Hauntological Corrective Exercise: A Critique of Physical Therapy

If I have to out-advertise you, I will lose. If I need to pay you to listen to reason, I can tell you I don’t have money, but what I do have are a very particular set of skills. Skills I have acquired over a long career of mistakes. Skills that make me seem extremely arrogant in text but also make my ideas entertaining to read. If you let your delusions go now that will be the end of it. I will not say you are too stupid to insult and I will stop yelling at you on the Internet. If you fail to let these delusions go, I will look for you, I will find you, and I will teach you how to deadlift (and force you to admit that your practice is a sham).

SUMMER 2019 – COMING TO THEATERS ACROSS THE GLOBE –

MAX BLOCHOWIAK STARS IN, TOOKEN.

Much to our dismay, we do not choose our interests. We either ignore them, pretend they are what they are not, or follow them down the rabbit hole. For me, philosophy was one of those pulls. This is probably because it is the most immediate way to satisfy curiosity, as one only needs time alone and a place to sit down. The Reader might be thinking “well so but Max, curiosity killed the cat.” Look, on a long enough timeline cats will die from every possible cause. The cat has to choose one way or another, and as far as cats go, good riddance.

Anyway, I started reading philosophy when I was in my teens and found more questions than answers. I always had an affinity for Nietzsche, as do most young philosophizers, but I, like the others, am not like the others. I started at the beginning with the Greeks, tolerated Descartes, waded through some Kant, tried a little Hegel on for size, fell into a postmodern pit with Baudrillard, and eventually circled back around to Seneca. I’ve wanted to re-read Simulacra & Simulation for some time because I suspect that I’d understand it much better now, but I seem to be unable to force myself to pick it up. I believe this is because of a realization I had: that it’s possible to read for hours while gaining nothing but lost time. Truly, it is possible to comb over hundreds of pages of text to (maybe) understand one single point that probably will not have an influence on the Reader in the Real World.

Although their writings often seem esoteric and wasteful, these hyper-intelligent men are rivaled by nobody in their ability to put the Reader through fantastical thought experiments, often ones that make the Reader question their grip on Reality. The beginning of this article will act as a thought experiment, then it will dip into my critique of physical therapy in theory, the implications of it as a practice will be laid out, and then I will bring it all together.

Writing helps me digest the ideas I’ve been mulling over and this post has completely transformed since I began. As usual, I am just following my fingers while they smash the keys. The thesis of this article will be an attempt to use one of these seemingly arcane philosophical ideas as a vessel through which we may be able to better understand rehabilitation theories/practices. Essentially, a chance for me to wax philosophical and get creative with the meaningless jargon in my head.

A fascinating implication of postmodernism is hauntology, which is a mixture of haunt and ontology, i.e. the study of being.

Jacques Derrida liked to talk about the present as being inexorably tied up with the past and future. The present is never simply this moment, but an amalgam of the three. Sorry, Eckhart Readers, but The Now is partly an illusion. Music would not work without this law. At any given point in a symphony, we are hearing only the note(s) being played in that instant. Although, we carry into that instant the prior notes and as that instant quickly dissolves into the past it is used as fodder for the notes that are yet to be played, and we sort of project them into what we expect to follow. This is probably why most jazz sucks, but I digress.

If we didn’t have this innate characteristic of continuous fusion music would sound fractured. More likely, the concept of music would have never been constructed because melody would be alien to our species. If all we heard from a guitar rhythm were individual notes, the guitar would have never been made. The Dionysian nature in all of us would not exist were it not for Derrida’s ontological insight. The current moment devoid of the past and future is utterly impossible to imagine because our entire experience of Being is an intermingling of all three phases.

Our existence, then, is haunted. The present moment is always partially a ghost of the past that no longer exists and the blurry image of conjecture. The question then becomes, how much of our existence is abstraction and how much is real? This is how I’ve come to view the phenomenon known as pain. If pain is a purely electrical defense signal sent down from the brain that does not have to be pinned down with a musculoskeletal abnormality, how much of it is real? Certainly, it has to be real when a snake sinks its fangs into the Poor Reader’s ankle. What if, later, we are brushed on the ankle in the same spot by a twig and a jolt of pain shoots into our leg because our brain thought it was another snake? That’s what happened to Lorimer Moseley, Ph.D. [13].

