When You Assume It Makes An Ass Out Of U and Me

This is a huge topic and I can only scratch the surface in a single blog, but this topic is so important and so close my own heart, I just have to write about it.

The sheer number of assumptions we all make when assessing and treating our clients is astronomical.

The trouble is, we don’t realise that what we are doing is making assumptions; we believe that we are merely applying what we have been taught, and that this fine … 

… isn’t it?

Well unfortunately no 😢

The biggest issue with making assumptions is that the problems created are cumulative.

We make 1 assumption and this naturally leads to another assumption, and then another, to the point where we are on such unstable foundations that nothing we do from that point on is viable.

Assumption = Conclusion = Action is the dangerous equation that I am dealing with in this blog. 

An equation that misses out THINKING and THOROUGH Clinical Analysis.

Please note:

The is a big difference between 'Clinical Reasoning' and 'Clinical Analysis'.

With Clinical Reasoning, we typically apply models, patterns and experience to arrive at the WHAT, WHY and HOW of a given client problem.

With Clinical Analysis, we work all this out, from scratch; no meaningless, imprecise language, no assumptions and no "I've seen this before, therefore ...".

At this point, If you haven’t read my last 2 blog posts, then I urge you to do so:

https://learning.theintegratedfitpro.com/blog/stop-using-bad-language

https://learning.theintegratedfitpro.com/blog/wysinwyg

The 3 Most Dangerous Assumptions Are These:

(1) If the language we are using (and thinking) is unreliable, and then:

(2) we are relying on what we SEE and what we FEEL to build an intervention strategy, how on earth can be move forward?

That’s 2 sets of assumptions already.

But actually, the most problematic (I’d say dangerous) assumption of all is:

(3) “Ah , I’ve seen that before, I know what that is / I can fix that”

If this is our starting point, there is no way on earth that anything we do from that point onwards will be stable or viable.

We must begin working with very single client from scratch, taking a position of “I don’t know, but I am going to find out for you”.

I recently posted about 8 Radical Changes that need to become embedded in our industry, changes designed to reverse a series of unreliable assumptions, that when stacked on top of each other, result in a VERY unstable structure!

I will map out these 8 Radical Changes and Associated Assumptions below.

My 8 Radical Changes

Let me go through my Radical Changes in relation to “When You Assume It Makes An Ass Out Of U and Me”

I will go through these in a slightly different order than usual.

Making assumptions typically leads to jumping to conclusions. And these conclusions typically lead to the interventions we then apply with a client. 

We are all taught that “Tight” equals “Stretching and Releasing” and that “Weak” equals “Strengthening and Conditioning”.

The fact that we have seen, felt or assessed (see later) what we believe to be “Tight” or “Weak” sets this assumption as a foundation for much that we do thereafter. 

But “Tight” and “Weak” are ‘Not Valid Clinical Conclusions’ (see my blog here ➜ https://learning.theintegratedfitpro.com/blog/stop-using-bad-language)

They are merely adjectives that we are all taught to use, but that lack any precision or meaningful information about WHAT is going on, WHY it is going on, and HOW we should proceed.

So, can you see that starting with a seemingly simple statement (e.g. it’s ‘tight’) can lead us to jump straight to ‘intervention’ (e.g. stretch and release). 

We have already made an assumption that has resulted in us laying unstable foundations. 

When You Assume It Makes An Ass Out Of U and Me!

The majority of “Tight and Weak Models” and Patterns we are taught are INVALID.

e.g.:

• Tight and Weak Are Opposites

• Tight and Inhibited Are Opposites

• Short and Weak Are Opposites

• Upper- and Lower- Cross Syndromes

Upper crossed syndrome (UCS) refers to the condition that is characterised by tightness and weakness of the neck, shoulders, and upper back that cross between the dorsal and the ventral sides of the body

Lower Cross Syndrome (LCS) happens when there is muscular imbalance between weak and tight muscles. The tight muscles are generally the hip flexors and erector spinae, and weak muscles are the abdominals and gluteal muscles.

I explained in my earlier blog (link below) that adjectives such as “tight” and “weak” are imprecise and meaningless.

They tell us nothing meaningful about what is actually going on inside tissues.

What we DO know is that:

• Tight and Weak Are NOT Opposites, they are not even mutually exclusive!

• Tight and Inhibited Are NOT Opposites, they are not even mutually exclusive!

• Short and Weak Are NOT Opposites, they are not even mutually exclusive!

And based on the above, how on earth can the ubiquitous Upper- and Lower- Cross Syndromes possibly be valid? 

As I explain here (https://learning.theintegratedfitpro.com/blog/stop-using-bad-language), we need to establish what is going on with muscle STRUCTURE (Physiology) and muscle FUNCTION (Biomechanics and Biochemistry) in order to understand what is going on in tissues that appear ‘Tight’ or ‘Weak’.

Applying assumption-based models and patterns (I SEE THIS therefore THAT must also be true) such as those listed above, merely serve to lay down more and more unstable foundations, rendering our conclusions unstable as well.

When You Assume It Makes An Ass Out Of U and Me!

This brings us naturally on to Radical Change 6, around the use of commonly used Clinical Tests.

Many of the clinical tests we are taught supposedly provide an indication of “tightness” in specific muscles or other tissues.

