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Tuesday, June 6, 2023

Using Research to Bash Theory

Brent Brookbush

Brent Brookbush


Using Research to Bash Theory

The Meme That Inspired a Debate -

Enough already with the "my citations are better than your citations" arguments, that is an unfortunate byproduct of an evidence-based movement misunderstood..

An Analogy by Dr. Brent Brookbush: Using Research to Bash Theory

Moderated by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS

This Panel Discussion was originally posted on my facebook page – https://www.facebook.com/brent.brookbush – on 4/2/2016


Leon Chaitow Synchronistically I have spent the last week updating citations for a book, first written in the mid-80s, and am drowning in conflicting research-based evidence.

In reality I have been able to find strong research support, for and against, most important statements that require validation. Now and then I've included opposing perspectives, but in the main, because the story I am describing is based on clinical experience - I am drawn to those studies that support the thesis I am promoting.

Is this unusual?

Bias is inherent in such an exercise, and usually has a foundation in experience, and I am aware that most statements can be challenged…and probably will be….

April 2 at 11:41am

Brent Brookbush Exactly Leon Chaitow, What would bother me more and what I was talking to in this meme… is if someone took a single research study and tried to use it as a stake through the heart of your entire text. That's just not right, doesn't make sense, and seems a bit disrespectful quite honestly.

Having written one book and working on another, it's an immensely challenging, labor of love, that rarely, if ever equates to an equitable financial reward… and when you look at books like yours, Travell and Simons, Neumann, Leibenson, Vleeming, etc… that have multiple editions, 1000's of citations and someone pulls out a dozen studies that they think proves it wrong… it bothers me.

I could have easily titled this meme: Respect the life's work of those who came before you.

April 2 at 11:50am

Kenneth E. Hoover …and set that example for those who will follow…and likely kick it up a notch, if they can learn that lesson. Respect effort, age and authority. Not revere it, necessarily, but at least respect it as you would would want your own respected? It is a big part of this disconnect that most people really do not know the difference between a study and "the science." Not really their fault in most cases. They just do not know what they do not know? Rock on Brent Brookbush! Haters gonna hate….

April 2 at 12:27pm

Brent Brookbush Kenneth E. Hoover Well said!

April 2 at 12:28pm

Sue Hitzmann A brilliant reply Leon.

April 3 at 6:01pm

Kathy Benson Zetterberg As a graduate student, I am finding that I am required to support and defend my statements and ideas with science-based peer-reviewed studies on topics. When it comes to bashing vs defending a topic, or series of topics that is a different story. I have concerns with some health and fitness professionals and what they are saying without proper citations, but to discredit and bash what has been scientifically researched and proven is not ok! Keep up the great work Brent, you have many followers behind you that won't take a single study and discredit your hard work.

April 2 at 12:29pm

Brent Brookbush There is a balance to be had, between wanting to scream at people…. "Read a book or research study… not a magazine, a blog, an article, facebook, twitter, etc…. but a book or study with a bibliography", and the other extreme which is looking for all the answers in research.

It's okay to use conflicting evidence to question and refine, but there are a group of individuals who take that one step to far to a disrespectful place.

April 2 at 12:10pm

Nicholas Rolnick What people seem to forget in their arguments is that it is nearly impossible for a single study to conclusively prove anything substantial about human movement. There are way too many covariates to consider that cannot be adequately controlled to definitively say a concept is "wrong". For instance, we know that our shoulder should move a certain way at certain times and this becomes altered with pain, excessive thoracic kyphosis, shoulder ER fatigue, excessive forward head, neuromuscular dyssynergies between the upward and downward rotators, etc. however, some of these studies only looked at individuals who were healthy, or who had met the particular inclusion criteria. What's not to say that the movement pattern would be different in those that hadn't met that specified criteria. It's not appropriate to make a blanket statement in any of these cases, only educated assumptions based on clinical and bio mechanical knowledge and observation. I dislike when I hear other professionals cherry pick their studies to support their claims. Yes, the study could have supported their claim in that PARTICULAR population, but what's to say that it would translate to every situation? That's why there are so many studies on particular topics, because we as evidence based professionals cannot and should not make blanket assumptions. I hope to employ some facets of EBP but along with practice based evidence, because if what we observe as clinicians works but doesn't have a particular evidence based study to support it for whatever circumstance (like difficulty in isolation or impracticality), do you think I am going to forgo that at my patient or client's expense? Probably not. Sorry I ranted, but I feel the EBP movement has gone way too far in some individuals and while I do think it has a huge role in our practice as movement professionals, we need to consider that one study in isolation cannot prove anything. Systematic reviews and meta analyses on the other hand….that has my attention. Have a great day everyone!

