Monday, July 26, 2010

Evidence

I am a professional.

When I say or write a statement, that is not obviously an opinion, it is based on evidence. I went to a university which was credited in the British Medical Journal as developing one of the most revolutionary ideas in Medical and Allied staff practice. This is the concept of evidence based practice.

Evidence based practice involves using research to develop one's professional practice. For an evidence based practitioner to use a particular drug or technique in their treatment arsenal there must be unbiased, sound research to support the particular intervention. The evidence must show statistical significance more so than a control group/placebo group.

It is this search for evidence for why I am doing something that has shaped the way I approach my sport, my body and the environment. If I were to give a colleague or teammate advice on running, I would base my advice on either evidence or state a personal anecdote of a technique that has worked for me. I base this advice on the evidence I encountered during my education including a Bachelor of Science in Kinesiology and MSc(OT).

The difficulty that lies with evidence based practice is that there is much of what is done by runners is not supported by evidence. For instance; One should never static stretch prior to a workout and especially not before a race. It is entirely counter intuitive. There is actually little evidence to support static stretching and running performance in general. There is no evidence to support massage after a workout (besides it feeling good) and most of the modalities used as therapy actually have no evidence to suggest they work better than a placebo. For the most part, most injuries we suffer will get better spontaneously just as fast as when we have treatment. It is the act of treatment that makes us think we are actually getting better. The best thing to do for any injury is to stop what is causing the injury while maintaining range of motion and strength in those muscles by doing something other than what caused the injury.

As an evidence based practitioner I read and look at the world with a critical eye. If someone reports a specific technique or tool effective I want to know how they know it is effective. When you go to the doctor or physiotherapist ask them why they are doing or prescribing what they are doing. Ask them how they know what they are doing will work. Check to see if they are familiar with the evidence that has led them to use a particular modality.

With our current world of 'everyone being an expert' one must use caution when listening or reading any advice. People can be greatly harmed by certain techniques or ideas that are based merely on anecdotal, first person evidence. Remember, is was once common knowledge that the world was flat and the center of the universe. If you have questions about running, illness, injuries, health, nutrition, or coming out as gay ensure you get your advice from the appropriately trained and knowledgeable professional. If you are on the internet reading random information about something that may be affecting you in your life ensure that the source of the information is from a trusted, well educated and informed source. Look for citations from peer reviewed journals and try and ensure these citations are not taken out of context.

There is a great deal of harm that can be accumulated from misguided or misinformed advice. At all times ensure that your source of information is accurate and professional. As an aside, I am very impressed with Canadian Running Magazine. They base their advice on evidence and have very well written articles.

I was able to walk this morning after my run yesterday. I am using evidence based practice at the moment as I ice my foot to relieve the inflammation that is a hallmark of most injuries. Again there is not much evidence to support the use of ice beyond the initial injury phase of severe inflammation. If you do not like the pain of icing take an ibuprofen. It will reduce the inflammation and the pain!

Happy Training!

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