Two notable examples of this are The Thomas Test and Ober’s Test. There are many others, but these two are sufficient to illustrate this issue.

Thomas Test supposedly indicates the presence (or otherwise) of tightness in the hip flexor muscles.

Ober’s Test supposedly indicates the presence (or otherwise) of tightness in Tensor Fasciae Latae (TFL) and/or The Iliotibial Band.

I'd also add to this list tests such as The Straight Leg Raise, often used to indicate the presence (or otherwise) of tightness or shortness in the hamstrings, based on the angle achievable.

Can you see a problem here?

They serve to reinforce a conclusion of “Tight”, which as I have already indicated, ‘is NOT a valid clinical conclusion’.

The vast majority of the clinical tests we use to 'indicate the presence (or otherwise) of tightness' suffer from a common problem; there are far too many innervated structures involved in the test action to allow us to be in any way specific about what we are testing or the meaning of any outcome observed or felt.

Let me hypothesise a common train of thought here:

• Our client reports (in the history taking and subjective assessment) that ‘something feels tight’. 

• We note this down

• We palpate the tissues concerned which ‘validates’ what the client is saying 

• We perform a clinical test (something that supposedly indicates the presence (or otherwise) of tightness in that same tissue

• We may then apply a model of pattern (e.g. Upper- or Lower Cross Syndrome)

• We now believe that we have confirmed this hypothesis of ‘tight’ (and possibly also ‘weak’)

We proceed to intervene accordingly (massaging, stretching and releasing or strengthening).

None of the above is clinical validation; it is merely reinforcing a train of thought that laid an imprecise and invalid assumption and then built upon it. 

Can you see the accumulation of assumptions being constructed here?

We have implemented, what in science and research, is termed confirmation bias. 

Confirmation bias is a tendency to process information by looking for, or interpreting, information that is consistent with existing beliefs.

We have started with a premise of “tight” and then proceeded to validate this premise with tests, models and patterns.

But since the original premise (assumption) was flawed, all we have done is reinforce this flawed assumption with even more invalid assumptions.

Any test that supposedly indicates ‘tightness’ in a tissue, is inherently invalid, since ‘tight’ is meaningless!

Anything that supposedly “confirms the presence of tight” is not a good approach and should be avoided.

All these do is build more invalid assumptions on top of existing invalid assumptions.

Our clinical reasoning ‘structure’ becomes even more unstable.

When You Assume It Makes An Ass Out Of U and Me!

As I explain in my the blog linked to above, when we apply the “treat what you feel and treat what you see” model, what we end up doing is chasing symptoms around the body.

The assumption that what we SEE or FEEL is actually what needs treating is a massive cause of clients returning to see a professional with the same (or related) symptoms over and over again.

What we SEE or FEEL is merely an indication that something is going on, somewhere in the body. 

Our job as soft tissue and movement professionals is to work out what this “something” is. 

Here are some more examples of applying these assumptions.

Postural, Gait (or indeed any movement) Assessments or Analyses are fundamentally flawed because they merely indicate how a particular client body is currently reacting and responding to things going on elsewhere in their body.

Firstly, the word ‘currently’ is crucial here, because how a body reacts and responds to things going can change regularly (even daily).

How can we base any conclusion on tests, assessments or analyses when what we are seeing is sitting on constantly shifting sands?

Secondly, the common established conclusion from postural, gait or other movement assessments is that X or Y tissues are tight or weak, and we all now know where that leads us!

Thirdly, the “things that are going on” in a client’s body that result in what we are seeing in postural, gait or other movement assessments, can be literally anything, anywhere e.g. (but certainly not limited to).

• The Cranium • The Neck • The Shoulder • The Manubrium • The Thorax • The Spine • The Pelvis • The Hips • The Knee • The Feet • Muscle Systems • The Nervous System

We cannot conclude that these ever 'shifting sand' reactions and responses from postural, gait or other movement assessments are in any way indicative of where we need to intervene.

Nor can we conclude, based on these reactions and responses, what these interventions should be.

Jumping to conclusions about what is going on, based on postural, gait or other movement assessments is yet another layer of Assumption.

When You Assume It Makes An Ass Out Of U and Me!

To conclude this blog, I merely want to ask you a couple of questions.

1. Can you, in all honesty, establish exactly WHAT is going on with a client, WHY it is going on and HOW to proceed based on all the assumptions I have highlighted above?

2. Can you, in all honesty, establish exactly WHAT is going on with a client, WHY it is going on and HOW to proceed in a single treatment session?

I will explore Fully Integrated Progressive Programmes in a future blog.

I realise this is a long blog and that I have thrown a LOT of challenges at you.

I said right at the top, that this is a huge topic and I can only scratch the surface in a single blog.

So, please do reach out and ask me ANYTHING about what I have said, as I absolutely know that this has probably exploded your head! 

It did exactly the same for me when my mentors first introduced the above to me. And It took quite a while, asking my mentors loads of questions, for this to truly sink in.

What I ask of you is this:

Regularly challenge what you think you know.

Nothing beats removing false knowledge and nothing is worse than clinging on to it!

Don’t Make An Ass Out Of U and Me!

If what I have said here resonates with you, or you would like to ask me any questions, then please book a totally free chat with me by clicking on the button below. No Selling, No Ego, Just Great Chat.