The world of injury diagnosis and management is vast. Our opinions on what the problem is, what to do and how to do it are heavily biased by our past experiences - previous learnings from knowledge attained or lived experience.
Sports Physio's very much operate in an art vs science space – we are led by evidence-based practice and lean heavily on research and facts to drive our knowledge and understanding of medical sciences. However, we also know first-hand the complexity of the factors that impact injury & recovery, the variables, and interactions between them, that change with every individual we see and ultimately combine to impact the outcome.
Humans are complex systems, and injured humans fundamentally need a complex systems approach to achieve optimal management.
“Making the simple complicated is commonplace; making the complicated simple, awesomely simple, that's genius.”
This blog is about understanding systems & frameworks, from a Sports Physio's perspective. Learning when to use each of these approaches, when to simplify and when to chase the details of complexity - or more importantly when and how to build a framework around the complexity.
In injury management there are three main things we can do:
1. Overcomplicate the Simple Stuff.
For example, spending time and energy to design complex exercises, making something that looks new & fun but ultimately could have been achieved with something much more simple.
The more complex something is, the easier it is for someone to do it poorly, compensate and for you to miss the mark on what you are trying to target.
2. Being Overly Simple and Miss the Complexity.
For example, prescription of pre-determined exercise progression streams, without seeing the detail in how someone is executing the exercise, handling the movements & how the joint is tolerating the loads.
3. Not Being Able to Make the Complicated Simple.
For example, having the ability to find the detail and navigate the complexity of a presentation and in the 1-on-1 setting being able to address it, but not being able to build and apply a framework to it for the execution of a wholistic and realistic management plan.
All injured humans are complex beings, and we need an understanding of complex systems theory to truly appreciate and manage them optimally.
By definition, a complex systems is “comprised of many components which may interact with each other and are intrinsically difficult to model”. They have dependencies, competitions, adaptations, non-linear relationships and contain countless feedback loops.
Layer this complexity into the biological, physiological, environmental & psychological systems already involved in injury recovery and we have one hell of a complex system to navigate.
This is where a few of our key skillsets as a Sports Physio need to come in:
Our Clinical Reasoning Skills – being able to explore all aspect of the complexity of an injured persons’ presentation and progression is fundamental to being able to manage them optimally.
Taking Control - To manage a dynamic and complex system, we need to be able to apply some control theory. We need to be able to apply corrective behaviours, monitoring and detailed observational skills.
Communication Skills – Developing rapport, having quality and clear communication is fundamental to the ability to investigate, manage and make change.
Development & Application of Frameworks – A framework is a set of rules, guidelines or best practice that provide a structure for developing or achieving something. To manage something so complex, and be able to execute a rehabilitation plan, we need to build and apply a framework to it – remember “genius is taking the complex and making it simple”.
It is fundamental for us as injury rehabilitation specialists to develop and be able to apply all of these skillsets.
‘Rehabilitation systems’ are becoming increasingly common (or labelled as such), but we need to be very careful with how we go about naming, interpreting and using them. Particularly, we need to ensure that we are not confusing them with being framework – guidelines for best practice & a common language.
A system involves interconnected components that all work together. In the rehabilitation space, the ‘rehab system’ includes the framework we are using but also the person we are managing (the super complex part), our service model, the facility, our rehabilitation staff & the clinical reasoning and medical management of the injury. If we miss this detail, we may find ourselves oversimplifying something that is very complex and missing the mark in achieving an optimal injury rehabilitation.
As Sports Physios' we need to be:
Always thinking about and exploring the complexities of in our clinical reasoning, but… Never missing the big rocks!
Always be developing and applying best-practice frameworks to assist in the execution of rehab, but… Never relying solely on them!
KB