April 2 at 12:18pm

Erik Korzen DC Well stated!

April 2 at 12:19pm

Brent Brookbush Well stated indeed… especially coming the guy who has been so instrumental in updating our citations. You see first hand just how much research goes into supporting our practice at the Brookbush Institute, and we both know that it is still not enough to answer all questions. Thanks again for your hard work and comments Nick Rolnick

April 2 at 12:26pm

Nicholas Rolnick Brent Brookbush always happy to contribute to bettering the BI as well as building up the support for human movement professionals! Thanks for the shout-out

April 2 at 12:30pm

Mark Jamantoc 100% agree with Nicholas Rolnick. I don't know if I've been out of school too long but clinical experience coupled with getting your hands on what's available out there while keeping an open mind on the latest evidence just makes you a better clinician overall. Also, seeking a mentor you can connect and communicate with through the process helps as you grow your practice. With the advent of the internet, information just suddenly became cheap and available and anyone can write a blog - and anyone certainly has access to certain studies and journals. I believe your labor of love for writing your book, Brent, is not only a brave way to reach out with quality studies but to set yourself apart from others.

Brandon Trujillo I've stated my position on it many times. It is important to have some scientific basis for what you are doing, but what we see in the "movement" marketspace is the complete abandonment of reason and logic. I see some of the most idiotic things being done at the gym and in CE courses being taught all in the name of "movement".

Show me a good scientific foundation that you created upon and I am open to see what great minds can do.

Try to promote stunts and parlor tricks as rehab or Fitness and I'm going to be all over you. (Not you as in YOU Brent)

April 2 at 3:08pm

Brent Brookbush Hey Brandon Trujillo,

When I said "theory or conceptual model," I meant in the scientific sense. As in a the conglomerate or postulate considering all of the data known at this time, including available research. I.e. the movement impairment/postural dysfunction model, the maitland/cyriax model, myofascial pain model, etc…

Most of the "movement" concepts that anger you (and me as well) cannot be called a theory, concept or postulate… they have little if any rationale, scarce scientific foundation, and most don't cite a single research study.

April 2 at 3:37pm

Brandon Trujillo

Brandon Trujillo I think that is what is so maddening. People say it is based on their Theory and offer nothing to support themselves.

I can roll with scientific based theory or if they can show me a small correlation, but the Movement Cult usually cannot. (Broad Brush Sorry, but they have earned it)

April 2 at 3:50pm

Brent Brookbush

Brent Brookbush There are models out there, that are making valiant attempts, but you need to look toward bigger orginizations… NASM, ACSM, NSCA, the Brookbush Institute ;-)

April 2 at 3:51pm

Jason Erickson It would help if those "theories" were correctly referred to as conjectures or, at most, hypotheses.

April 3 at 1:15am

Brent Brookbush To be fair Jason Erickson, the theory and conceptual frameworks I am speaking of are large broad based systems based on all available evidence (research included). I am not sure the words conjecture or hypothesis would be appropriate. For example, the Movement Impairment/Postural Dysfunction model or the OPT Model from NASM.

April 3 at 9:10am

Tony Susnjara Brandon Trujillo I'm not sure which movement cults you are referring to specifically but relative to human movement and fitness, I will say this. My background is in yoga and martial arts and I studied more 'conventional' fitness and also corrective exercise and hands on techniques to support my main interests because at the time, there was not much quality anatomy and physiology to be found within those circles.