Was his pain real if he had not actually been bitten by a snake this second time around? Perhaps real isn’t the best word since the sensation feels as real as any other. Was Moseley’s pain accurate? Or, at least, how much of it was accurate and what percentage was an apparition projected by his brain? If a certain pain symptom is completely fabricated and “all in our head,” how can we call it real or measure its existence? If two people have the same musculoskeletal abnormality and it causes pain in one but not the other, what is that pain? Or rather, what is the lack of pain in the other? Moreover, if two people have the same musculoskeletal abnormality – both have pain – and the same healing intervention is applied to both but one’s pain goes away and the other’s does not, what is the purpose of that leftover pain? Is it accurate if the tissues are healed? What is its purpose if it is not actually protecting us from danger? Why is it so unreliable? Am I ever going to stop asking the Reader questions?

Nope. What do we think of pain in a phantom limb, one that has been amputated or lost catastrophically? Or a rubber limb that is merely perceived as our own? That pain is obviously inaccurate, so why does it persist?

The Writer’s (really truly very humble) opinion is that pain is an exceptionally confusing phenomenon that we are only beginning to understand. Adding to the uncertainty, what are we to do with this study [11] of 350 Italian Air Force cadets? They were all 18-22 years old and asymptomatic when they underwent MRIs, but 270 (77 percent) showed spinal findings, meaning only 23 percent of these young adults “passed” their MRI. A whopping 30 percent (106/350) of the subjects had at least one disc desiccation, i.e. extreme dryness, and 13 percent (47/350) presented at least one disc narrowing. At least one bulging disc was found in a staggering 49 percent (176/350) of cadets, 18 percent (62/350) of subjects showed disc protrusion while eight percent (28/350) had disc extrusion. How can we interpret the fact that almost half of 350 young adults had bulging discs but not a single one was symptomatic?

Seriously think about this, why do they not feel any pain? Don’t give me the “they’re just whippersnappers” cop-out because we all know people who’ve had back pain in their teens. What, more generally, are symptoms if they don’t occur reliably from musculoskeletal abnormalities, just intermittent sensations? Do we need to modify our definitions of normal if all of these young adults are failing MRIs so miserably? What does a diagnosis provide if the patient has no pain or symptoms of any kind and is in good enough shape to make their way through the Italian Air Force?

A study [4] from 2017 took a 63-year-old woman to 10 different testing centers in order to see the variation of diagnoses for her history of low back pain and L5 radicular symptoms. Across all 10 tests, there were 49 findings of distinct pathological presence. However, not a single one was present in all 10 tests, only one was reported in nine of the tests, and 32.7 percent (16/49) of the pathologies were only found once. The sensitivity, or the true-positive rate wherein a positive is accurately diagnosed as such, was 56.4% ± 11.7%.

On one hand, we can become quite pessimistic about the capacities of our radiologists and their tools, but on the other hand we can become quite dubious of what it means to be diagnosed. Our Pain Sufferer has radicular symptoms, usually an indicator of Oh No, Something Has Gone Terribly Wrong, and each doctor is quite sure it is ____. But what does the confidence of each doctor mean to us, the Objective Outsiders who can see that they all found, for the most part, different pathologies? Is it a problem of interpretation or measurement error in our state-of-the-art tools? A combination of the two? What does this mean for the Pain Sufferer? If she has pain and radicular symptoms but The Doctors can’t figure out exactly what is wrong with her, what is actually wrong with her? Contrast her case with the Italian Air Force cadets from the previous study who had root causes but were asymptomatic.

I am not implying that there is absolutely nothing wrong with her and this old bat is out of her gourd, but I am asking what it means to be diagnosed with a particular ailment given the range in what could possibly be the cause. Only one pathology showed in 9/10 tests, and if we are under the impression that pain and radicular symptoms are purely mechanistic phenomena, we would see one or more pathologies show up in all 10 tests with a much smaller margin of error. True black and white are on the opposite ends of a spectrum, but an infinite array of grey exists between.

The smartest, most credentialed and experienced doctors can and will err, and they will do this even with the best tools we have available. If this is the case, how willingly should we accept the interpretation of the doctoral majority, the ones who lie between the 30th and 80th percentile? Furthermore, and perhaps more importantly, what do we do about incompetent medical/health professionals – especially ones who do not even attempt to use objective criteria – who are under the impression they know that which they do not know?

I do believe in the abilities of competent medical professionals to accurately diagnose disease and illness in the body, but it always has been and always will be an applied science learning on the go. The average practice is much improved over the days of bloodletting, lobotomies, and giving crying babies heroin, but it would do the Reader good to foster a skepticism of The Authorities. This is especially important now that there is an unfathomable amount of money involved in our “healthcare” companies [19] and bonuses, kickbacks, and/or commissions somehow find their way to The Authorities. The rest of this article will be a bit more down to Earth than Derrida’s teachings, but we will combine the pragmatic with the obscure in our conclusion. I can’t make it too easy on my Dear Reader.

