The single most complicated thing that I am uncertain any study can fully capture is the client or patients attitude to pain, movement and general demeanour. And how this affects pain, rehabilitation and training outcomes. Many a inept plan have been salvaged by a cheery, optimistic client with a terrific attitude.
And let’s hypothetically assume that we will only do or try things are entirely scientifically ‘validated’. That is to say if there is no high quality study to prove something, you will not try it. Be it exercise selection, rep schemes, cues, use of different training protocols or tools. But that can be very limiting. And lead you to say no to ideas and protocols that can help the client.
Case in point. We have a weird pull up bar at the gym. Two rods angled at 90 degrees to each other. I’ve had three clients who cannot hang without pain on straight bar comfortably perform pull ups on the unconventional pull up bar.
I speculate it’s the relative position of the humerus in the shoulder socket that allows for the comfortable flexion, rotation while the scapula glides, retracts and depresses. The shoulder is unable to do so in when the palms are prone and shoulders rotated in. The externally rotated position that is not quite neutral seems to be doing the trick.
I have no study to prove this. Should I not do this and wait for high quality evidence that it is fine to do this? Should I not let clients do this chin-up variant. I know studies don’t prescribe individual exercises. But when you can use sound reasoning and have tangible evidence in the form of a happy client who is feeling better, does it matter?
When you are in the trenches working with clients or as in Sneha’s case treating clients, I am fairly certain there will be cues, exercises, protocols that are not by the book. You will find clients respond positively to these measures and interventions. And there will be a perfectly sensible and scientific explanation for why it works. The evidence will follow.
And let’s hypothetically assume that we will only do or try things are entirely scientifically ‘validated’. That is to say if there is no high quality study to prove something, you will not try it. Be it exercise selection, rep schemes, cues, use of different training protocols or tools. But that can be very limiting. And lead you to say no to ideas and protocols that can help the client.
Case in point. We have a weird pull up bar at the gym. Two rods angled at 90 degrees to each other. I’ve had three clients who cannot hang without pain on straight bar comfortably perform pull ups on the unconventional pull up bar.
I speculate it’s the relative position of the humerus in the shoulder socket that allows for the comfortable flexion, rotation while the scapula glides, retracts and depresses. The shoulder is unable to do so in when the palms are prone and shoulders rotated in. The externally rotated position that is not quite neutral seems to be doing the trick.
I have no study to prove this. Should I not do this and wait for high quality evidence that it is fine to do this? Should I not let clients do this chin-up variant. I know studies don’t prescribe individual exercises. But when you can use sound reasoning and have tangible evidence in the form of a happy client who is feeling better, does it matter?
When you are in the trenches working with clients or as in Sneha’s case treating clients, I am fairly certain there will be cues, exercises, protocols that are not by the book. You will find clients respond positively to these measures and interventions. And there will be a perfectly sensible and scientific explanation for why it works. The evidence will follow.