I have a collection of physical therapists I reach out to whenever one of my athletes has a problem. If I can’t figure it out, then the next step is to reach out to one of these guys to find a solution

One of them is John Ball, the well-known track injury guru out of Arizona. What I love about John is that he is blunt. He tells you like it is, which is why I’m always amused when this master of injury rehab tells me point blank  (and I’m paraphrasing) “I don’t know if any of this works. I have a hunch, but no one really knows.”

Along similar lines, my Houston based PT, Roderick Henderson likes to say “Sometimes, it’s better to do nothing,” when he sends you away with instructions to let things calm down before starting up a program.

What are these supposed experts getting at?

The Art of Cupping

When phenom Allie Ostrander dropped out of women’s 5k at the
NCAA indoor championships, you may have noticed some peculiar looking circular bruises on her leg. No, these weren’t signs of abuse or a rare skin condition, but instead a well-meaning athletic trainer intentionally put them there. The bruises are a result of the practice of “cupping”, a traditional Chinese method using suction.  If you’ve been paying attention, you’ve seen an explosion of the use of this ancient method

The initial theory for why this worked is based on the pseudoscience of toxins and such. The newer explanation uses another in vogue term that is poorly understood and often misused: Fascia.

I have no idea if it works. I haven’t researched it beyond a curious glance into the research literature. Regardless, it has all the trappings of a wonderful placebo. It is novel and exotic, it is an ancient secret, and most of all, it leave a mark behind to symbolize that ‘something’ happened. All of which lead to an enhanced placebo effect.

The point isn’t whether there is science behind it; the point is what it represents.

When one ventures into the training room or to the local PT, often the kitchen sink is thrown at them. From Ice to compression boots to muscle stim to lasers to graston to dry needling to ultrasound; they are all used.  Undoubtedly some of these things work and some don’t.  The problem is, often we don’t know exactly what does and doesn’t work. So everything gets thrown at an injury.

The premise is that if we throw enough at it, something will help. Something has to be better than nothing. I think that’s a false premise. We often perform treatments not to actually get something better, but to make us, and the athlete, feel better.

There’s nothing worse than sitting there as a coach, PT, or trainer and saying “I can’t do anything for you right now, the best thing is just give it some time.”  That sucks. It’s a horrible feeling not being able to do anything. We are relinquishing all sense of control that we have, admitting defeat, and letting the injury be the master.

It’s this fear of losing control, being able to do ‘nothing’, that paralyzes us. It creates the fear response, the unending worry that we should be doing something, almost anything, to work towards getting better. As coaches and athletes looking forward hoping for continual progress, standing still seems like the exact opposite of what we should be doing. Yet, doing something might actually do nothing.

Making our selves feel better.

At the Stanford Invite I was standing next to my podcast pal, Jon Marcus, as we watched our respective athletes run in the men’s and women’s 10k. We got on the topic of coaches yelling at their athletes mid-race. I’m as guilty as the next person to going crazy during a race. I get excited and pumped up for the athlete and my way of releasing that energy mid-race is to yell encouraging things to them.

Many think that this behavior is for the athlete, to encourage them or provide that cue on when to strike. Next time you attend a track meet, sit back and watch the coaches. The hand waving, the yelling, the crazy behavior is not to encourage the athletes, it’s for us. Perhaps at the high school level with athletes, who aren’t quite motivated, yelling works? And sure, every once in a while the athlete responds or seems like they are responding and we feel like we contributed, but those are few and far between. Instead, the athlete was still going to muster out that last lap quick, or the gritting of the teeth to latch onto the chase pack for a minute longer.  If they are motivated, they are going to try.
If they are race savvy, they are going to make the pass at the right time or not, and it’s not going to have anything to do with you yelling from the stands. Instead, all the crazy gesturing and yelling is for our benefit. As coaches, it’s to make us feel good. It gives us the illusion that we are actually doing something. We gesture and yell to give us some sense of control on an event which we have absolutely none.

The same principle applies when coaching out at practice. I often catch myself saying things just to say things. It’s this urge to comment after every lap or repeat to make myself feel like I’m doing something besides standing and observing. Other coaches I’ve worked with or observed display the same behaviors. Sitting there watching, you can see the need to say something, almost anything, to the athlete to make themselves feel involved.

