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A Case For Earlier Access To Advanced Imaging

There is a prevailing sentiment in the pain medicine community that advanced imaging techniques like MRIs are overutilized. While I tend to agree that given the current set of constraints dictated by the health care system that MRIs are overprescribed, this acknowledgement need not justify the demonization of anatomical/structural considerations that is beginning to pervade pain management as a field. I’ve been very critical of the manner in which painful conditions are reduced in medicine to single anatomical sites. That said, an MRI just provides information and with the right diagnostic and conceptual framework, more information is generally helpful, especially something that visually depicts the site of one’s pain.

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Performance Teams and “Lanes”

“Stay in your lane,” said nobody any of us would like to work with.  When it comes to medical and performance teams in sport, it is not always clear where the lanes are.  First, who decides where to draw the lanes? In medicine, the lanes are often guided by political and economic incentives, not necessarily by clinically meaningful criteria.  The “lane lines” are typically drawn by the party with the more powerful political lobby in anticipation of, or in response to, competition for market share.

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Movement Realism: Why Sports Medicine Can’t Be Reduced To A Hashtag

It is hopefully uncontroversial to say that there is no such thing as perfect posture or ideal movement.  That perfect posture or ideal movement is, at best, a theoretical fantasy does not justify a prevailing sentiment in the rehabilitation and training world that any movement pattern that emerges under particular environmental constraints is beyond reproach.  The thinking here is that the body is a highly adaptable system that organically “finds” the optimal solution to environmental challenges. From a training or rehab standpoint, therefore, one need not do anything but regressively or progressively load the pattern that emerges in the absence of coaching or cuing.

Ideal movement isn’t supposed to exist but some commentators suggest that any motor pattern that allows for task completion is effectively ideal because emergent movement is always “best” even if they don’t use that word.  It’s “best” to them because they never consider that changing that pattern may help improve performance or mitigate the potential for injury. Instead, every training and rehabilitation situation is purely a load management issue.  Emergent movement can’t be “best” though if optimal doesn’t exist in the first place. The real question is whether the emergent movement is “good enough” or if a movement-related intervention is warranted. While errors of commission (doing too much) tend to pervade medicine, errors of omission (doing too little), to include ignoring alternative movement-related solutions, can also be quite consequential.

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Toughness: Reconciling The Military And Sport

I recently returned from the 2018 Physical Preparation Summit where Steve Magness was the keynote speaker. Steve spoke about conditioning for track and field and team sports, “toughness”, and the relationship between intuition, data, and objectivity. He seamlessly navigated between the micro and macro much like he does in Science of Running and Peak Performance.  

His toughness talk really resonated with me because it reconciled many of the practices I encountered in the military with psychological preparation for sport. Developing “toughness” has become a multi-million dollar enterprise and a series of hashtags and platitudes paying homage to things like “grinding”, sleep deprivation (he/she who awakens the earliest is the toughest), crawling through mud, and training offensive lineman like middle distance runners. In sport, coaches and executives sometimes misguidedly implement practices from the military, particularly the special operations community, in an effort to develop athletes’ toughness. As articulated here and here, sport practitioners frequently confuse military selection and talent identification with technical and tactical training. Using Steve’s toughness model as a guide, military and sport practices can be harmonized without mysticism and theatrics.

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Antifragility and Adaptive Reserve In Sport

What is really the point of physical preparation and strength and conditioning? Human performance professionals sometimes fixate on concepts like transfer and specificity but attempting to mimic sport outside of a practice or competitive setting squanders an opportunity to introduce novel stressors that improve readiness through seemingly indirect means. Nothing transfers like playing the actual sport so if it’s mainly transfer or specificity we’re after, it’s hard to make a case for doing things like squats and running at maximal velocity in a straight line. Moreover, transfer is very difficult to quantity as so many variables influence sporting outcomes. Nevertheless, linear speed development and strength training can and probably do positively influence sporting outcomes but not necessarily because they mimic the game. Challenging physiology off the court or field is worthwhile because it helps develop Antifragile systems.

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