musculoskeletal system ( or perhaps more inclusively , it should be called the myo-fascio-skeletal system , or perhaps even better , the neuro-myo-fascioskeletal system ).
If this does not make sense , perhaps a good comparison might be why adolescents who smoke do not die from lung cancer or heart attack , but adults do . It takes time for the cumulative effects of a chronic stressor to impact the person ’ s health . And I believe that there is no doubt that FHP is a chronic stressor to the tissues of our body .
There is an old adage that I believe applies here : “ If we do not change our direction , we are likely to end up where we are headed .”
And actually , there was one more piece of information that should have made the authors of this research study come to the idea of overuse accumulated stress as the most obvious reason ; that is that the authors of the study state that “ In adolescents , forward head posture is associated with lifetime neck pain prevalence and doctor visits due to neck pain .” ( Emphasis in italics is mine .) In other words , adolescents with FHP will be more likely to have neck pain later in life . However , even with this information , the correlation was missed .
This is another reason why I sometimes find evidence-based research to be frustrating . Although research can give us some wonderful data , we need to also be able to critically think by understanding and applying the principles of the structure and function of the body .
Role of Evidence-Base Research
So , I have devolved into a discussion of evidence-based research and its role in the world of manual and movement therapy . I must say this first … I love research . Scientific evidence-based research shows reproducibility . It is extremely important . True unbiased research is an excellent antidote to the increasing tendency in our modern world for confirmation bias . It can help to keep us honest and point us toward safe and effective means of assessment , prevention , and treatment . But it is not flawless . Ultimately , even if an entire study is carried out flawlessly as a gold-standard , double-blind study , with random sample populations , excellent inclusion and exclusion criteria , and appropriate treatment and placebo sham treatment , there still must be interpretation . And as we have seen with this study , I believe that the interpretation here was lacking . Further , most people read only the abstract of an article wherein it is hard for us to take any conclusion other than the interpretative conclusion of the authors of the study .
How Do We Know What We Know ?
So how do we know what we know ? I believe that there are four major models for accumulating knowledge and wisdom : 1 . The authority model , 2 . The experimental model , 3 . The evidencebased research model , and 4 . The critical thinking model .
Authority Model The authority model posits that we follow whatever authority we believe can impart knowledge and wisdom to us . Sometimes the phrase “ sage on the stage ” is used to describe a seminar or workshop presenter who is the proponent of some technique . Or perhaps “ sage on the page ” for the author of a book that we read ( or even this article ?). The problem I have with this model is that authorities often disagree with each other . So , whom do we believe ?
Experimental Model The experimental model involves us trying out with our clients some manual or movement therapy technique that we have learned . After all , if it is valid , we should see good results with our clients . The problem with this model is twofold . First , our clients do not necessarily want to be our guinea pigs for us to learn . Second , and more importantly , when first learning a new technique , we might not have the expertise to carry it out well enough to judge whether it is effective or not .
Evidence-Based Model The third model is following evidencebased research . I believe this is important but can have the limitations that I have discussed ( as well as others ). I recently came across a post on Instagram that said : “ Don ’ t let ‘ the research ’ get in the way of LOGIC and CRITICAL THINKING … Research is only one piece of the puzzle , don ’ t let it blind you .”
Critical Thinking Model While there is some value in each approach to gaining knowledge and wisdom , I believe that the fourth model for learning is the most important . That is , critical thinking . We might never know all aspects of how the human body works , but our understanding of the fundamentals of the biomechanics of tissues ( characteristics like tissue adaptation , elasticity versus plasticity , creep , etc .) as well as the biomechanics of forces and movement ( compression , shear , torsion , tensegrity , etc .), as well as our understanding of how the nervous system organizes the myofascialskeletal system ( proprioceptive neural reflexes , neural facilitation , etc .) are well understood and time-tested .
Ultimately , it is our role to treat and counsel our clients about their postural patterns , including FHP . While we can consult what thought leaders in the field say , and we can consult the latest research findings , I believe that the most important thing is to take a step back and look at the mechanics of the posture . What muscles are shortened , lengthened , or working harder ? What are the loads on the fascial tissues and bones ? What are the mechanics ? What are the pathomechanics ? What are the physical stresses to the tissues ? What will be the likely effect of those stressors on the health of the client ’ s body ?
12 | vol28 | no1 | JATMS