Theoretically Speaking

Early in one’s biological/kinesiological education, he learns about supercompensation theory. An individual trains, recovers, and supercompensates to a performance level that is greater than it was before the training. A more general but less theoretical idea is the Stress, Recovery, and Adaptation (SRA) cycle that is constantly occurring whether an individual is training or not. A stressor is anything that diminishes performance in an arbitrary time interval, short, medium, or long-term. A period of recovery follows, and the individual is now adapted to the prior stressor.

SRA cycle.png

From Starting Strength

If desired, the Reader can find an image of the supercompensation model on the Internet in under a minute, but the differences between it and the SRA cycle are subtle. The SRA cycle shows us a new baseline, a new homeostatic norm that is created during a specific cycle of training stress. It is not based purely on a nebulous performance but on the stress we place on the body and our new level of homeostasis.

An excellent article has already been written [14] about this phenomenon and the Grey Book [18] covers it in great depth, so I will operate from the standpoint that the Reader has already done their homework. Quickly: a set of biceps curls is a stressor that diminishes one’s ability to perform contractions of the biceps, which is why we can’t continue performing biceps curls for several consecutive hours or on through eternity. We need to recover, even if it’s just for a couple minutes or so, in order to execute another set similar to the first. Then, we need time for the biceps to recover from the total stress they underwent during the training session. The best teaching method for instilling the truth of the SRA cycle is going through the Novice Linear Progression [20].

Transgression of the Law

When combined together, we have been conditioned to think of the two words physical and therapy as a demarcation of a specific profession. I once heard somebody explain language as the scaffolding of thought. This is an excellent way to put it because without language our thoughts would be feral images bouncing around our skulls. Hopefully, this article can act as a way to help the Reader and me better understand the previous and upcoming thoughts. Moreover, I believe sloppy thought leads to sloppy language and sloppy language leads to sloppy thought, so let me try to dig into this with some diligence.

Alone, therapy means the relief or cure of a disorder, and physical is relating to the material substrate of the homo sapiens. We could argue the semantics of the words inside of those definitions, but I am making much broader points in what’s to come. We can see a problem already: the name of the profession implies the necessary existence of a disorder, without such they are superfluous.

The various forms of physical/occupational therapists and exercise physiologists, people I like to call Occupational Activators, are the type of folks who can name all 650 muscles of the human body but don’t seem to understand the SRA cycle in the slightest. Many trainers who regularly vomit the word functional pitch a dumbed-down version of the common Occupational Activator practice as well. We shall call them Functional Proselytizers. In addition to these folks there are chiros, massage therapists, athletic trainers, coaches, athletes and many more who peddle similar dogma. It’s everywhere.

Their overarching narrative: every person is tremendously fragile and we have to make sure the client can perform [bizarre, arbitrary test] or display [arbitrary degrees of ROM] in [specific joint] before we can even think about allowing the client to perform [compound movement] with an external resistance.

I’m going to walk the Reader through the logical progression that an Occupational Activator/Functional Proselytizer/et cetera would go through with the average client. Somebody comes in complaining of knee pain with intermittent hip and back pain. I’m sure the Reader has never experienced any of those issues. His training history is yada, yada, yada and he is a milquetoast accountant who makes a lot more money than me. The OA has him perform some slow, bodyweight squats with little to no direction in order to see how the client has been moving on his own. Shockingly, they see an ugly squat with poor mechanics and several Red Flags.

One well-known physio, I won’t name him but the Reader might know exactly who I’m talking about, popularized the idea that the “big” joints of the body split roughly into stable or mobile categories. The foot needs to be stable, ankle mobile, knee stable, hip mobile, lumbar spine stable, thoracic spine mobile, scapula stable, shoulder mobile, elbow stable, wrist mobile, hand stable. This is a simplified version of his version of simplification, but it’s the meat and potatoes of what he preaches. Most OAs explicitly or implicitly follow a methodology close to this.

So, our accountant has poor squat mechanics (probably because the OA hasn’t taught him anything). The arch of his foot is collapsing and that’s creating a poor working environment for the ankle, hampering the individual’s ability to dorsiflex without hitch. Because the ankle is unstable, his knee tends to wobble laterally throughout the movement, which is not something a hinge joint wants. This creates a need for his hip to attempt stabilization of his femur/knee, not allowing it to be the mobile working environment for which it is designed. The lumbar spine isn’t as sound and stable as it should be because of the hip movement, causing some loss of integrity. This can continue on up through the chain. This is cause for celebration (found the problems) and chastisement (the accountant is the biggest problem).

The physio can now tell the accountant every single thing I noted about the joint instability/immobility quagmires and make him terribly aware of how horrific his movement patterns are and how much risk he’s placing on his body throughout his various ranges of motion. Usually, an OA will inform the client that these movement errors will cause this pain or that injury if not addressed, or they are the cause of the current pain/injury the accountant is, I mean has.

