Thursday, 11 December 2014

Neuroplasticity, neuroplasticity, neuroplasticity … The new overuse syndrome: Neuro-babble Tourettes

Never have I seen a word bandied about with such reckless abandon. 'Neuroplasticity' is simply ubiquitous, try a search on Twitter or Google, it’s a veritable delight of the good the bad and the ugly.

BUT what if I told you that ‘neuroplasticity is considered by some to be a dirty word … Not my opinion, but rather that of Vaughan Bell a London based neuroscientist and clinical psychologist.

So why does an eminent neuroscientist have such an aversion to the term?

Well my advice is to read the post, he describes far better than I ever could, how phrases like ‘your brain is plastic’, ‘rewire your brain’ and ‘neuroplasticity’ are virtually meaningless.

‘Neuroplasticity sounds very technical, but there is no accepted scientific definition for the term and, in its broad sense, it means nothing more than ‘something in the brain has changed’. As your brain is always changing ... the term is empty on its own.’

The article has a helpful educational element and puts neuroplasticity into perspective, going on to describe some of the most common processes associated with the term. With the rider that  ...

‘the next time you hear anyone, scientist or journalist, refer to neuroplasticity, ask yourself what specifically they are talking about. If they don’t specify or can’t tell you, they are blowing hot air.’

But Bell is not the only one critical of the current trend towards neuro-babble. Tom Stafford a Cognitive Scientist at the University of Sheffield in the UK wrote an equally cutting piece on the emerging trend of neuroessentialism, a classic neurologism if ever I heard one!

‘The belief in, or tactic of, invoking evidence, or merely terms, from neuroscience to justify claims at the psychological level...’

It goes on … in a delightfully written piece entitled ‘Your brain on pseudoscience: the rise of popular neurobollocks’ which appeared in the New Statesman. Stephen Poole the British author and journalist dissects ‘the plague of neuroscientism – aka neurobabble, neurobollocks, or neurotrash …’ Poole has written previously on the misuse and abuse of language in the brilliantly acerbic ‘Unspeak: Words are weapons’ and his rhetoric comes as a warning to all with regard to the rise in neuro-vernacular. His incisive observation of how ... 'the “neural” explanation has become a gold standard of non-fiction exegesis, adding its own brand of computer-assisted lab-coat bling to a whole new industry of intellectual quackery that affects to elucidate even complex sociocultural phenomena.' takes a couple of reads (whilst I neuroplasticise and conceptualise ...), but is particularly enlightening.

Further, he quotes Paul Fletcher, professor of Health Neuroscience at the University of Cambridge, who suggests …

‘Too often, a popular writer will “opt for some sort of neuro-flapdoodle in which a highly simplistic and questionable point is accompanied by a suitably grand-sounding neural term and thus acquires a weightiness that it really doesn’t deserve. In my view, this is no different to some mountebank selling quacksalve by talking about the physics of water molecules’ memories, or a beautician talking about action liposomes.’

As physiotherapists we should both know and care what other professions and key writers are making of the real achievements and developments in neuroscience. Not least, because we need to be able to communicate effectively but also because we need to maintain and develop credibility. To spout forth repetitious neuro-babble, risks making us sound like new age neuroflaneurs and I am pretty sure that’s not a route we should be taking, as the profession steadily weeds out the nonsense.

While I’m on the case, just keep a look out for the emergence of neuro linguistic programming (NLP) amongst the maelstrom of information that comes your way. Indeed, I saw a tweeted PPT slide from a recent Physiotherapy conference detailing the key elements of NLP. If you’ve read around the subject, you may have encountered this eloquent deconstruction of that particular branch of ‘neurononsense’ … which you can find here.  If you are of a scientific persuasion, it would be wise to root out the ‘neuro-flapdoodle’ of NLP before it has chance to take root.

