This is the first entry in a series of blogs that I will randomly put out whenever I feel there is a random topic that deserves mention but isn’t big enough for a full article of its own.
Over the last week an article questioning the biopsychosocial (BPS) model (https://www.regenexx.com/confounding-biopsychsocial-model/) has made waves in the physical therapy & rehab worlds. I’m not the type to slam anyone or call anyone out on social media – that’s not my style. However the article, and recent research on pain, warrants some discussion and points.
1) In the health & fitness industry we, to quote Results Fitness owner Alwyn Cosgrove (http://alwyncosgrove.com/) “overreact in the short term and underreact in the long run.” Initially we thought every single postural, structural, or biomechanical abnormality was causing our patients pain…and in recent years we sometimes tend to brush off imaging findings and not worry so much about posture or movement.
In reality a healthy mix is indicated as many “abnormal” MRI findings are common in painfree people but can also be linked with pain in some situations. Same idea with postures & movements. Read my brilliant colleague Ben Cormack’s article on the topic here (https://cor-kinetic.com/quit-arguing-matters-just-not-everybody/). It shows the importance of clinical reasoning in determining what’s relevant to the individual.
We as humans like simple answers. I’d love to think that biomechanics (or psychosocial factors) are or aren’t relevant to everyone – but it doesn’t work that way.
2) It is important to educate people about the strong, adaptive nature of the body. I don’t doubt that. At the same time we also have to be realistic about the body’s capacity to adapt and bear load. For instance, while the SI joint is strong and stable as hell it isn’t bombproof. Just saying.
3) The article made a good point that bears mentioning. While we have a large body of research (see my previous articles for references) saying that psychosocial factors can be risk factors for pain – I do believe pain and injury can cause anxiety, stress, fear of movement etc. Some research (again cited in the original article) showed that eliminating (or reducing) pain can alleviate the psychosocial factors.
While some may disagree with me I also anecdotally believe that certain injuries can be great sources of anxiety, fear and depression as well. Take for instance someone who easily dislocates their shoulder or knee … or someone with a history of recurrent ankle sprains … or someone who easily fractures due to osteoporosis.
The big takeaway from this is that it all matters – just in varying amounts to each individual.
On Monday I will release my next article which discusses the topic of CrossFit. As I promised I would have some content geared towards the meatheads, lifters, trainers, and strength coaches out there and I figured its time to take a short break from all the physical therapy content.