“Education is not the learning of facts, but the training of the mind to think” – Albert Einstein
Einstein was a genius, both literally and figuratively. Yet, he had a remarkable ability to make the complex seem simple (but not, as he would say, simplest). Straightforward and actionable information goes a long way but it’s not sexy, and it sadly does not impress others. Perhaps this is the reason that we, as therapists, tend to over-complicate matters while arguing over the minutiae. Nonetheless, there must be a rational way we can digest ideas and concepts that perhaps move along a continuum of simple to complex, and then—more importantly—utilize these ideas to effect meaningful change.
Streams feed into larger bodies of water, and knowledge seems to follow a similar path. As our Performance Therapy intern group at ALTIS hears (probably far too often), our various foundations in knowledge ultimately set the stage for what we will discuss later as actionable intelligence; the driver for immediacy in therapy and the ultimate goal of any therapists.
With that in mind, a component of our intern’s education involves exploring three distinctive streams of knowledge: BUD/S, Procedural Knowledge, and Actionable Intelligence. These three streams are akin to the concepts of breadth of knowledge, depth of knowledge, and creative knowledge. Although this article is not intended to explore all forms of knowledge and understanding, it should provide some context as to how our current framework helps drive our manual therapy approach.
Knowledge Stream #1: Basic Undergraduate Deconstruction and Systems Learning
“Variability in most organic systems is a good thing, and at the organizational level, this variability in knowledge helps to fill in multiple gaps in understanding.”
While BUD/S is an acronym that everyone is surely familiar with, for our purpose it will represent Basic Undergraduate Deconstruction and Systems learning. This stream is by far the most variable form of knowledge that interns will walk in with—and it is also the most important as it represents breadth of knowledge.
Variability in most organic systems is a good thing (think of heart rate variability or movement variability), and the same thing goes for high performance environments, as having variability in knowledge among practitioners helps to fill in multiple gaps in understanding. Returning to Einstein yet again, “You cannot solve a problem with the same mind that created it.” Hence, the reason the ability to think differently is a crucial trait in any high-performance organization.
Learning how to learn is just as important as knowing what to learn. Share on XAlthough some of us may be in the same vocation, it is highly likely that the road leading to our particular career is unique and likely not traveled by another individual who shares a similar title. As such, we all have differences in our foundational level of knowledge. But how much of that are we able to recall and how much do we incorporate into our current thought processes?
Learning how to learn is just as important as knowing what to learn. From personal experience, there is a common thread as to why most clinicians have a difficult time recalling information they may have learned 10-plus years ago. Time obviously plays a factor in this, but of more importance here is the idea of linear learning, or learning concepts in successive steps.
An excellent example of this would be the glycolysis: a pathway we all are forced to learn and one that would inevitably appear on any Biochem exam. I’m sure we all had some mnemonic to help us recall the order of events that took place in this pathway, but did that help us learn what was going on and did it expose us to the idea that various steps could move in multiple directions? Stop for a moment and try to recall the pathway in your mind. Did you resort back to the same mnemonic you used to pass that exam the first time around?
Unfortunately, this type of learning may not be the most conducive to gaining knowledge, as it compartmentalizes ideas instead of explaining how they work in robust systems. For example, how many times have we heard an athlete say they have lactic acid building up? Our mnemonic surely won’t help us understand why that doesn’t make sense, nor will it help explain why one possible end-product may be a source of energy in a different organ system altogether.
Nonetheless, it is always worthwhile to stop and revisit what you already know you know, as it may be the catalyst that resynthesizes answers to questions you may have had in the past. Once we form these ideas, it’s difficult to always examine ourselves to ensure confirmation bias is not governing our clinical audit process. This process is similar to what we explain as Procedural Knowledge.
Knowledge Stream #2: Procedural Knowledge
“Each checklist that you develop should ideally be organic in nature and not solely the product of what you have read or have been told.”
A “Checklist Manifesto” will no doubt make therapeutic methods and clinical decision-making both more time-efficient and more consistent. From a practical perspective, this list could represent what is currently best practices for a given condition, with the flexibility to incorporate the practitioner field experience with these conditions. This manifesto should constantly be evolving and you should revisit it often, as it needs to remain an emergent property of experience.
This type of categorical knowledge is what we define as Procedural Knowledge, and it represents depth of knowledge. Each checklist that you develop should ideally be organic in nature and not solely the product of what somebody has told you or something you have read. The underpinnings of these lists could follow the 75/20/5 percent rule. This would mean that you structure 75 percent of your list on sound evidence that you know works, while 20 percent of your list contains ideas or processes you think work. The final 5 percent of your list should be a hypothesis you want to test.
As a caveat to this assumption, there should be no inherent red flags in your hypothesis. As important as checklist manifestos are, they are also often a point of contention and, unfortunately, can be an area fixated on by therapists. Social media has made it far too easy for individuals to assert their expertise on various conditions or treatment protocols and, as any challenges to these claims spark blows to their egos, the progression of knowledge seems to come to a halt. Needless to say, people often become the victims of confirmation bias without having any real experience utilizing the 75 percent of what they know to be true. This bias is in stark contrast to the practical stream of knowledge: Actionable Intelligence (AI).
Knowledge Stream #3: Actionable Intelligence
“If you had the ability to go back even a year, would you still be treating any given condition as you did at that time?”
Time is the most valuable commodity we have as therapists. It’s something that you can’t buy, and it’s certainly something you can’t buy back. If you had the ability to go back even a year, would you still be treating any given condition the same way you did at that time? Or would you incorporate what you know now to elicit perhaps the same result, but one that is free from the burden of temporal occlusion?
When time is of the essence—as is often the case when working in high-performance sport—immediacy matters, and sometimes real-time action isn’t fast enough. How then do you prepare for situations where you need to make executive decisions and implement the appropriate course of action? This is where the concept of Actionable Intelligence becomes almost a make–or-break factor in correctly assessing the situation and executing the appropriate plan of management.
The depth of Actionable Intelligence (AI) that a therapist creates over time is no doubt related to the other two streams of knowledge, but the rate at which it is generated is proportional to their time in the trenches. It may be a cliché, but having skin in the game forces you to appreciate the fact that success leaves clues and failure leaves lessons. Now, it’s not to say that you need to be working in a high-stakes environment ad nauseam to gain AI, but you need to ensure you understand both streams of knowledge discussed above.
It’s one thing to be confident in your procedural knowledge of, say, a knee exam, but it’s another to have the haptic perception needed to interpret the findings of your exam correctly. To complicate things further, if you don’t have a grasp on how complex and intricate the anatomy of the knee is, you may find yourself struggling to make an accurate diagnosis.
Actionable Intelligence becomes the skill set that defines you as a therapist. Share on XWe call it clinical “practice” for a reason, as manual therapy is a skill that you need to continually refine over the course of your career. Actionable Intelligence is then the product of this continual improvement, and it becomes the skill set that defines you as a therapist. Thus, it is important for every therapist to realize that AI becomes your ultimate goal. The antithesis to this would be the mundane act of solely going through the motions or, more specifically, lacking intent with your interventions.
Creating Process-Driven Performance Therapists
We often say we want to create process-driven athletes who are not entirely driven by the end result. The ALTIS intern program tries to accomplish that same outcome. Being process-driven ensures that people gain knowledge rather than simply accumulating facts. It also develops a rational thought process and teaches you to be critical of your current understanding. The process of being a well-rounded therapist begins once you utilize the three knowledge streams of BUD/S, Procedural Knowledge, and Actionable Intelligence.
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