Thankfully, there does appear to be some awareness that we need to consider what we say and how we say it … I was alerted to an excellent piece on pain by Lorimer Moseley, entitled ‘It is not just the brain that changes itself – time to embrace bioplasticity?’, where, somewhat ironically, but honestly, he discusses the concept of ‘bioplasticity’. Moseley, clearly alerted to the linguistic pressures of the topic, makes light of the neurobabble by constructing a few (tongue in cheek) terms of his own. Then adds the following slice of antipodean back pedalling humour:

‘Bioplasticity is, from herein, the new black. I repent my neurocentric ways and hold aloft the banner of biocentricity. It seems to me to be a fairer reflection of what we know about ourselves and it is a sensible umbrella term for the changes that occur across multiple systems when, for example, pain persists, or when, for example, we try to change pain. In fact, these tasks that we call neuroplasticity training, do not only induce changes in the nervous system, so perhaps they should be called bioplasticity training. Just a thought. And immune activation. And endocrine response. And motor output. And heart rate fluctuation….’

So there we have it … and it truly is a thought that we should keep. Perhaps we really should consider a ‘system based approach’ (I think I have argued this case before…) to our consideration of pain and dysfunction. We should work together to combine the brilliant emerging elements of pain science and brain function with a sound consideration of the amazing system that is the human body, which of course includes the periphery. A brain requires a body, and vice versa … ask any suffer of quadriplegia or Wallenberg syndrome. BUT let us not become the new neuroflaneurs of pseudo pop-psychology, by endless repetition of meaningless neurobabble, because there are folk out there who clearly, can see through it.

Our role requires us to work in multidisciplinary teams and it may be prudent for us to be cognisant of the opinions of other professions with regard to the way the emerging knowledge is considered, disseminated and taught. It may be wise to consider our own linguistics and mantras in this field too ... lest we begin to sound like 'beauticians talking about action liposomes'. Therein lies our challenge ...

Here's a helpful linguistics tip … via the eloquently entitled neurobollocks website

‘when you see (or hear – sic) the word ‘neuroplasticity’ think ‘bollocks’ instead ... 99% of the time you’ll be absolutely dead-on.’ 

For those who find that perhaps a little harsh ... My own personal strategy hereon in, is to simply substitute 'neuroplasticity' with 'neuro-flapdoodle' every time I encounter it in common parlance ... It just brightens my days up no end. Such is the power of language. 

Alan J Taylor is a writer and critic who thinks about stuff and works as a Physiotherapist and University lecturer ... The views contained in this blog are his own and are not linked to any organisation or institution. Like Bukowski, he writes to stay sane.

You'll find him mostly on Twitter

Wednesday, 29 October 2014

Confirmation bias, physiotherapy and the highlighter pen ...

The recent Body in Mind blog post ‘Exercise for chronic whiplash: does it matter how we do it?’ by Zoe Michaleff, was an unexpected delight and breath of fresh air. Here you can see a top researcher reporting on a study that found the virtual OPPOSITE of what her team found, in an open objective account, without bias and without trying to tear that study apart from a methodological (or any other) perspective. She even went on to offer a plausible scientific explanation for the differences between the studies.

Why, you may ask is this so refreshing? Well, because we so seldom see it!

Whilst some commentators have gamely suggested we think carefully before alighting the latest 'bandwagon' (whatever that may be this week) and others have exhorted us to simply think. More commonly, we see a plethora of blogs/articles/tweets which support various theories or schools of thought, which are driven consistently by confirmation bias. In fact, it could be argued, some have even gone so far as to patrol the internet, helpfully fulfilling the role of rapid response 'Cyber Evidence Police'... and that's OK ('it's for your own security'), providing they are always right, BUT sadly, no-one is right 100% of the time.

Let's first consider the definition of confirmation bias or 'my side' bias ... 'the tendency for people to favour information that confirms their beliefs'. 

This YouTube clip is an excellent short resource.

Have you ever picked up a newspaper or magazine article and been drawn to a particular article and read it voraciously, lapping up the prose and rhetoric as you go? Conversely, have you picked up an article and discarded it after the first paragraph or less? Most people have, and the one of the factors that dictates whether you persist or stop is confirmation bias. In other words we like and enjoy reading stuff that floats our boat, or that confirms our long held/new found ideas and beliefs, and tend to avoid or ignore the converse.

The result is that we may become biased towards articles, research literature, books blogs, tweets, people etc. that confirm our thinking … It is human nature. I often see students working on critique of research papers for example, using a single marker pen. I can’t resist asking what they are highlighting … “the interesting stuff”, “the relevant stuff”, “the bits that support the theory I’m working on” etc. 

