A response to "Exercise Culture Overwhelm"
Opinion piece on the swamp
Context
This unprompted piece of work is written in response to Alice Bacquie’s recent Substack (linked below). Which was written in response to a comment on a reel (also below) which received some critique from other health care professionals in the form of comments on the reel. I’d recommend reading Alice’s post first.
A letter to the editor
Hello Alice,
Welcome to Substack. I love it here. The process of jotting down thoughts and ideas before turning them into a well-written blog post with a neat font is something I’ve found rather enjoyable and quasi-productive.
Now - I fear I may be inserting myself into a conversation that I needn’t bother. It would be off-brand and remiss of me to ignite the AHPRA-Athletics Drake-Kendrick-J. Cole beef that we didn’t know we needed. But here we are.
If you’d do me the honour of reading my dictated thoughts as I’ve read yours - perhaps we can commence a respectful, patient dialogue that leads to positive, albeit uncomfortable, outcomes for everyone involved. Perhaps all of us can learn something.
Introduction
For those of you following along and new to this - I began this Substack as a method of putting out material to counter the “swamp.”
Shamelessly, I quote myself:
Online running content is a murky swamp of anecdotal and pseudo-intellectual advice …(I’ll refer to all online running content as the swamp, perhaps even all running advice in general). You might suggest I am contributing to this swamp, but I’d argue that writing on Substack is hardly self promotion.
There’s too much online content on gimmicky running tips and tricks that leave people injured, frustrated and confused.
Alice puts this in a similar manner:
…the wellness/fitness industry is being consumed, divided, commercialised and spotlit more than ever
…and wants, “a decent place to start a discussion.”
Well. Here we are. Substack is as good a place as any.
Competition and Comparison
A fun fact I learned from my sports psychologist. The word "competition" is a compound word originating from the Latin words com (together) and petere (to strive for). Competition is striving for goals, together.
By definition, healthcare professionals compete with each other. Multi-disciplinary work is people with a range of backgrounds and qualifications working together to improve patient wellbeing, a shared goal. This has the potential to cause people to rub each other up the wrong way, but I believe it’s a requirement for a healthy exchange of ideas.
It’s no secret, I love competition. It’s one of the reasons I love running. I also hate losing. But I can’t have my cake and eat it too. This is the wonderful oxymoron that gets me out of bed in the morning. To win competition, I risk losing. I can have it all, but I might leave with nothing. We teeter on the edge. We feel alive.
Competition forces me to be better - I want to win, so I pull out as many stops as I can in order to achieve.
As is the case in my role as a healthcare professional.
Honestly, my physiotherapy resume pales in comparison to my running resume. I’ve misdiagnosed, I’ve miscommunicated, I’ve stuffed up countless times. I see the interventions I gave as a new-graduate and cringe. In time, I’ll look back at what I do now and question if I was thinking straight. At a PD session two days ago I was put on the spot in an attempt to diagnose Suprascapular nerve neuropathy. I blanked, and looked like a fool in front of a doctor I admire and respect. Two years ago, I was spoken down to by a senior colleague for not remembering that a positive Babinski test signals upper motor neuron lesion. I haven’t forgotten that.
Moments where we fall short, where we are made to recognise our insufficiencies, make us uncomfortable. A wonderful side-effect of the human condition is we have infinite possibilities as to what our response to that is. That’s how we improve as a profession and an industry. Someone makes a claim, and someone has the right to refute it. We learn and we move on.
We see this all the time in physiotherapy. Hands on or hands off, pain science, tendon isometrics, PRP injections, big toe stretching, glute bridges and clam shells - all incredibly fascinating topics that can elicit a response out of even the most calm and composed clinician.
But we’d still be doing frictions on acute tendinitis followed by a warm wax bath if we didn’t critique each other. We have to. We adapt or follow suit. Critique is ok.
Is pilates an appropriate exercise intervention for runners to decrease injury risk?
