Kelpie Korrespondent #5: Running Technique Wars & Info Overload - Part 2

Part 1 was about the complicated information landscape that exists surrounding the technical aspects or running, like technique, but also permeates all healthcare. I finished the last post with an exhortation to understand the strengths and limitations of the scientific enterprise. I’ll now continue on outlining the ways I think you can make sense of the landscape.

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Value the opinions of quality professionals who are up front about uncertainty

One of the sad casualties of the ascendancy of evidence-based practice has been the demotion of the opinion of the caring, intelligent, and careful expert. You see, it’s good to defer to objective research over expert opinion, but not all experts are equal and not all research is objective.

 The evidence-based practice paradigm frowns upon the doctor or healthcare professional (or running coach!) that strays from the best practice guidelines to experiment with you to find which approach works best for you - or seems to. And, if evidence-based practice could be fully implemented in the real world, this disapproval would be entirely justified.

BUT, because human beings are so vastly complicated, and because health and medical research is often methodologically unsound, there’s a lot to be said for trusting the opinions and experience of experts. Like anyone doing the same work over long stretches of time, they can observe patterns about what works for whom and develop a kind of practical wisdom. So, let me nail my colours to the mast. I for one am not ready to downrank expert opinion as much as people who are bullish on evidence-based practice would have me. I will look for trustworthy experts and continue to value their experiences and intuitions alongside objective research. Here’s what I consider to be some features of a trustworthy expert:

⁃            They’re observably ethical and honest

⁃            They follow working hypotheses about whatever it is that plagues you and are not dogmatically invested in their pet diagnoses and treatments (unless it’s obvious what’s wrong and what needs to be done)

⁃            They are upfront with you about the uncertainty inherent in their opinion

⁃            They prioritise cost-effective and low risk interventions

⁃            They’re fussier about evidence-based practice when risks are high, but less so when they’re low

⁃            They expand your personal agency, not diminish it through paternalism (but this does not mean they won’t talk straight with you)

Come to grips with grey areas

 OK, let’s zoom out from the experts and zoom in on you. One of the reasons experts and professionals can be dogmatic is that we, the public, demand certainty from them. We distrust the expert who says, "I'm not quite sure what's happening but here's some possibilities...". We may even feel short-changed in this situation. The human body (and mind!) is immeasurably complex and health issues are often inherently grey - not black & white. If we want great healthcare we need to have realistic expectations and reward healthcare practitioners who are open and honest about uncertainty. Expecting easy answers and quick fixes will undermine our health. If we don't do this, we send a message that we cannot tolerate complexity and uncertainty, and we need to be told what to think and what to do when it comes to our health. That message will be heard, we'll get what we ask for. Come to grips with grey areas and learn to be comfortable viewing healthcare as a problem-solving process, not simply a matter of black and white diagnosis and treatment.

Understand that truth shakes out over time

 Fads disappear over time. The latest running technique “system” being spruiked by influencers on social media or training method/paradigm gaining traction in the academy will shortly be validated or invalidated in the real world. The truth will emerge as time passes. Take the barefoot running phenomenon. It clearly under-delivered on its promise but was not without value. A person who dabbled cautiously with the ideas, perhaps adding in some barefoot training and footwear in moderation, could have benefitted tremendously. A person who went in hard on the paradigm without holding back could have ended up with stress fractures. Maybe not, but holus bolus acceptance of the barefoot proposition would have increased the risk.

If you accept that truth will come out in time, you can experiment with new ideas with an open mind - thinking about new hypotheses. You may benefit, and maybe you won’t. But you’ll be well served by letting the waters of time flow on. The flotsam and jetsam of bad ideas will flow to the sides, the truthful and valuable insights will stay afloat.

Be suspicious of gurus, silver bullets and dramatic paradigm shifts

 Sadly, even something relatively simple like distance running can be complicated and mystified by guruism. This is not helped by our tendency to look for silver bullets or quick fixes when, in fact, the solution is straight forward but difficult. We want a solution we can buy now (like a new pair of shoes, or a massage gun) when the answer is more likely to be free but hard - like consistent, sensible training and getting enough sleep.

Don’t fall prey to gurusim - people offering a novel solution to an old problem which only THEY understand. You can spot a guru by looking for these things:

⁃            They claim they have ground-breaking insight into old, well studied problems

⁃            They offer proprietary solutions to these problems (e.g. only their trademarked product can “fix” you)

⁃            They are overly dismissive of other experts in their field and claim to have understood something every else has missed

⁃            They are overly dogmatic about minor details (e.g. “you MUST do this drill and NOT that drill”, “you MUST NOT sit for more than 30 minutes in a row EVER”)

From my outsider’s perspective, it seems like the aspects of the scientific enterprise which deal with distance running (Exercise Physiology, Sports Medicine, Physiotherapy etc) are less vulnerable to gurus than they used to be. This is a fantastic development! But is worth being vigilant about a subtle form of guruism: the dramatic paradigm shift.

Sometimes, when a stubborn problem exists (e.g. the high injury rate in running), and a new insight emerges (e.g. it turns out people are sitting down HEAPS more than they used to), people can get overly excited about a potential causative link between the new insight and the stubborn problem, hoping that the newly uncovered knowledge holds the key to unravelling the problem. Skepticism is thrown to the wind and, suddenly, sitting is the major cause of running related injuries. It becomes the single, unifying explanation for the stubborn problem. This dynamic was at play with “core stability” and chronic low back pain. It was a mystery why people experienced seemingly unexplainable back pain. The core stability paradigm became the thing that explained all back pain. And now, we know that the concept did not live up to expectations. Chronic back pain is very complicated and still somewhat mysterious.

Stay sceptical – treat gurus with suspicion and be slow to buy in to dramatic paradigm shifts.