Only occasionally does anyone have two different coloured marker pens … one for the supporting evidence and one for the opposite point of view. Try it yourself, concentrate on what doesn’t support your theory for a moment, concentrate in the holes in the theory, the method, look at an argument from the opposite side. It is both illuminating and revealing and naturally, you’ll probably find the second marker pen is used a lot less than less than the first. Of course, that may be because of what you chose to critique in the first place.

Believe it or not … Human nature and confirmation bias may lead you to overlook the methodological, scientific, statistical or philosophical holes in one paper, whilst using all of your might to apply those things to another. In other words, there may be a tendency to ignore or under weigh evidence that could dis-confirm an opposing hypothesis. We see examples of this time and time again in the interpretation of physiotherapy evidence.

It is always worth asking yourself ... “When is the advocated theory ever wrong?” Nothing works all the time. An astute person is aware of the limitations of any idea or practice. Challenge any 'authority' to explain the alternative of their position, and when they might use another option ... You can see more on that approach here.
What is even more revealing is when we see ‘conversions’ from one school of thought to another. Take a moment to look at this blog article on the 'conversion' of a staunchly religious person to an atheist and what happened thereafter. Not untypically, the post conversion individual went on the attack and " … dismissed all others’ beliefs and assumed his was correct". That frankly, is not a brilliant scientific or philosophical stance to take regardless of the 'evidence', there is always a contrary view and another side to any coin ... and the evidence base, as we know is an ever changing landscape. 

So that is why Michaleff's article was a breath of fresh air … I think, as a profession we can all take something from that ... and perhaps 'work together and learn together'.

If you want to read a little more on the various types of bias that may permeate our World ... this article is not a bad place to start. 

Personally, I’m just off to the 24h multicoloured highlighter pen shop.

Author: Alan J Taylor is a writer and critic who thinks about stuff and works as a Physiotherapist and University lecturer ... The views contained in this blog are his own and are not linked to any organisation or institution.

You'll find him mostly on Twitter

Wednesday, 2 July 2014

What is the difference between cancer & whiplash?... Here's what!

That was the question ... posed by David Butler on the noijam BLOG on 29th June 2014

When I first read this post and the reaction on Twitter, I was initially surprised by the fawning sycophantic compliments of self proclaimed skeptics... so I read it again and frankly I was appalled (at many levels).

Then when I suggested via Twitter that the post was 'bombastic nonsense' … I was asked quite logically by a PT student, exactly why I thought so?

Twitter with its 140 characters is hardly the best medium for such discourse, so here is the response in detail.

Well here’s why …





1. The analogy 'Cancer-Whiplash' is meaningless and badly chosen . . . 

Whilst sympathising entirely with the authors’ stated proximity to the subject (cancer), this cannot allow us to stray into emotional territory … lets keep it as factual as possible.

Cancer is acquired insidiously – Whiplash associated disorder (WAD) results from trauma.

Cancer may lead to death – WAD rarely (to avoid that unwanted complication see here)

Cancer is easy to diagnose – WAD diagnosis is in its infancy

Cancer has clear care pathways and the ‘management process can be mapped out with confidence’ – WAD is both difficult to diagnose and little is known about the most effective treatments.

Cancer research is MASSIVELY funded all over the World – WAD has pockets of minor funding.

In oncology, clinicians are more often than not, able to be very clear about the diagnosis management and prognosis - In WAD sadly, this is not so.

Cancer and WAD are NOTHING like each other … the analogy is meaningless.

To suggest so ... frankly verges on disrespect to the genuine sufferers of either malady .... of course, REMEMBER only WAD patients are ever doubted.

2. We don’t need another bullshit acronym!


This is the bit when I first started to laugh and double-checked the date …could it actually be April 1st ...? 

Then I began to laugh again, this time with tears rolling down my cheeks (see below).

Yes, at its basic level WAD is (‘just’..!) a sprained/strained neck … providing of course, that is ALL the patient complains of!?!

BUT … SNSNI = ‘Sprained neck at speed with frequent neural irritation’ …Help me please … 
This HAS to be a joke??