Research
Here’s my one cent (anecdotal evidence): I see runners in the clinic who load inappropriately, and who haven’t prepared their body amply for the high loads that running places on their lower limbs. Yes, the movement makes them feel alive. It fits their lifestyle, economy and physiology. Temporarily.
They need an effective intervention. What is an effective intervention? We research it. Or better put, other people do.
It would be tone deaf if, to seem intelligent, I referenced a list of papers I’d only read the abstract of. Healthcare research is today’s equivalent of the Catholic Church’s hold on the Latin Bible pre-Martin Luther and the printing press. Hidden behind a paywall, and within academic jargon, is the answer to the individual's pain in their shin. So the plebeians pay modern-day papal-figures in their healthcare monasteries, but instead of recognising our limits we proclaim to be the second coming of Dr Christ.
AHPRA-registered health professionals sign up to the job, knowing that it is a requirement that they critically analyse the research they read, and ensure what is read has quality and applicability to their practice. The joy of the profession means that we shoulder the responsibility of saying, “I have spent the time understanding this, let me help you.” It’s what makes us different from a kind stranger on the street saying, “let me help you.” Both are wonderful, but there is a variation in effectiveness.
We need to read the research with a critical lens. Is the content riddled with biases? Is it claiming something outrageous with little data to support it? What is the quality of the data like? Has this been confirmed by other papers? What do healthcare professionals I look up to have to say about the paper? What are the implications clinically?
If you preach to the masses, if you’re a healthcare professional, the responsibility that is shouldered is tiring. It’s hard work. But we have to do it. It’s how we separate the wheat from the chaff.
A sustainable routine is hard to find, and even rarer to maintain - but it doesn’t mean I can’t help someone find it. It’s my job.
Running loads are high, we need to prepare our patients' bodies for them. I haven’t seen it all, and never will, but I’m yet to see a runner rehab effectively purely on their reformer. Research is in place so we don’t have to experiment on our patients. When I prescribe a heavy split squat to a patient, it’s no guarantee that it’s going to improve performance, but the research on heavy resistance training for runners ensures that I can make an informed and quick decision to pick what will probably be best. Because it will probably be better than a clamshell. If I’ve assessed properly and accurately.
Can we even do that? That’s for another post.
Does pilates have its place? Absolutely. I run classes in the clinic week in, week out.
Would you have an ice cream for breakfast? Everything has its place, and everything has its not-place.
Professionalism
BUT.
As healthcare professionals, we also shoulder the responsibility of how we deliver our knowledge. It sucks, but the requirement is that we are the bigger person. As fantastic as they are, witty one-liners and cheeky comments don’t capture the nuance and complexity of the human body we admire and observe.
The real world clinic is chalk and cheese to the instagram reel and podcast bro. 40 minutes with a patient is whittled away debunking ChatGPT diagnoses, unlearning Dr Huberman one-liners and other swamp-like crap. As I’ve already said, it’s tiring. It’s no ones fault, but it’s hard. So then, it’s understandable that we make a smart-arse comment when we’ve seen the 100th or 1000th post that goes against what we justifiably believe. We’re human.
And if you’re Blake Withers, you’re an uber-intelligent guy that is passionate about a flawed profession. But he’s still human. He might leave a comment. It might even be funny. Anyway, while we’re here - check his work out! His online content pipes are filled with brain-tingling, inadequacy-inducing research reviews and clinical pearls that would make any physiotherapy student on placement quit on the spot.
Was his comment necessary? Perhaps not.
Was your Substack required?
Was my response needed?
But here we are, having articulate, long form discussion in a respectful manner that might help us get one iota closer to understanding the truth of whatever it is we want to know.
Is Pilates an effective intervention at reducing injury risk and improving performance in runners? Clinical evidence says heavy resistance training and plyometric work is better.
I think you missed Alice’s point, and I think I might have missed yours. Not quite clear what you’re trying to say here, Isaac! Big fan of your writing but a little lost.