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Progressive exercise fails a test?!

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Ever seem like science is all about disappointing us? 😜 It sure does in the pain and rehab world, where things that “makes sense” rarely seem to hold up when tested. Hopewell et al., regarding rotator cuff disorders, emphasis mine:

Progressive exercise was not superior to a best practice advice session with a physiotherapist in improving shoulder pain and function.”

The principle of exercise progression in rehab — taking baby steps from the injured state back to normal — seems extremely sensible. It seems so reasonable that it’s hard for me to wrap my head around the idea that it might not actually, y’know, work. (Where “works” means that it results in recovering faster/better.)

But here we are. Test all the assumptions. Most ideas/claims about health prove to be wrong. The null hypothesis usually gets confirmed, in the same way that “the house always wins.”

Obviously I am not saying that this citation is the Last Word and that progressive exercise has to be thrown out. (And, for the record, that is almost never what I am saying when I cite anything. Though occasionally it is on a topic like, say, homeopathy). It’s just really interesting that this test of progressive exercise in one context had quite a clear negative result. It pisses on my bias, that’s for dang sure. I do not like this outcome! It bothers me! It makes me want to peevishly look for flaws in the paper so I can dismiss it, as one does.

But I am resisting that impulse. For now, I’m just absorbing the message that there is some evidence that clearly casts reasonable doubt on what I have believed and want to continue believe.

I’m just going to sit with that for a bit and practice being comfortable with uncertainty.

Flow chart: first cell, new study published. Second, does it confirm my beliefs? If yes, must be a good study. If no, must be a bad study, nitpick and find flaws, bad study confirmed. Both pathways lead to the conclusion: I was right all along!