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The prodigy problem

 •  • by Paul Ingraham

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 PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

I often report evidence that Brand X therapy or exercise doesn’t work very well, if it all. And, almost always, I get protests that it works if done properly — as opposed to the presumably typical version that was tested. This is problematic, even if it’s true. There’s probably not much point in branding a method of therapy or exercise if its benefits are inaccessible to most people. This is the “prodigy problem” for modalities: if it requires exceptional intelligence and skill to implement, then it’s a hollow victory that is excluding everyone else. How good can it be if the average professional cannot deliver it, and/or the average patient cannot learn it? And can anyone actually tell who the prodigies are? Treatments that aren’t reasonably replicable are not worth much in practice. I can’t really recommend a treatment that is useless in the hands of 85% of practitioners. And yet the world of therapy is quite preoccupied with the idea of the special therapist who can deliver results that others cannot …