After the tiniest bit of extrapolation, if the accountant is so inclined, he will be able to see how this affects every movement he makes during every waking moment of every single day. All he has to do is be totally and completely present in every passing second in order to ensure that his body is moving optimally. He simply needs to become a Movement Monk. No pressure, buddy, you got this!

In case my Dear Reader is dubious of my description of these OAs, I did not create a fallacious straw man. I promise the Reader can find many examples with a cursory perusal of YouTube, Instagram, or Facebook. They are everywhere, the Internet is crawling with these parasites.

OBJECTION(S), YOUR HONOR

Extremely Very Basic Mechanics

The squat is the most technically complex of all the slow lifts (squat, press, deadlift, and bench press), but we can break down the rudimentary mechanics quickly. From the top, a controlled descent begins with the eccentric contractions of the quadriceps, proximal hamstrings, adductors, glutes, and distal calf musculature. For the most part, the various spinal/back/abdominal muscles are contracting isometrically throughout the whole movement because of our desire to keep the torso rigid and maintain intra-abdominal pressure. During the ascent, all of this musculature – quads, glutes, hamstrings, adductors, and calves – concentrically contract to raise the body and the external resistance against gravity. The quads tug the tibia to pull the femur straight over the lower leg, the glutes pull at the femur from the ilium and sacrum to extend the hip, the adductors pull the pubic bone for a bit of hip extension, the calves create plantar flexion to push into the surface we stand on to verticalize the lower leg, and the hamstrings tug at the ischial tuberosity to create some hip extension while they lengthen at the tibia and fibula insertions, creating a sort of action and non-action throughout their length.

The hamstrings are a touchy subject in the squat, but at the very least, they are acting at the knee and hip equally, lengthening at the knee and shortening at the hip to create a net change of zero. Although, we know from Lombard’s paradox [17] that the hamstrings and quadriceps both concentrically contract in a standing motion, and the moment arm of the rectus femoris at the hip is smaller than that of the hamstrings, so it’s likely the hamstrings force a net extension at the hip and quadriceps bring net extension at the knees. The hamstrings do stuff while we squat.

This is to say that there is a lot going on in the squat, but this is also to say that every time one squats down and stands back up, all of these contractions happen. In other words, no matter if the person is squatting their bodyweight or 550 lb on their back in a low-bar position, all of their musculature is performing the contractions noted above. I am not saying the musculature under each resistance is working equally “hard.” A person squatting their bodyweight is not going to maximally recruit a muscle’s motor neurons the way a person squatting a 1RM is going to, but they are still using all the same muscles. However, it is terribly common to hear nails-on-the-chalkboard talk of quadriceps dominance or a lack of activation in the gluteus medius during the squat which is causing such and such.

This is absolute malarkey. Talk of dominance between two muscle groups is pure conjecture of the feeble-minded. The muscles are not rogue entities that are talking to one another throughout movement and the Reader is merely along for the ride. If one is using “all quad” to stand up in the squat, it’s likely that they are not using any serious hip drive (hyiup drahve) [21] out of the bottom position. This is a matter of movement mechanics, not a symptom of muscular imbalance. Make them squat correctly, even if it takes a ruler across the knuckles.

One would think such deep knowledge of anatomy would give the OA a strapping foundation for understanding movement mechanics, but one could not be more wrong. Furthermore, people who have trouble activating muscles are usually called paralyzed. It is some form of a lack of communication between the central nervous system and the muscle fibers. If the person stood up, they contracted their muscles and the CNS worked. The percentage of motor neurons that were activated in a given muscle group is a different question, usually one of intensity. If a person attempts to jump as high as possible or lift a 1RM squat, the percentage will be quite high. If one is squatting their bodyweight and their 1RM is 500 lb, the percentage is quite low, or at least it is probably as close to a minimal recruitment of fibers that a contraction could possibly achieve.

COMMON ALERT, VERY COMMON: a client’s knee caving in during the ascent of a squat is from a lack of good coaching. If an OA/FP sees repeated clients who have this problem, it is not the clients’ problem. The root cause is the poor coaching ability of the OA/FP. Often when one of them sees this issue in a client, they will take them far away from the squat to get the glutes properly activated – or whichever problem first comes to mind and has nothing to do with their coaching incompetence. This will likely include, but is certainly not limited to, standing/lying/seated hip abductions, banded walking of various flavors, something called a “bird dog,” et cetera.

