best to proceed or not.” What is load management? Load management is when you tell people to stop doing what they’re doing for a period of time. They don’t describe assessments, they don’t describe treatments, and they definitely like to inform the public of how smart they are. It is a movement born out of graduating chiropractors from the edges of the fitness industry. These practitioners say that they exclusively follow the evidence, and mock anyone who doesn’t practice exactly like they do…but I digress. It appears we have a pedantic sandwich in the chi-ropractic profession. The straits of old, and now the aggressive fitness buffs. The Instagram talking heads are image building – this isn’t patient education, this is dogma pulled from an obsession about social media. They put more emphasis on winning the argument rather than educating anyone. Cherry-picking papers and highlighting afterthoughts are a primary weapon. Variability in healthcare, life, and sport is essential. The most famous example is heart rate variability. Heart rate variability is when the timing between heartbeats is measured in milliseconds, and there is some ‘variability’ in the timing between the beats. This is indicative of a healthy and low stressed heart. In the sports world, variability is a key factor for avoiding or tolerating injuries, and performance. If you are a long jumper, it is hard to hit that board perfectly each and every time. But world class long jumpers will assess at various points along the runway and adjust up to and including the most important step – the penultimate step. This step is arguably more important than take off, because how you place this www.Cndoctor.ca second to last step will create success at the board and in the air. Andre deGrasse is another example. His right arm flails back. I’m sure someone somewhere tried to correct it. But the variability in his right arm may be releasing strain through one of his anatomical chains that assists for that perfect drive that has resulted in so much success. Why does all of this matter? Musculoskeletal medicine is imperfect. It’s imperfect be-cause we are dealing with the actions and behaviours of hu-man beings. As chiropractors, we modify motor control, we change how the brain perceives pain, and we get people stronger. Some need more of column A and some need more of column B. Doing the same thing over and over again and expecting a different outcome is generally the qualitative measure of a fool. Are all variables the same? Unlikely. Touch is likely our greatest tool however… a systemic review from JBI Evidence synthesis titled ‘The neurophysiology of human touch and eye gaze and its effects on therapeutic relationships and heal-ing: a scoping review protocol’ written in 2016 by Kerr et all, found the following: “In summary, touch and face-to-face interaction with trusted others have a number of neurophysiological effects that are relevant to both healing and the building of a thera-peutic relationship. These neurophysiological effects are heightened, created, moderated or mediated by the quality of the relationship shared by the individuals. Trust and em-pathy, in particular, appear to be mediators as they have a profound effect on the body’s generation and/or secretion of beneficial chemicals such as serotonin.” We would be foolish to throw away the power of touch. Having said all of this, what does the evidence say in general for the treatment of low back pain? All of the recent low back pain guidelines of the last five years, based on meta-analyses don’t have identical recommendations. If the best paper re-viewers can’t agree on what makes a good paper, and what a good result is, why are we paying attention to attention grab-bing instagrammers? Entertainment. That’s it. It’s not knowl-edge, because knowledge is inclusive, not cultish. As practitioners, we need to read the evidence, and under-stand the evidence. We take this, and we apply it with our experience, the experience of the patient, and yes, the interests of the patient. This is patient-centred care. This isn’t about making money, this is about being a good doctor. Social media has been a primary driver of the current pe-dantic tribalism we are seeing. Covid, politics, social justice, and in our professions. We are fed information that is on a positive feedback loop through an algorithm that ironically strips out anything we may not agree with. So if you’re an Instagram talking head, you’re going to get a lot of feedback from other similar talking heads. Those mixers who have taken to social media to mock anyone whose primary treatment isn’t to wait out natural history are no better than the straights that they mocked as students years ago. We need variability in our nature, our lives, and as provid-ers, our treatments. Human beings need patient-centred in-dividualized treatment, not an Instagram fad. When is it time to ask the hard questions? Well, when someone says they’ve got it all figured out. That’s why we call practice, practice. January/February 2022 Chiropractic and Naturopathic Doctor 21
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