My thoughts on the mainstream fitness industry is that it is relatively movement impoverished. Conceptually it's like moving from complex, fractal geometry to simple, linear, euclidean geometry.

As the movement system gets more and more complex, I think it gets harder and harder to study the benefits of it scientifically however there are underlying principles around loading the body, metabolic effects, heart rate zones, safe ranges of motion around joints, principles around recovery and so on that can translate across because the body is the body.

If you keep the conceptual framework simple and stick to the concept of adaption, SAID, FIIT, RRR and so on, they are pretty generic across all forms of movement.

I've also never set out to provide a 'remedial' yoga class but the number of times people have come up to me after a few weeks or months of practice and said, "That ache or pain that I had to 10 years has gone." Also people who have been on medication for joint pain and even long term hypertension have no longer needed it. I've tried to be as informed as possible on what I am doing from both a Western scientific perspective and a conventional yoga perspective but I haven't found any research relating to what I do. I've researched stretching, breathing, I've tried to understand the mechanics of the joints so as not to put excessive pressure on them but I don't if there is research pertaining to the methodology that I have put together by combining various models and learning first hand from my students or clients.

April 3 at 6:13pm

Scotty Butcher This is an awesome thread with great comments. I was just about to agree with, but also rebutt, Nicholas' comment when Brandon's was posted. This is a multi-aspect topic and you can't rely solely on any of the three EBP pillars. Both the pubmed warriors and the clinical gurus go way too far into their own side of things that the big picture is lost.

April 2 at 3:34pm

Brent Brookbush It is a balance, we cannot rely on any one pillar, but all pillars have to be there.

April 2 at 3:38pm

Scotty Butcher Not to mention the patient protectors that state the only thing that matters is patient experience/goals. And yes, you can quote me on those three names wink emoticon

April 2 at 3:40pm

Scotty Butcher I see this very much with some of the pain science crowd.

April 2 at 3:41pm

Brent Brookbush Unfortunately Scotty Butcher, the pain science crowd is who inspired this meme. They all fight the same way.

  1. Bash the model you use
  2. Hit you with research on pain science
  3. Hit you with a research study or two, that supposedly disproves the model you use (despite the 100's or 1000's that were used to build that model)
  4. Hit you with logical fallacies (confirmation bias, sharp shooter bias, etc.) (as if they are the only one's to read Aristotle's Rhetoric)
  5. If you ask what they do, they mention techniques that have yet to be researched.

Their whole argument is based on the premise that if they can prove you wrong they must be right, but they have very little to support the practical application of pain science.

My suggestion is block them. Pain science is wonderful, Moseley, Butler, etc., are wonderful professionals, but what this very loud group of individuals has done to their work is shameful.

April 2 at 3:53pm

Jason Erickson You are making a "tone" argument here. Ironically, you are bashing them for bashing others.

Jason Erickson's photo.

April 3 at 2:23am

Brent Brookbush And I will continue to do so Jason Erickson until they stop attacking every other approach to rehab and training. Someone has to stand up for decency. The key difference between my comments and the comments I am criticizing is I am not going after pain science or their approach. I am going after unethical behavior, commonly referred to as "trolling" on the internet.

April 3 at 9:12am

Kennet Waale I will tune in to this later on.Thanks Brent!

April 3 at 12:29am

Ken O'Neill some call it 'evidence based science' while some imbued with epistemological wisdom otherwise lacking report of 'eminence biased science'. does the emperor have new clothing, and can we do science by assuming or taking for granted Faith Based Scientism? Yes, in the bigger scholarly community such powerful salient questions are posed. And for good reason: evidence based science is a mantra of Big Pharma, while at least 20 years of peer reviewed studies virtually censored out of existence renders real objective empirical science neutered, impotent, essentially road kill for a anti-science, faith based scientism.

all of which is to say when 'evidence based science' is phrased before persons both educated and literate, a red flag is raised simply due to uses and abuses of 'science' in promoting Commercial theories- you got it, speculation for a cause - the cause being Big Pharma whoring once again for Patients for Life at the expense of radical empiricism.