Rarely will an OA/FP continue the squatting prescription out of fear that the client’s knee will explode out of their leg and shoot across the room. They do this backing off of compound movements because when, say, hip abduction is monitored in a vacuum, we see that the gluteus medius is the Prime Mover. However, this is almost entirely irrelevant to normal human movement and the large system in which the gluteus medius actually operates.

If a client is truly struggling with wobbling knees, put all of their attention on it and do not progress the intensity of the exercise. They will figure it out. All the OAs doing is taking them away to practice controlling their femurs in isolated functions while fumbling around with bands for three weeks, and when they return to the squat their knees don’t wobble as much. Miraculous that it only took three weeks for the OA to get the client to pay attention to their knees. The only problem is that they’re still disgustingly weak and three weeks got the Fargo treatment, being tossed into the wood chipper. They are looking through a keyhole into a secret room while Real Coaches have had the key for decades.

Overload Events (Or Lack Thereof)

Moving on, perhaps the most important aspect of the SRA cycle is the overload event. The stress we place on the body in order to cause an adaptation needs to be above a threshold that is relative to the individual. If we place a stressor on an individual that is less than or equal to their baseline as shown in the SRA trajectory, the individual will cease to make any progress. If the upcoming stressors are shrunken, and since the body is constantly in a state of flux whether we believe it to be or not, we will see a negative adaptation – one in which the individual’s baseline will be lowered instead of raised. Equated stressors over days/weeks/months years, e.g. running two miles on Monday, Wednesday, and Friday for six miles every week, will call for pure maintenance of homeostasis.

I think, now, it would be helpful for us to place our applied stress in one of four categories. Negative, maintenance, positive, or no mas. Negative would be a stress that is below baseline, causing our adaptations to be regressive. Maintenance is maintenance. Positive would be what we want, which is a stressor that constitutes an overload event and causes a desired positive adaptation. No mas is inspired by Roberto Duran and it is too much stress, the kind that would be an overload event, but far enough beyond that threshold to become an unproductive dose of stress, i.e. too much of our recovery resources will be spent on repairing damage and not dying. This could, in a way, be added to the list of negative stressors, especially because of our tendency to perish from chronic, extremely intense stress. However, our baseline is dropping/stagnating from our inability to adequately recover, not from a lack of sufficient stimuli.

Much of the activity done in the office of an OA or in the gym of an FP would fall into the maintenance or negative categories. At first, let’s say if the client was recently bedridden, the stress of walking (or the attempt) would be a positive stimulus. However, the body of someone who cannot walk would, by comparison to “normal” homo sapiens, have an extremely low baseline. This means a couple things. One, a minimal stressor would probably cause an adaptation. This is highly contextual and relative to the individual, as walking a couple miles is hardly stressful for me but an impossible task for someone who is only capable of a couple consecutive steps without a break. Two, their baseline will likely climb quickly until it is in a more “normal” range. I think we can agree that walking should be considered a normal human movement. Bigger stressors are needed before the normal range is reached and, once the individual becomes normal again, even bigger stressors will be necessary to disrupt the new baseline. Once we become super-normal, our overload events will take such large stressors that they would baffle Thor Odinson.

The kind of training tactics I see often employed by the herds of OAs and FPs seems to be utterly devoid of even the most basic understanding of the SRA cycle, particularly overload events. These tactics include, but are not limited to, lying shoulder external rotation with a miniature dumbbell, various hip bridges, the glute “activation” exercises I discussed a minute ago, or anything else that feels so awkward it should be done only in the privacy of one’s home.

For a vanishingly small chunk of the population these exercises may constitute an overload event. However, likely after one or two workouts, these will be an outright waste of time. It will become movement for movement’s sake that will not disrupt homeostasis. For the folks who are even remotely trained and sustain an injury – or simply fall under the spell that they need the help of an OA to “fix” something – these exercises will be tomfoolery, buffoonery, horseplay, fandango, et cetera.

Where Is Waldo’s Pathology?

My third objection has to do with the notion that any of these movement issues have direct, causal links to certain injuries or pain. I am under the impression that most of these things should be avoided while lifting and moving from an efficiency standpoint, but the burden of proof is on the Occupational Activator/Functional Proselytizer to show the studies that prove certain movements cause pain and/or musculoskeletal injury.

When I say movements, I mean patterns commonly discussed as abnormal or bad, e.g. walking with a knee valgus. This is usually talked about as a general “caving in” of the knee, not the actual medical assertion that the distal bone of a joint is externally rotated, which can be noticed in an individual’s leg from about a mile away. Real valgus makes me somewhat queasy, but movement errors as described by OAs/FPs rarely have a concrete definition, much less evidence for their causal links to pain/injury.