Physiotherapy as a profession, has been beset with a plethora of ever changing, confusing acronyms since its inception … ANT changed to AND … Mmmmm!

ULTT1 (UK) is also BPPT (Aus) ... even better! 

In the perceived wisdom of the ‘noijam group’ we should be adopting SNSNI … Oh, wait a minute, can’t we lever in some MORE LETTERS?

'SNASWFNI' is surely a lot catchier ... The (Welsh) medics will really take to that??

Maybe NOIgroup (note the acronym) can hype it a little ...?

Wait a minute … Haven't the pain scientists been spending some time QUITE RIGHTLY suggesting that we should be changing our vernacular (lose the SCARY language people) when describing conditions to patients.

Lets just imagine the patient-therapist discourse for a moment …

Patient … “Hello I have some neck pain following a motor vehicle collision”

Therapist – “Oh you are probably suffering from SNSNI” ... (go on try saying it out LOUD!)

Patient – “Pardon me, … Uh uh, you sound like you have sinusitis?”

Therapist – "Let me explain… You have SNSNI … That means you have a sprained neck" (smiles knowingly)

Patient – "Is that what they used to call ‘whiplash’"

Therapist – (Laughs) … “I suppose so”

Patient – "So what do all those fancy letters mean?" (looks a little worried)

Therapist – "Oh, it’s just short for 'Sprained neck at speed with frequent neural irritation'”

Patient - … (looking around nervously) “… errr, excuse me, I think I need to use the bathroom." (gets up and bolts for the nearest door … )

Is that just THE SCARIEST description you have ever heard??

Shame on you Noijam … You’re promoting the very thing you asked us all to STOP!

… and anyway, why would any skeptic worth their salt, buy into the concept that it is JUST neural tissue involvement in WAD ... That is nonsense by any stretch of the imagination.

Oh of course the caveat of the cleverly used word ‘frequent’ allows a brilliant get out clause.

BUT the suggestion remains. Is this really sound thinking?

'There's no room for bullshit ...'

NOIjam group suggested that there was “no room for bullshit” in WAD … and then IMMEDIATELY introduced a massive wedge of nonsensical Guru generated acronym BS straight into the pot??

3. There IS no sectarian war …!

Or if there is, it is self promulgated, self promoted and self fueled by nonsense and evangelical hype. 

Yes, there IS an on-going ‘guru’ culture in PT, but any perceived 'war' is of the protagonists own making. What we have in PT, is a young profession (this is not medicine), struggling gamely to make sense of the ever changing science and the BRILLIANT work done by folk in many fields ... see here and here and here for some examples in WAD.

In WAD … YES at this point in time, confusion reigns, but that is not a time to scoff, sneer or hype up your own paradigm (you're not the first ... and you won't be the last). 

YES … Recent RCT’s have shown that many current methods of management have be called into question … THAT IS BRILLIANT ... thanks to those researchers.

…but it is NOT A TIME TO DEMAND APOLOGIES … in some kind of perverted game of 'you were wrong ... BUT we were right' ... that truly would be nonsense of the highest order.

Remember students, clinicians and the PATIENTS sit in the middle of this maelstrom …

Let’s all try and help physiotherapy to change together, with a little less of the NONSENSE & HYPE!

It is a time to reflect, a time to change, a balancing act ... and it may be easier to balance on the middle ground ...

Nothing stays the same ... and pendulums swing!

CANCER & WAD ? Yes, it was just an analogy, of course!

But just like the acronym that arrived on our doorstep uninvited ... it was badly chosen.

Go on NOIjam …tell me #SNSNI was actually a product of the hayfever season ...

Sneeze hard enough and the 'war' might be over ... Cheers!

P.S. This post was was submitted to the NOIgroup in response to their BLOG ... Can you see it?

'the comment is awaiting moderation' ...

UPDATE (03.07.14) - Deleted .... they said it was the link!

Just the sycophants (WITH hyperlinks...) remain ...

UPDATE (11.07.14) Ad hominem attack from NOIgroup (Group V's individual) ... Here ... Accused of being a 'troll' for daring to disagree ... and prodding the soft underbelly of a Corporate giant.  

