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1st Sep

2018

Progress in Rehabilitation and Sports Injury Prevention Enhanced by Unbiased Scientific Thinking

Over the past 30-40 years, we have seen significant progress in health care, including rehabilitation and preventive care. We have learned that to recover faster and better after injury and surgery, early activation and start of rehabilitation is better than bed rest ( which e.g. was the norm 35 years ago after a bout with acute back pain) and prolonged immobilization in a cast (e.g. typical protocol after ACL reconstruction 35 years ago).

Advancements in surgical techniques and technology as well as improved understanding of optimal tissue healing and stimulation, have led to quicker and better recovery of function, and fewer post-operative complications and infections. A wealth of research has resulted in more effective rehabilitation programs, enhanced by improved understanding of the impact of cultural and socioeconomic factors, and the mind-body connection, as well as nutritional science.

This has allowed us to return faster to daily activities, work, and sports participation, while suffering less pain and other difficulties along the way.

In sports injury prevention, programs such as the teaching tool Heads Up Football has significantly decreased high school football injuries, and concussion protocols in sports such as football, hockey and soccer, have greatly reduced the number and severity of head injuries, although the number is still too high.

Many problems still exist, of course, including the large number of people suffering from chronic pain, and in particular chronic back pain, which has contributed to the current opiod epidemic and resulting high number of tragic deaths.

In health care, just as in life in general, science plays a vital role in our continued progress. Science by nature, is forward looking and always strives to look for better solutions, while testing itself to prove its accuracy.

This has led to evidence-based medicine and health care, replacing many old methods taught by so called experts or gurus, which have been shown to be ineffective or even harmful.

However, this can also have its downside, as it, in order to be made more useful to the masses of clinicians, often gets packaged as predetermined protocols or algorithms, to apply in diagnostics and treatment.

This does not have to be a problem by itself, but can actually be very useful, as long as the clinician uses it with scientific thinking and reasoning, i.e. by continuing to question its accuracy and appropriateness for each patient in a given situation, by considering both the best evidence to date and his or her own clinical experience. This requires a combination of continuous curiosity and modesty, with the realization that we don’t have all the answers yet.

A clinician who claims to always have the right answer (especially if it’s one that the patient wants to hear) may at first attract many patients, however this is not in the best interest of our patients. Unless we stop and question ourselves, and consider different sides to a problem or solution, we will not contribute to progress, and best serve each patient.

This process of relying on accepted high quality scientific findings (i.e. accepted by the scientific community) with an unbiased mindset (or at least an awareness of our own bias), even if it goes against what we have previously believed to be true, or what our “sub-cultures” in life (or groups we identify with) think is true, is as important for future progress in health care, as it is in life in general. Certainly, it could be adhered to more in politics, in today’s partisanship and resurgent national populism movement.

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