Padawan: “How do you know what to do?”
Bill: “I don’t yet.”
Padawan: “Doesn’t that make you uncomfortable?”
Bill: “Not anymore.”
The Human System is complicated (structural constraints e.g., biomechanics), complex (functional constraints e.g., autonomic response), and at times chaotic (think crisis mode). This often results in a great deal of uncertainty in regard to how we may best choose to influence the system via training or rehab to achieve the desired goal.
Consider the following as a short, incomplete list of possible uncertainties:
How sensory inputs are processed
Internal biology
State of tissues
Life experience
Emotional state
Understanding of self and environmental influences
Memories
Exposure to stressors
To make progress we need some level of understanding of how the system (human) responds to any measure of ongoing external and internal inputs or outputs.
The point of greatest uncertainty is the beginning of an interaction whether it be a client, patient, or athlete in question. At this point we know little to nothing about this specific system although we do tend to make some assumptions based on our biases and the model we have formulated based on our own experience and acquired knowledge (think foundational sciences).
It is at this point where we must observe the system for what and where it is at the moment always with the understanding that as each moment passes the system is changing. In physical medicine, unless we have some way to measure the internal environment (i.e., HRV, EEG, Galvanic Skin Response), we observe primarily based on the structural constraints and a minimal amount of functional constraints (estimates of energy production during exercise) as they are relatively consistent and movement-based behaviors. Certainly, our own brains provide an element of empathy that may extract some information as well, but if we’re hoping to determine the adaptability of the system, the motor system provides us our best representation of the system as a whole.
Our observation leads us toward what we deem the appropriate intervention. Again, we must welcome our biases and limited understanding of the system. Treatment and training decisions are never based on absolute understanding but rather coherence.
Test > Intervention > Retest > New state > Intervention > Retest > New State and so on.
Each iteration closes the gap between the current, ever-changing state or level of performance and the end goal whether it be to broaden variability in the rehab setting or narrow it to enhance sport performance.
The environment of unknown-unknowns (complexity) demands that our strategy remain adaptable and flexible. Remember that complex adaptive systems may react to a particular input strongly, weakly, or not at all. The same input may result in a different response when delivered a second time (thus the keyword adaptive) or produce an entirely different response when applied to unique system (a different human). Stimulus (locus or magnitude) does not guarantee a response (locus or magnitude), and one size does not fit all.
Peer-reviewed research possibly and science certainly assists in the decision-making process, but the reality is that the subject (client, patient, or athlete) is their own within-subjects research project because of their idiosyncratic functional constraints. The evidence lies in the outcome and provides answers in hindsight.
Theory + Practice = Success
But this is not to imply that we remotely even know what will happen or how the system will respond. We don’t know what element of the system is too rigid (too stable) or too variable (too unstable).
So how then do we progress?
Consider that rigidity (reduced variability) limits system adaptability and undesired instability represents compensatory strategy. The first goal then is to provide an avenue to allow the system to self-organize by restoring sufficient system variability to the limited subsystems within the entire system.
In protective states that include pain, depression, or anxiety, as well as limited motor capabilities, consider focusing on a developing a greater degree of variability than we would in a performance training environment. Too much variability inserted into a performance state may actually reduce the ability to generate the desired output (think run fast and jump high).
As an example, in the rehab environment, movement is our representation of variability of the system. It is the measurable based on convenience and scope of practice. The hope is that within the interpretation of our measurable also lies the representation of the rigid limiting subsystem (sometimes it does not). Our goal then is to maximize movement variability in an attempt to maximize system variability, and in this case, adaptability. This strategy is necessitated by the fact that the true limiting subsystem may be an unknown. Providing a maximum level of adaptability across systems (if movement is representative of such) attempts to ensure that variability is restored to the limiting, previously rigid subsystem.
Specialized performance often benefits from limited variability of subsystems. For instance, too much aerobic development may interrupt anaerobic adaptations necessary to maximize the rate of energy output required for top sprinting performance. “Normal” hip rotation may represent the need to increase neural demand to actively stabilize the hip joint thus taking away valuable neural drive away from propelling the sprint in a straight line down the track. However, if this same sprinter gives up adaptive potential to perform but suffers an injury as a result, it may necessitate increasing aerobic adaptations and restoring movement variability (possibly representative of increased system variability) to allow appropriate healing and restoration to occur. Once resolved, the resumption of training will inherently narrow adaptive potential again (SAID principle), but with the benefits of hindsight and monitoring, it is the hope that any further risk of injury is mitigated.
Bill: “Why is it okay not to know?”
Padawan: “Because sometimes we do not exist in absolutes and the system is continually adapting.”
Bill: “If it’s continually adapting, how to you know what to do?”
Padawan: “We make logical assumptions based on foundational sciences derived from our clinical tests to at best make reasonable practical applications.”
Special thanks to Adam Loiacono in the creation of this blog.