "The Invisible Gorilla." If you know what that title means then you should already understand this phenomenon a bit. But if you don't know what the title means then watch this video, it's only 1:21 minutes.

I'll repeat something I've said before: I'm not claiming to have a better brain then other people. I suffer from the same illusions and cognitive difficulties as everyone else. Instead, the difference is that I work hard to have "neurocognitive humility" as Steven Novella puts it. I don't have a different brain, I engage in specific behaviors intended to address the known limitations.

And I'm sure I fail at it sometimes.

What's the Harm

Of course, the follow-up question is, "what's the harm?" So what if the tui na did not do anything? Well, the list of harms from these kinds of pseudo-scientific or not at all scientific medical treatments include:
  1. Wasted money - this is real harm, especially for those who struggle to pay for healthcare and since these treatments are usually not covered by insurance (with good reason).
  2. Wasted time - which can also be money lost if a person takes time off from their job for the treatment.
  3. False hope - if a person thinks that an alternative treatment will help and it does not then that is harm.
  4. Delayed treatment - if a person delays getting effective treatment because they undertook an ineffective treatment first then that is harm - a longer period of disability. And it increases the likelihood that the problem cannot be fixed or fixed fully.
  5. Additional, unnecessary and ineffective treatment - it is often the case that pseudo-medicine practitioners fancy themselves as general practitioners able to diagnose all sorts of problems besides the one you came in for. Many of which are just made up. Then they sell you supplements (that they profit from), order tests that are unnecessary (that they profit from) and recommend treatment that does nothing (that they profit from).
  6. The treatment may be harmful - unlike with medicine the alternative medicine field is essentially unregulated and so even harmful treatments are able to proliferate.

Generalizing this Post

This is a bit of a rant. So what does it have to do with strength and conditioning training? Don't believe in fad exercise programs. Don't believe in fad recovery methods. Don't believe in "ancient wisdom" until it has been studied.

Don't believe yourself.

Acknowledge that your own experiences may not accurately represent reality. That your conclusions may be based on the common illusions of the human brain.

The basics of both exercise and injury treatment and recovery are well understood and good results are reliable with these basic approaches. This may seem boring. And it is, but it also works.

So do it.

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