By: Joel Luedke
Evidence-based practice has been the trend in most areas related to health, wellness, performance, training and treatment, and for good reason. I'll be the first one to support how important it is have to have ideas that are being implementing with our athletes that are ground in good science and that have withstood the tests of the scientific method. Without it we would have increasing problems with false claims, more so than we already do (and there are plenty).
That being said evidence-based practice can have its set backs as well. An example I always like to use with my students is to go out and find some research on a specific injury or training method. They will find a few that support exactly what they are looking for. Then I tell them to dig a little deeper and odds are they are able to find at least a couple that say the exact opposite thing that they just found and its just as statistically different as what supported it. So what is a clinician to do?
Lets use an example for this one and then break it down.
In the world of athletic training iliotibial (IT) band injuries can not only be highly debilitating but also highly annoying as they don't seem to go away with any type of urgency. So we dive into the research. There are a couple good studies that look at hip strength and how important it is to have abductor (moving leg away from midline) strength and how this can help with biomechanics, posture and pelvic control during running and that should help prevent and rehab issues with the IT band. Great! We have it figured out and off we go to strengthen the hips.
Then we keep reading (because we are nerds and we do that type of thing) and we find a study that looks at strength of the hips and its correlation to IT band issues and it shows that in their case, it didn't work at all. Their recommendation is that it doesn't matter if you strengthen the hips or not, you'll still have the potential for IT band problems.
So what are we supposed to do.
The idea of 'clinical reasoning' comes into play. We have to stay with evidence-based practice as it is a huge cornerstone to all of the health related professions. It gives support to everything we do and validates our ideas. When we find information that is contradictory I believe this is where the 'art' of it all comes in. You have to use what you know from personal experience and observation to take in all the information you read and apply it to your knowledge base. You take what works, discard what doesn't and try it all at least twice (maybe three times if you're stubborn).
It isn't so simple as 'art' vs. 'science' and when you can find a healthy balance between the two I think that is when you really start seeing the results and benefit to everyone. Make sure you are open to both.
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