27th November 2015

What would you do if you won the lottery? Most people’s response would be to quit work immediately throwing their champagne soaked resignation papers at their boss. However, it is worth considering that there is evidence to show that around 75% percent of people who unexpectedly come into large sums of money, end up broke within 5-7 years. Ok. Maybe seven years of luxury and decadence isn’t so bad, but it makes me think of the old adage that if something seems too good to be true, then it probably is. There is always a catch!

The Health and Fitness industry is replete with products and interventions claiming to provide you with a golden ticket to health, normally in the form of a six pack torso, or shapely behind. Minimal hassle with maximum gains. But before you go investing, it is important to consider that most of these peddled goods are not classified as medical products. As such they are not subjected to scientific scrutiny, essentially giving a free pass for advertising and marketing. As an example, think of the half-clad body shots we are accustomed to seeing – ‘this was me before my magic supplement (breathing out), and this was me after just four weeks (breathing in with photoshopping)’. These are classic examples of selective reporting; a sneaky trick in the ‘health and fitness industry’ whereby only relative successes are advertised. So before you fall for the next transformation photograph, ask yourself the following simple questions: How many others were photographed? Is this an average result? Or an outlier? Were there any side effects? And most importantly, what are the chances of a long term benefit?

When an athlete gets injured, they will often try to seek out quick fixes. These often come in the form of pills, potions, or magic interventions from a self-proclaimed treatment guru. But don’t these interventions often work? Almost everyone has a friend whose sore back was clicked back into place by a local bone setter. These types of anecdotes do exist, but they do not represent a high level of scientific evidence and delineating a causative mechanism is often difficult. The longer an injury persists, the more likely athletes are to try extreme interventions. Paradoxically, the chance of recovery also increases with time, a phenomenon known as regression to the mean.

We must also consider that many extreme treatments (eg. aggressive manipulations or ropey supplements) carry more risks than benefits. So for every tale of miraculous recovery that is selectively reported, there may be numerous tales of harmful side effects or at best money wasting. Still many interventions oversell their benefits and contrary to popular belief there is not a treatment on earth that can actually speed up healing (at least not to any clinically relevant level).

Rehabilitation is as close to a panacea as we can get in Sports Medicine care. I say this without fear of bias as there is significant evidence in peer reviewed journals, based on tens of thousands of athletes that progressive rehabilitation enhances the quality of healing (note I didn’t say speed) and decreases the chances of re-injury when athletes return to sport. But just like a lottery win, and miracle cure, there is a catch. And the catch is that rehabilitation takes time, energy and is sometimes hard work. This is why, in spite of excellent scientific evidence for rehabilitation, athletes continue to be tempted by the lure of quick fixes.

This type of dilemma resonates across modern life whereby we often procrastinate the hard stuff, in favour of an easier alternative that provides instant (albeit short lived) gratification. Finding ways to comply with rehabilitation advice (or exercise or physical activity advice for that matter) is without doubt our greatest challenge in today’s quick fix world. In his book ‘The Procrastination Equation’ Dr Piers Steel provides some clever advice on this. Here’s how I see some of this advice fitting in with the challenges of rehabilitation. Whilst we can never get to the point where there is ‘no catch’ these pointers should certainly ease the process:

– Focus on short term goals. Often athletes focus entirely on returning to the field of play and therefore often overlook important daily or weekly achievements. Rehabilitation can be a long road, so remember to celebrate and recognise small accomplishments thereby spiralling further motivation and successes.

– Keep rehabilitation challenging. Once you have mastered an exercise or goal, move on. Rehabilitation should be progressive and challenging – therefore engaging. If exercises are too easy, or too hard, we tend to disengage.

– Take control. As in any relationship, there should be a healthy balance of power between an athlete and a therapist. If your therapist is too autocratic then change to one who listens to you and helps empower you to take control of your rehabilitation.

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