I haven’t seen the studies that show that this faux-valgus causes ____ injury/pain in non-athletes. All that has been shown (here [10], here [9], here [8])  for the faux-valgus is that it increases tension on the ACL when landing, which is painfully obvious. If we perform an altitude drop off of a box and let our femurs internally rotate and allow our knees to shake around like those of newborn fawns, we will probably increase our risk of injuring our ligaments/tendons. A simple fix: learn how to land on the ground and absorb force like somebody who does not suck at moving. Two weeks of minimal plyometric practice would solve this issue for every athlete. Strength solves it for the non-athlete.

To properly do my job and play devil’s advocate, why do people like Dmitry Klokov [15] or almost the entirety of the Chinese weightlifting teams [16] rarely sustain, if ever, any knee injuries while regularly displaying what would be considered by the OAs to be a dangerous movement error? If we are under the impression that humans are antifragile, meaning they grow stronger rather than weaker from exposure to acute stressors, then it’s possible that these folks have been able to develop some of the most powerful performances in the history of mankind on top of what should be a career death sentence. The OAs, like Baudrillard, do not live in the Real World.

Moreover, we know from this longitudinal study [1] that back pain is not correlated with posture, spinal mobility, or physical activity. For some reason I don’t believe this data will convince the golden retrievers out there. A great example of OAs gone rogue with postural rigmarole is the issue known as Upper-Crossed Syndrome (and Lower-Crossed Syndrome).

UCS is an absurdly complicated phenomenon that essentially means the subject’s head and shoulders are forward. However, when Lab Coats attempt to define what forward means, i.e. what normal position v. abnormal position should look like, they cannot agree because of the natural variation of homo sapiens. That fact, unfortunately, doesn’t stop the OAs from adding to the diagnosis with complicated root causes. Obviously, if the symptoms cannot be defined the root causes are going to be spurious. What is the root cause of a problem that doesn’t exist?

Usually, though, it’s muscular imbalance. All the data shrug their terribly rounded shoulders when asked what exactly is imbalanced. The Lab Coats have for decades been unable to agree on the definition of muscular balance, what constitutes a “tight” muscle, and what is perceived as “tight” and that muscle’s correlation with pain, strength, or anything that can be even remotely measured. Sloppy language, methinks.

I want the Reader to take a second to think about what it means exactly to have a “tight” muscle. Is it “tighter” than the muscle on the other side of the body? Or is that a comparison to how it felt yesterday or the day before? Is it restricting range of motion in a particular movement? How about after getting warmed up? Did the perceived tightness disappear? What if one woman thinks her hamstrings are tight but another doesn’t and they both have the same ROM in a sit-and-reach test? I’m sure gymnasts across the globe complain of tight muscles regularly while being capable of dropping into the splits at any given moment. By what objective markers are their muscles tight?

A fantastic article was written by Paul Ingraham of Pain Science about postural correction [3]. The gist of the article: we cannot define poor posture because of the innate variability of human anthropometry and kinetics, therefore, any diagnoses to address specific symptoms are spurious and various “treatments” of the symptoms provide us with no hope that “poor posture” can be fixed. It’s quite difficult to fix something if we can’t even draw a line between how it should and should not be operating. The good news is that posture matters about a tenth of what we think it does. At the first Starting Strength seminar I attended, a fellow attendee asked Rip which exercises should be done to fix poor posture. He said, “do the don’t-stand-like-a-shithead exercise.” Sound advice.

Adding to imbalance, much talk is spent on hamstrings/quadriceps ratios for preventing ACL injury, this has been futile [2]. The entirety of the last couple of decades of H/Q ratio study has proven that stronger hamstrings are better than weaker hamstrings. Imagine my shock. With the panoply of issues that arise from people who do nothing but sit on the couch and the cases of men who deadlift with a rounded back for decades while rarely experiencing pain worth writing home about, it’s nearly impossible to predict which movements should or should not cause pain/injury.

The bigger question then, is whether the OAs are doing harm by telling the clients they will feel pain when they have no supporting evidence. A study [5] showed in two groups who were exposed to a safety signal or a pain signal that we feel more pain, catastrophize the pain felt by others, and fear pain more when we see a pain signal rather than a safety signal. We can also be classically conditioned – recall Pavlov’s dogs from 10th-grade Psych – to feel pain in particular movements [6] [7], creating fear avoidance behavior, i.e. we avoid movements or positions out of the fear that they will cause pain, even if the pain was manufactured by somebody else. Wait a second, the burden of proof isn’t on me. Why should I have to link studies? I know that I know nothing.

