Evidence-based Practice

If you watched much of the Rio Olympics last month, you probably heard a lot of talk about a thing called "cupping."  Michael Phelps was covered with bruises from this thing. 

The other one that seemed all the rage was all the brightly colored tape adorning knees and shoulders. 

Here's the problem with those:  They don't work.   There is no evidence whatsoever that cupping has any benefit on performance or on injury recovery.  None.  Nada. Same thing for all those strips of tape. 

The tape may help with muscle re-education and/or biofeedback but not in competition.

Physical therapy, athletic training, sports medicine, and other disciplines responsible for the health care of athletes have changed.  The last 20 years has seen health care embrace what is called "evidence-based" medicine.

What that means is that the interventions that we use today are based more on things to which there is evidence. 

Let me walk you back to the early days of my career.  Treatment of back pain back in those days almost always consisted of hot packs, ultrasound, massage, and Williams Flexion Exercises.  It's all we knew.

Things have changed.  We have hot packs in my clinics but they are rarely used.  Ultrasound is still around but we know that it has very limited benefits.  Massage helps a lot of things but not a bulging disc.  And Williams Flexion Exercises?  Nobody today even knows what they are.  They didn't work then and they don't work now. 

Research has produced evidence which tells us what will work and what won't.  It is our responsibility to base medical care on that evidence.    I do recognize that to remain on the cutting edge we don't have to be open to trying new things but I also know that without some basis of medical physiology, using these techniques detracts from time better spent on interventions based on evidence, experience, common sense, and science.

So why do all these Olympic athletes resort to all this stuff? 

Olympic athletes are not necessarily professional athletes but they share many of the same characteristics.  To compete at that level, you have to devote everything to your training.  Some, like the NBA players, get paid well to play their sport outside of the Olympic venues.  Others scrape and save and depend on the largesse of others to help them pursue their dreams.

And like athletes everywhere, they will sometimes do anything to succeed at their sport. 

Several years ago, a survey was completed of Olympic athletes.  Basically, they were asked if they would trade two years of their lives for Olympic gold.  An overwhelming number of them said yes.

I defended Lance Armstrong up to the bitter end as the most drug tested athlete in all of sports.  But at the end of the day, he and the entire peloton were using Performance Enhancing Drugs (PED's).

And you don't think that PED's in the NFL is rampant?   Yeah, OK...and I have some ocean front property in Arizona for you.

The fact is that at the highest levels of competition, many athletes are willing to do anything and everything to succeed, including a lot of things that simply don't work.  And maybe too many that are illegal (the fact that Lance and a lot of others didn't get caught for a long time is testimony that those drug tests can be beat).

Maybe there's a placebo effect to it and they get some benefit from that but evidence does not exist to support the use of a lot of these "treatments."

So when you come see me or any responsible health care provider, expect us to use what works--interventions that are backed by the evidence.