Coherence (Part 1 of 4): What is the sense of all this?

This is a long overdue follow-up series on a post on “Confident Ambiguity” from 2016.

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Most of you reading this post will have some background in the biopsychosocial model, pain science, and movement science. Based on this premise, my assumption is what I am about to say rings true with many of you:

Despite all the knowledge we have gained, the data we have scoured and synthesized, little of what we have learned “makes sustainable sense” when you throw it all together in effort to make it workable. With increasing knowledge, more gaps are inevitable and gaps in knowledge are never ending. Somewhat haphazardly, we patch the gaps as quickly as we can but the patches we use to bring them together are often mismatched. 

If knowledge feels patched together to you, what does it feel like for our clients/patients?

Think about it. We’ve got this biopsychosocial model (framework!), the neuromatrix, the needless distraction of predictive processing, the sensation versus perception arguments, and all these other cool neuroscience things. But what about consciousness, what is it??? There are also aspects of contemporary biomechanics and loading capacity that need to be understood and incorporated. Then we’re dabbling with psychology, we’ve got expectancy violations, graded exposure, fear avoidance, yellow flags, resilience…. But wait, what about social and cultural implications? How can we be so cruel as to expect someone in the worst socioeconomic status to be anything other than trapped, they could never develop resilience and be another self-help success story because nothing of their environment supports it! Then there are arguments of logical fallacies, continuing battles of epistemology and ontology, and, wait is there a value to philosophy? But what about the person in front of us? Their story, their narrative! Surely we shouldn’t forget the person! But what about the new graduate navigating the whizz bang shiny objects excited that by finding that “dysfunction”, poking, scraping, corrective exercising, or constricting the circulation of their client into oblivion hoping for that magical, “that feels better!” verbal response to be provided. What about our patients’ autonomy? And our science! What about our science? Outcomes measure outcomes not interventions, the limitations of the peer review process, the poorly (sometimes fraudulently) performed systematic and meta-analysis, the lack of disclosure of conflict of interest, poor blinding and lack of bias observation in much of everything that is available. Oh. and don’t forget, what about our own self care? Don’t look now, there’s the next social media post and the next article to argue about, wait what are we arguing about? Are we arguing?

            ….If you are reading this paragraph several times, you may wonder, like I have, how most clinicians who fell into this curse of wanting to learn more and do better have not all gone mad. It is no wonder the transference of this information has been poor and slow to take on culturally, it’s like we don’t even have ground. We’re taking on all this information but we have no idea where we stand, how to make sense of it, and not just how to apply it, but how do we meaningfully share it with others?

No matter where you are in your career, do you feel that inner turmoil? Read Part 2 of this blog post next week: “Coherence: Something Isn’t Right!”