I unequivocally reject the practice of making a new client/patient perform their normal movement without any prior coaching. This is lazy, cruel and malpractice. Lazy because it requires only the effort to say “do this,” cruel because the client already knows they aren’t doing ____ right and are going to feel embarrassed, and malpractice because of negligence and priming the client to expect pain/injury where we could have easily programmed them to build strength of will, body, and self-efficacy. Bad coaches do the above because it allows them to point out how poorly the client is moving which is supposed to expose their level of expertise. It is a pathetic tactic of a person who is often wildly overpaid for the non-work they are doing.

Diagnosis, Intervention, and the Ether

“If you see fraud and do not say fraud, you are a fraud.” – Nassim Taleb

There are a near-infinite number of things that can be wrong with our accountant at any one time and the Occupational Activator can grab at any one he fancies. Call into memory the study we discussed earlier wherein the woman was found to have 49 potential pathologies, none of which showed up in all 10 of her tests. The professions of OAs and FPs are, by nature, exponentially more ambiguous and arbitrary because of their distance from objective criteria. It is rare that one of these characters even attempts to show tangible evidence of pathology before they diagnose the client. The other scenario is the client showing up to the OAs office with a slip that says “I have ______. Please fix me.” After this, the client goes through the prescribed intervention until they no longer feel the need to continue or when the pain stops.

I must now bring all of this together. OAs and their minions regularly see arbitrary movement errors and diagnose pathologies that do not exist, or they will tell the patient that their current issue is not thoroughly pathological yet but will cause a particular (yet still fabricated) pain/injury in the future if not addressed immediately. Once the pathology is on the table, they attack a counterfeit root cause which is bringing about some highly arbitrary amalgam of symptoms/pain. They tell the client to dance around with colorful bands and dumbbells until the pain goes away – almost all pain disappears on its own time – or the client ceases to be terrible at moving, which would imply that future pain/injury has been proactively avoided. Then, the client or the OA are satisfied with this intervention and it ends. Perhaps some clients continue because they are sick of using $100 bills as kindling and would rather give it to a runner disguised as somebody who understands strength.

In a not-so-hilarious case of cosmic irony, OAs have themselves become the root cause of the pain/injury they are diagnosing. By definition, they must discover an issue to cure or relieve. They are conditioning the client to see, feel, and experience that which does not exist. However, if we are under the impression that pain is real, then the OAs are causing actual harm. The root cause does not exist, but the painful symptoms do. We then have a hauntological kerfuffle of pain/injury that is both abstract and concrete.

The pathology doesn’t exist in science or in the Real World, but the client feels the pain that is supposed to come with this non-existent issue. They have been diagnosed with a cooked-up disorder and because of the initials after the OAs name, the client will likely absorb this disorder as an integral part of their being. How many times has the Reader seen a loved one or close friend become a diagnosis? Imagine now that we have millions of people walking (limping) amongst us who are living out the painful experience of a disorder that doesn’t exist, all because they were conditioned to do so by The Authorities.

Every person will experience pain, and organic decay is an unavoidable feature of biology. The question is not how one rids themselves of that which is natural, but how to manage that which is inevitable. OAs and algophobics – people who fear pain – are in denial of Reality. We must accept our pain’s flaky nature and overcome our dependence on it as a reliable tool. Meditate on what percentage of our pain is a byproduct of rumination, catastrophizing, conditioning, or all of the above.

The Reader might get defensive and reject my description of their pain, and that is only natural. However, the longer one thinks about these topics the more they will realize that this philosophy of diagnosis is liberating. It frees one to be no longer beholden to an affliction, no matter its severity. We are all born with a diagnosis of finitude.

The most common disposition of the knowledgeable amongst us is befuddlement. The more we dig into any one thing, the more we unlock its complexity and realize how much we do not know. Forgive me for this sentence: we not only cannot know what we do not know, but we cannot even fathom how much we do not know about any one subject until we attempt to learn its truths. There are an infinite number of pieces of information available to notice for any individual at any one time. We see or “know” a fraction of one percent of these data. If we put this into perspective, our accumulated knowledge is closer to nothing than it is to infinity. In this sense, the universe is stupefying and it would behoove us to practice humility. Except for me. As a prophet, I am exempt from discarding my hubris.

Do not fall into the false dilemma that being dazed by the universe is good or bad because it’s probably an immeasurably complicated blend of the two. Furthermore, feeling overwhelmed at the necessarily confusing and arbitrary nature of most phenomena that do not seem so at first glance, is nothing about which the Reader should feel embarrassed. The ancient Greeks revered this feeling of aporia, which is basically utter puzzlement or reaching a cognitive impasse, and they were smarter than the Reader and me (or at least the Reader).