For those not familiar with this sort of thing ... In argumentation, an 'ad hominem attack' is an attack based on some irrelevant fact about the person NOT the argument ... This sort of thing is not uncommon when someones view or strongly held belief system is challenged see here. 

It is perhaps about as low as argumentation gets ... and in its delivery, often reveals a great deal more about the attacker/s than the target.

It makes interesting reading, and illustrates what can happen when any individual challenges a Corporate view of the World ... ugly, unnecessary and perhaps not the best of endorsements for the profession.

What was perhaps most interesting about this vitriolic, attempt at character assassination (apart from the distortion of fact) was the complete lack of insight and humour.

Humour (or lack thereof) can tell us a lot about how people approach critical thinking ... and as one commentator said, "Think about the last time you had your mind blown by a new explanation backed by some elegantly simple research. My automatic reaction is always laughter followed by the words, “Son of a bitch. Why didn’t I see that before?”. 

Never be so humourless, as to think yourself above critique. Or, as the French would say, it is always wise never to "péter plus haut que son cul'.


UPDATE (12.07.14) Here is the bottom line ...

If, on the internet, someone (anyone) chooses to write a provocative, emotive blog ... They simply HAVE to expect someone to be provoked by their rhetoric... to raise a debate or challenge ... Unless somehow they think themselves fireproof or above such challenge.

The kitchen, as we all know ... is HOT.

... It would be a sad passive World if everyone simply nodded in passive agreement to ANY so called authority or belief system.

This whole thing goes way beyond this little storm in a TweetCup, it is a much bigger debate about how a profession deals with change, moves forward ... and how it (and the players within it) really should WORK TOGETHER ... Long may it continue :-)

ACTUALLY ... and for clarity, I think the above paragraph was my KEY POINT


Alan J Taylor - is an ex-professional cyclist, Physiotherapist and writer. Like Bukowski ... "he writes to stay sane". He is a medico-legal expert witness, in the field of clinical negligence related to manual therapy and stroke or other haemodynamic events.

He has worked as a lecturer in Physiotherapy and Sports Rehabilitation & Exercise Science at the University of Nottingham since 2010.

He worked full-time as a physiotherapy clinician until joining the UoN and maintains a clinical case load via his Consultancy, which regularly takes him to to some of the UK's leading sports clubs. He deals with a variety of pain and performance related cases, many with a haemodynamic bias. 

Tuesday, 1 July 2014

The Tour de France is coming to town … Time to get on your bike!

University of Nottingham Physiotherapy Lecturer and ex Tour of Britain rider, Alan Taylor reckons there has never been a better time to get on the cycle path to health and happiness! 



The Tour de France is coming to town LITERALLY, as it visits Yorkshire for the ‘Grand Depart’ on Saturday 5th July. 


Exciting times … and your chance to soak in the unique atmosphere of the Worlds biggest bike race. Cycling and the Tour de France in particular, has a little bit for everyone. Billed as the Worlds toughest sporting challenge, it has more than its fair share of blood, sweat and tears, with drama and controversy never far away. That’s not to mention the beautiful countryside that serves as a backdrop to those well oiled legs.

The Worlds top bike riders take on the hills and valleys of Yorkshire as they make their way from Leeds to Harrogate (Stage 1) and York to Sheffield (Stage 2) before heading south for leg between Cambridge and London (Stage 3). It promises to be fun all the way as road becomes lined with LIFE, the bunting goes up, the flags are waved and the music plays. All along the route ... it's party time!

Don't just be a spectator ...

But it’s not just about being a spectator there’s a host of events for wannabee Chris Froomes’ – For those of you who may have missed it Chris Froome won last years event for Team Sky, following the success of Sir Bradley Wiggins in 2012 - Team Sky host a series of rides to keep up the momentum of the Tour visit and encourage cycling for everyone.

From a health perspective, cycling gets people active, it's gentle on the joints and gives a cardio vascular workout.  It’s also a super cheap and quick way to commute in busy cities. As a pastime that can be enjoyed by all age groups, it fits well with Government backed activity schemes like ‘Change4life’. The positive benefits of cycling on happiness and mental health shown by recent research, have far reaching health benefits for everyone.

Remember, Einstein said of his theory of relativity … "I thought of it while riding my bicycle." If you need any convincing at all, that dusting off that old Claude Butler is the right thing to do, then take a look at this ...!

