Special Interest Groups

Not Familar with Laws of neuropathology

Well, actually, the NFL has been aware of the obvious neuropathology going on in its players for some time now, but has been able to feign innocence by conducting subpar studies of its own, and by sweeping good science under the rug.

Will Smith - Concussion

Until now – with the emergence of the documentary League of Denial (on Netflix) and the dramatized version of it – Concussion, featuring Will Smith who plays Bennet Omalu, the neuropathologist who takes on the NFL “corporation”, David vs. Goliath-style.  I would highly recommend both films, and would recommend seeing the documentary prior to the Hollywood version.

The obvious theme in Concussion is that football causes neuropathology or CTE (chronic traumatic encephalopathy), however perhaps the greater overarching theme is that science can be deliberately ignored by special interest groups.  CTE is endemic to football players in the United States which is rather unfortunate to players/their families – a relatively small scale.  However, deliberately sweeping away science can be pandemic/worldwide, affecting the entire global population (as per large oil corporations suggesting for years that global warming was not caused by human activity, when climate scientists knew all along that it was).

Sidenote:  Today, I passed by two homeopathy clinics (one on Yonge, one on Eglinton).  Despite being absolutely, 100%, denounced by science, homeopathy continues to exist, because of special interest, and/or because of a lack of familiarity (either the patient or the clinician) with the concepts of confirmation bias, placebo, and regression to the mean.

Understanding Patients

John Hopkins Hospital

An interesting quote by a famous Canadian doctor, Sir William Osler, and I do believe there is some truth to this,

“It is much more important to understand what sort of person has a disease than what sort of disease a person has.”

Fun fact:  William Osler’s father, Featherstone Lake Osler (1805–1895), the son of a shipowner, was a former Lieutenant in the Royal Navy.  In 1831 Featherstone Osler was invited to serve as the science officer on Charles Darwin’s voyage to the Galapagos Islands, but he turned the offer down because his father was dying.

Another fact:  Although a decorated physician and even considered by some as the “Father of Modern Medicine”, Osler was “in support” of bloodletting, which is now a largely abandoned practice and considered pseudoscience.


Intrinsic Motivation and SAID

Patrick O’Sullivan wrote a fantastic auto-biographical piece recently, in which he recounts the horrific abuse that he endured throughout his childhood at the hands of his father.  His father beat him quite severely, and would force him to train long hours outside the rink (weight training + running etc.) in order to help his son realize NHL dreams that he was never able to attain himself.

Patrick does a great job of summarizing these painful experiences, and then alludes to two very important principles in sport psychology/physiology.  The first is SAID (specific adaptations to imposed demands) which I’ve spoken about before – he hints that it isn’t the extra weight training or long runs that make great players, but rather the passing/shooting/stick-handling practice that actually occurs on the ice.

“Having a 12-year-old kid run six miles after practice isn’t going to turn them into Jonathan Toews.  You know when you actually get good at sports? When you’re having fun and being creative. When you’re being a kid. When you don’t even realize you’re getting better, that’s when you’re getting better. If you’re not engaged in what you’re doing, it’s as helpful as taking the trash out. It’s just another chore.”

The other theme alluded to, is that of intrinsic motivation.  In this case, this simply means wanting to play hockey for the sheer enjoyment factor.

“But that’s not what some parents, even normal ones, want to hear. Honestly, that’s not the direction youth hockey is trending. When I was in the NHL, I’d be doing my off-season workouts at the gym with Daniel Carcillo and some other NHL buddies, and we’d look over and see 12-year-old kids doing the same two-hour workout we were doing, with a trainer screaming at them the whole time. Half the time their parents would be there, yelling at them, too.  And it’s absolutely comical. It’s doing nothing.

True story: I played with Drew Doughty his rookie year in Los Angeles. He came into camp and he could barely do one rep on the bench press. He’ll laugh about it now. He was not in shape at all, at least in the way these “Old Time Hockey” blowhards talk about it. Then we’d go out for practice and he’d be the best player on the ice. Doughty was just a pure, natural hockey player with incredible vision and a brain for the game.”


Clinical Pearls from a PT familiar with modern pain science

Nice blog post from Jarod Hall, physiotherapist.  FYI – DDD means “degenerative disc disorder”, and DJD is “degenerative joint disease”.  Two of my favourite points:

  • Stop basing everything you do and the way you think off of a patient’s x-ray or MRI. We now know and have a plethora of evidence that tissue damage often does not correlate to pain presentation. Imaging is important, but we need to talk patient’s off of the I have DDD/DJD cliff and onto the you don’t have to be in pain because of your imaging ride.
  • …the vast majority of those asymmetries, leg length discrepancies (if you are even able to get close to accurately diagnosing them), forward head rounded shoulder postures, increased lumbar lordosis, etc rarely actually have anything to do with your patient’s pain. Very often your patients sit in prolonged positions and don’t move/exercise much at all through the day. Merely getting them moving in safe and progressive manner can be incredibly powerful