True, pioneering scientists fought for 300 years to push germ theory into the consciousness of the professionals who had been placed in charge before them. Countless lives were lost because of this. Several plagues were spread by priests going door-to-door trying to bless away the spirits killing these people, not knowing that these men were themselves carrying the disease through town and dying like cattle. The other Men of Importance saw this as proof that the priests had been living sinfully and were not exempt from the illness. All the while, germ theorists were screaming at a concrete wall about the truth of what was happening.

The military still believes jogging five miles is the epitome of fitness. The Authorities regularly tell patients that squatting is bad for the knees, or some related hogwash. Indeed, this study [12] showed less than 12 percent – as low as only SIX percent – of doctors polled knew about the ACSMs recent guidelines for strength training and recommended it to their patients. Basketball players who try to lift weights will see that it “throws off their shot.” The foundation of strength is core training, et cetera. Fortunately, though, The People are learning. Unstoppable forces for good are growing in size and gaining momentum.

I believe we have now reached an impasse with the Occupational Activators, Functional Proselytizers, and their minions. Decades of research and evidence – and a complete lack thereof for their assertions – is proving them thoroughly wrong from top to bottom. We have the opposite problem of the germ scientists. Those who know the truth claim to know nothing while those who sincerely know nothing portray omniscience.

Go lift some weights.

  1. Widhe, T. (2001, April). Spine: Posture, mobility and pain. A longitudinal study from childhood to adolescence. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11345632
  2. Individual risk factors for ACL injury. (n.d.). Retrieved from https://us.humankinetics.com/blogs/excerpt/individual-risk-factors-for-acl-injury
  3. Posture Correction: Does it matter? (n.d.). Retrieved from https://www.painscience.com/articles/posture.php
  4. Herzog, R., Elgort, D. R., Flanders, A. E., & Moley, P. J. (2017, April). Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27867079
  5. Caes, L., Uzieblo, K., Crombez, G., De, L., Vervoort, T., & Goubert, L. (2012, May). Negative emotional responses elicited by the anticipation of pain in others: Psychophysiological evidence. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22564671
  6. Meulders, A., Vansteenwegen, D., & Vlaeyen, J. W. (2011, November). The acquisition of fear of movement-related pain and associative learning: A novel pain-relevant human fear conditioning paradigm. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21723664
  7. Madden, V. J., Bellan, V., Russek, L. N., Camfferman, D., Vlaeyen, J. W., & Moseley, G. L. (2016, October). Pain by Association? Experimental Modulation of Human Pain Thresholds Using Classical Conditioning. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27452948
  8. Quatman, C. E., Kiapour, A. M., Demetropoulos, C. K., Kiapour, A., Wordeman, S. C., Levine, J. W., . . . Hewett, T. E. (2014, January). Preferential loading of the ACL compared with the MCL during landing: A novel in sim approach yields the multiplanar mechanism of dynamic valgus during ACL injuries. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24124198
  9. Shin, C. S., Chaudhari, A. M., & Andriacchi, T. P. (2009, February 09). The effect of isolated valgus moments on ACL strain during single-leg landing: A simulation study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19100550
  10. Shin, C. S., Chaudhari, A. M., & Andriacchi, T. P. (2011, August). Valgus plus internal rotation moments increase anterior cruciate ligament strain more than either alone. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21266934
  11. High Prevalence of Spinal Magnetic Resonance Imaging… : Spine. (n.d.). Retrieved from https://journals.lww.com/spinejournal/Abstract/publishahead/High_Prevalence_of_Spinal_Magnetic_Resonance.94770.aspx
  12. Walsh, J. M., Swangard, D. M., Davis, T., & McPhee, S. J. (1999, May). Exercise counseling by primary care physicians in the era of managed care. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10493287
  13. Lorimer Moseley – https://www.youtube.com/watch?v=gwd-wLdIHjs
  14. The Biggest Training Fallacy of All | Mark Rippetoe. (n.d.). Retrieved from https://startingstrength.com/article/training_vs_exercise
  15. Dmitry Klokov – https://www.youtube.com/watch?v=cv_EWWDV2O0
  16. Chinese weightlifting – https://www.youtube.com/watch?v=PRgQu7OwHpk
  17. Lombard’s paradox. (2017, January 01). Retrieved from https://en.wikipedia.org/wiki/Lombard’s_paradox
  18. The Grey Book – https://www.amazon.com/Practical-Programming-Strength-Training-Rippetoe/dp/0982522754
  19. Healthcare Companies by 2017 Revenue – https://www.beckersasc.com/leadership-management/these-are-the-money-makers-world-s-10-biggest-healthcare-companies-by-revenue.html
  20. Starting Strength Training Programs. (n.d.). Retrieved from https://startingstrength.com/get-started/programs
  21. Hip Drive in the Squat – https://www.youtube.com/watch?v=dYsktA7iFwY
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