There is a fine line between saying something to say something and providing a cue that translates into improved performance, behavior, or technique. Research on feedback when coaching tends to back this up. As shown in this nice graph from Frans Bosch latest book shows, the timing and frequency of feedback impacts learning.

 

 

So what?

It’s not just in the training room or out on the track where we search desperately for this sense of control. This need to ‘do something’ guides many of our behaviors are. They are there to make us feel like we are doing something. It’s to give the illusion of control.

The yelling and screaming, the use of the latest fad treatment, the post race talk; these are all examples of things we do to make ourselves feel better. The same thing happens in the collegiate and corporate world. The leadership meetings, the pseudo-enforced ‘charity’ meetings, the programs designed to look good but accomplish very little (i.e. most life coaching/skill programs) are all further examples of making us feel good. They all create the illusion of control and accomplishment.

So next time you assign a workout, give a lesson, or tell an athlete to get a treatment, ask yourself if you really think that it will improve the athlete. Or are you simply pushing them in that direction for the simple sake of “doing something.”

 

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When doing nothing is better than doing something.

5 thoughts on “When doing nothing is better than doing something.

  • April 7, 2016 at 8:25 pm
    Permalink

    Steve,
    I follow much of your work and have read most of what you've written, great stuff. I had to comment on this article though for a few reasons. One, the analogy of cupping treatment to that of a coach waving and yelling at an athlete is a bit a of a stretch. I get the point, but the truth of the matter is you are taking secondary knowledge, pairing it with primary and then dispensing it to the masses. I don't practice cupping, but we do a lot of similar techniques, and while I'll be the first to admit that placebo/nocebo is a much larger player than most give it credit and thus should be used appropriately, but the surge in all of these methods/techniques is largely in part due to the swell of interest/information in pain neuroscience. The 'do nothing' mantra is a card to have in your deck, but we now know more than ever that tissue pathology does not correlate to pain, and that subcortical compensations set in early with an injury cycle. So, to get to my point, even though sometimes tissue does need to be left alone to heal, there are 'things' that should be done to keep a high level athlete from putting in more work than needed after an acute injury.

    Beau Beard, DC, MS, CCSP

    Reply
    • April 7, 2016 at 8:33 pm
      Permalink

      Beau- Thanks for taking the time to read and reply. I actually agree with most of what you've say. I intentionally left the discussion of whether it was efficacious or not out of the reader. The simple fact is I could have used any modality and the point remains.

      And I don't think it's a stretch. My point was that many of the things we do, whether it's in treatments used or things said or doctors dissension of medicine, isn't because we know for sure this will work. It's to 'do something.'

      Not all of the time, but often, we get in the mode of throwing the kitchen sink at things. The point isn't to always let the body heal, but it's to know when you need to step away or know when to try something different. The point of the post is to get people to step back and not follower their default "do something" mode. Instead, think about whether something is really efficacious, or whether you are doing it to simply satisfy the need to do something.

      If you truly think cupping or stim or whatever is the best course of action, then you aren't in autopilot 'do something' mode. But I'd argue that we are in that mode far often than we'd like to admit.

      Reply
  • April 8, 2016 at 12:55 pm
    Permalink

    Thanks for another great piece Steve.

    Personally, I like to keep the Plato quote front of mind:

    “Wise men speak because they have something to say; fools because they have to say something.”

    Reply
  • April 8, 2016 at 3:11 pm
    Permalink

    Interesting reading! I think, too often we turn our heads with frustration from the plain fact that some things take time for the body to compensate for/heal from. There is little we can do to speed up nature but , boy oh boy do we try! I'm all for helping/assisting any way possible. I'm a massage therapist working in an office of certified sports chiropractors. We use much of what you mentioned, Graston, e-stim, ultrasound, also cold Lazer, traction, etc, but end of day, sometimes the body just needs time. In my own personal marathon training I did EVERYTHING I read about to speed recovery, etc. Ice baths for months ulgh! Not really sure it was the best thing in the long run. The point I'm making is I understand YOUR point, that even though we feel like something needs to be done doesn't mean that anything really should be done except to make us feel like we have more control in what the body is doing. Super interesting thinking, thank you!

    Reply
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