What now?

What now?

What now?


As I write this, a serious controversy is raging in several parts of the country, particularly the Northwest, as a result of an outbreak of cases of the childhood disease, measles.  Under control, and almost eliminated, for decades as a result of widespread vaccination programs, the disease has reappeared now in areas where there has been a conscious effort on the part of many parents to withhold vaccination (and not just for measles) of their children.

This so-called “anti-vaxxer movement” is not new, but it has gained credence and passionate advocates at an increasing rate over the past dozen years.  The reasons for this are numerous and it is not my intention to address all of them or debate the legitimacy or their arguments, though I will state that I do not agree in any way with their viewpoint.

What fascinates me is the question of why so many people are so amenable to accepting these questionable claims in the face of overwhelming, contradictory evidence provided by established, credible health organizations and government agencies such as the National Institutes of Health and Centers for Disease Control.  Contrary to what many might expect, most of the people involved in this movement are highly educated and relatively affluent, so the issue is not one of simple ignorance.  Those opting out of having their children vaccinated are accessing reams of information on this issue via the internet and social media.  The question is, how valid is this information?  Those on the pro-vaccine side would argue it is not valid at all, but they are having great difficulty convincing these skeptics.

I have to believe much of it is due to a backlash against the ever-changing information we all receive from the mainstream media – print, electronic, social – on a particular medical topic.  We are constantly hearing about “this study” that shows this, only to hear a short time later about “that study” that shows the opposite.  Conflicting Information and recommendations regarding PSA tests for prostate cancer and mammograms for breast cancer over the past few years are examples of this whiplash effect on the public’s impression on what is best to do.

Health professionals are not immune to this effect.  Over the past few decades there has been a profound push to adhere to the tenets of “evidenced-based practice” in lieu of simply following the recommendations of “experts” or, worse, “gurus” in our respective fields.  This evidence is supposed to be found in well-designed, methodological studies that “prove” the efficacy of a particular intervention for a particular condition.

But, as it is for the lay public, so it is as well for professionals that what seems to be solid evidence to support something one day is contradicted by new evidence the next day.  We are as likely as the general public to sometimes throw up our hands and say, What now?

A recent example of this in the physical therapy world is found in the research over the past two decades on the most effective interventions to address the condition of Achilles tendonitis (or, more accurately, tendinopathy).  When I first wrote about this problem 25 years ago (Therapy Corner #24), the prevailing wisdom recommended ice and rest (in the acute stage), heat, ultrasound, and prolonged stretching (in the chronic phase).

These recommended interventions eventually gave way to more structured exercise to rebuild damaged, degenerative tendon tissue, and eventually this was refined further to limit exercises to the “eccentric contraction” type of strengthening exclusively (TC #113).

This approach became enshrined by 2010 in what are known as Clinical Practice Guidelines, developed by the Academy of Orthopedic Physical Therapy, as the standard recommended treatment for this condition.  But now, more recent evidence – based on supposedly better research – indicates that this specific form of exercise is no longer thought to have any increased benefit over general exercise, as long as it is performed in a “heavy load/low speed manner.”

I anxiously await the next study that challenges this finding…

My point in relaying all this is not to encourage you to ignore all information on what to do about any given problem, or to look for “alternative” approaches that are probably based on even less reliable evidence.  Rather, your goal should be to become discerning consumers who are skeptical of a single, brand-new, latest-and-greatest claim, in favor of evidence that has been replicated in multiple research studies conducted by multiple researchers/institutions.  In other words, it may be wise to avoid being an “early-adopter,” but rather one who takes a “the jury is still out” attitude when you first hear of a significant change in advice.  And, like a good juror, don’t make a decision until you have looked at all the evidence and feel you can render a verdict beyond a reasonable doubt.