You’ll find no less than 30 good reasons for joining in the fun.

So if you want to look younger, live longer, bolster your brain power and … errr improve your sex life? ... Le Tour is coming!


... erm, I'm sure there's a haemodynamics link here somewhere??

Get the wind in your hair ..!

It’s time to get those wheels turning, British Cycling is on the threshold of a change in attitudes in the UK, and we can all get the wind in our hair (laughs...).

As ex-tour rider Chris Boardman so rightly said "This isn’t just about cycling, it’s about creating accessible, pleasant, healthier places." Read about the Tours projected lasting legacy here

Alan Taylor is a Lecturer in Physiotherapy and Sport Rehabilitation & Exercise Science at the University of Nottingham. He rode the Kellogg's Tour of Britain in 1988 and still rides a bike for pleasure and commuting. Sometimes he plays in a band ...

(Follow on Twitter @Tayloralanj)

For a full run down on the PARTY that is the Tour de France ... Go here 


Oh ... and if you happen to be near Hebden Bridge... Go here

Wednesday, 23 April 2014

The art of ‘naysaying’ …evidence based practice and whiplash associated disorder

So first of all, what is a naysayer?

Well, the Merriam-Webster gives the following definition – “a person who says something will not work or is not possible: a person who denies, refuses, or opposes something”
The Urban Dictionary definition is somewhat lengthier and perhaps more revealing:
One who frequently engages in excessive complaining, negative banter and/or a genuinely poor and downbeat attitude.”
They continue … “Naysayers are distinguished by their tendency to consistently view the glass half empty, make frequent one-way trips to negative town, and constantly emphasize the worst of a situation. They have the keen ability to spread their pessimistic attitude to a group of unsuspecting bystanders and encourage others to employ their mind-set.” 

From a behavioural perspective they suggest that “Naysayers … will stop at nothing to bring a general sense of negativity to any situation.” 


BUT … What has this all got to do with Physiotherapy and evidence based practice?


Because it is EASY to be a naysayer in the tiny World of evidence based medicine (EBM) or practice (EBP). We seem to be beset by a veritable queue of them, some aspiring desperately to be the next EdzardErnst (he made a career out of it … and still does!) within their own ‘specialist’ domain. 


Physiotherapy (PT) has not escaped this trend. There is an increasing army of bloggers (he said from his blog … such irony!) and Twitterati, who now peddle their view of the World. They utilise the latest evidence, to back up their statements and often negative rants about WHAT DOESN’T work in PT (Yawn! If you haven't seen one, don't go looking for one ... you could end up writing a blog!). 
They pre-empt criticism, by cleverly suggesting that anyone who disagrees  with their interpretation of the the evidence, is either ‘unscientific’, a ‘fool’ or perhaps a ‘curmudgeon’, thereby discouraging discourse or opposing views from the outset.
…and so what?  I hear you ask!
PT has come a long way in the last decade or two, in terms of its use of the evidence base, to drive treatment interventions and mould out-dated thinking and practice. As each day goes by we find more and more studies, which guide the way we treat and rehabilitate our cases. 

Of course, it can be very puzzling and even soul destroying for clinicians to find that a mode of treatment which they believed was ‘effective’, is suddenly found by the latest study to have little or ‘no effect’ ...BUT that's life, it makes us stronger!

A good example is the recent publication in the Lancet, which suggested in its ‘Interpretation’ section … “We have shown that simple advice is equally as effective as a more intense and comprehensive physiotherapy exercise programme.”


This type of conclusion ... naturally comes as a body blow to clinicians, many of whom have an inherent faith in the belief that their interventions are doing good. 


So just when you were feeling a little vulnerable ... ENTER THE NAYSAYER! … Usually a confident and bold academic type, who with all the guile of Jeremy Clarkson in a dog naming competition
...explains gleefully in a detailed blog, that, ‘actually folks you got it all wrong’ ... which of course he/she knew all along … and which is now ‘evidenced’ by the latest trial!

Brilliantly done and incredibly EASY … BUT WHAT IS THE POINT?
Answer … There isn’t one!
… Though they WILL say, they are disseminating information … updating us all on the latest evidence. 

Errr maybe … OR it could be argued, gleefully exercising blatant ‘told you so’ promotion of their own Worldview. 

Naysayers seldom offer a pragmatic alternative ...

Academics have the luxury of being able to access, read and analyse the latest research and some do that brilliantly, as do many clinicians. As a result there is a plethora of blogs, which are designed to be genuinely helpful to clinicians and academics alike, and give thoughtful interpretations of contemporary evidence, which can be translated into practice. The sportsphysio is one excellent example, rogerkerry.wordpress is another.
Thankfully, as the Urban Dictionary helpfully suggests, naysayers are, “Not to be confused with non-naysayers … who fight against the negativity brought forth by naysayers, make the best of a situation and are not afraid to call out a naysayer on the spot.”
My personal advice to busy clinicians is to seek out the pragmatic NON-NAYSAYERS (like those mentioned above and here). Those who have the ability to construct rather than deconstruct their own profession, whilst at the same time, embracing the concepts of contemporary science and evidence based clinical practice. 

Change is required, but not via the medium of lofty negativity.

On the subject of whiplash injury

This is NOT a trivial subject … The emerging science is welcome, it is clear that PT’s will need to look carefully at current practice in the light of contemporary studies relating to Whiplash Associated Disorder. 

Prof Michelle Sterling herself, suggested a PT role in assessment, sub-grouping, early recognition of PTSD and triage (for early cognitive behavioural therapy) may well be sequelae of the groups latest findings. 
Using Michaleff et al’s study as an example, DON’T FORGET ... it only looked at one particular ‘pragmatic exercise programme’ ... devised by 'experts' YES, but was it the right type of rehab, applied at the right time? 
In other words, in the same way that the emerging research has guided our thinking on best practice in ACL rehab for example, it may well guide us further in the field of WAD.

DO NOTE (because the naysayers may have missed it ...) the final paragraph in another Lancet Article relating to WAD and exercise… 

 “… These findings should NOT be interpreted as encouragement to abandon exercise therapy in these patients: ... the question is HOW & WHEN to exercise people with chronic whiplash-associated disorders.” (upper case, for non-naysayer emphasis) 

Academics might dwell for a moment on this statement from Nijs and Hickman 2014 ... 

"Physiotherapy curricula are only starting to integrate cognitive behavioural therapy as part of pain management modules ... Future physiotherapists might have the necessary attitudes, beliefs, and skills to apply specific cognitive behavioural therapy rules during exercise therapy for chronic pain patients, including those with whiplash-associated disorders."

FINALLY clinicians, ask yourself honestly … (with or without CBT) when was the last time you REALLY applied resistance to cervical spine musculature during neck rehabilitation?  ...and more importantly, would it make any difference to outcomes?

The jury, on those particular questions will remain out for some time.  

REMEMBER pendulums swing! 

For a guide on useful BLOGS and 'Physio Twitterati' ... Here is the helpful physiotalk BLOG


This article was written by a curmudgeonly, argumentative NON-NAYSAYER, entirely for the purposes of pleasure and self promotion (..ha, ha!). 

Any association of this article with any particular blog ... or any person living or dead, is entirely constructed via the imagination of the reader.


Alan J Taylor - is a medico-legal expert witness, in the field of clinical negligence related to manual therapy and stroke or other haemodynamic events.

He has worked as a lecturer in Physiotherapy and Sports Rehabilitation & Exercise Science at the University of Nottingham since 2010.

He worked full-time as a clinician until joining the UoN and maintains a clinical case load via his Consultancy, which regularly takes him to to some of the UK's leading sports clubs. He deals with a variety of pain and performance related cases, many with a haemodynamic bias. 

Geary K, Green BS, Delahunt E (2014). Effects of Neck Strength Training on Isometric Neck Strength in Rugby Union Players. Clin J Sport Med. Feb 24. PMID: 24561636  

Michaleff ZA, Maher CG, Lin CW, Rebbeck T, Jull G, Latimer J, Connelly L, & Sterling M (2014). Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. Lancet PMID: 24703832

Nijs J, Ickmans K.Lancet (2014). Chronic whiplash-associated disorders: to exercise or not?  Lancet PMID: 24703833