Thus said, don't employ 'evidence based science' polemics without backing it up with genuine science. Calls to whoring authority only result in casting reputations as 'stupid science' per Charlie Laughlin's categories in anthropology of knowledge

April 3 at 12:39am

Jason Erickson Brent Brookbushh said, "they have very little to support the practical application of pain science".

Brent Brookbush h said, "they have very little to support the practical application of pain science".

What? Where did you get this idea? How can you appreciate Lorimer Mosely and David Butler r but ignore all of the other people who have been contributing to pain science in various ways. Even people who aren't directly involved in pain research/treatment have made important contributions to the development of pain science.

There is a ton of excellent information about practical applications of pain science. Thousands of people are using it to inform and develop their use of manual therapies, movement therapies, psychosocial therapies (CBT, ACT, etc.), personal training practices, etc.

Coincidentally, Lorimer Mosely was keynote speaker at the 2015 San Diego Pain Summit, and he was very happy about the many different ways clinicians of all types were already applying his work. Mosely, Butler, and their colleagues teach seminars on Explain Pain and related topics, including some focus on practical applications of pain science. Their former collaborator Adrian Louwe (now of the International Spine and Pain Institute) also teaches seminars, authors/coauthors books, and hosts conferences on the practical applications of pain science.

The International Association for the Study of Pain (IASP) produces a highly respected peer-reviewed journal (PAIN) and many other resources for clinicians of all levels, hosts international conferences on research and practical applications, and maintains a taxonomy of words and definitions related to pain. The taxonomy is immensely practical because it permits people all over the world, in all fields of science and medicine, to communicate clearly with one another.

I can go on and on and on. Surgical centers are starting to implement a modest one hour pain neuroscience education session with joint replacement patients (prior to surgery) because research shows those patients tend to utilize fewer health care resources and pain medications following those procedures. Emergency rooms are starting to do limited staff trainings (four hours) on basic pain science concepts because ER patient satisfaction following such training is significantly higher than it was before the training.

Robert Sapolsky's work on the effects of stress in primates, Fabrizio Benedetti's groundbreaking work in placebo and nocebo, Michael Shacklock k's work in neurodynamics (both demonstrating the movement of both peripheral nerves and of the spinal cord, and manual therapy applications thereof), Robert Melzack's Neuromatrix Theory unifying biomechanical and psychosocial aspects of therapy, Melzack and Patrick Wall's Gate Control Theory, ….none of this is important nor useful nor supported by research nor clinical practice?

This weekend I am assisting in teaching a seminar on Strain Counterstrain. This is well supported by pain science. Many people have adapted the concepts of S/CS and developed various modalities based on similar premises (Positional Release Technique, Orthobionomy, etc.). Leon Chaitow has written a nice book about it. So has Kerry D'Ambrogio. Dr. Lawrence Jones, DO spent half his life developing S/CS and the Jones Institute has considerably advanced the applications over the last 10 years. Do you still think there is little support for practical applications of pain science?

By putting down pain science, you are insulting and dismissing the work of tens of thousands of scientists and clinicians around the world who have helped develop many of the concepts, practices, equipment, and pharmacology that we rely upon today. Even simple things like decorating medical facilities so they are pleasant and reasonably comforting places to be is an example of practical applications of pain science. When a massage therapist dims the lights and keeps their table a little warm, and does their best to block out/cover external noises/distractions - that's all pain science at work, even if they don't know it yet. Recent changes in policies regarding opioid use by patients with certain types of pain is a result of advances in …(you know it!).

If you still don't how pain science is of practical value, come see me. I'm teaching a number of classes on the practical applications of pain science this year. You've missed me in California and New Jersey, but I'll be in Illinois next month, Washington and Virginia and Ohio in May, etc. If I can make it easy for massage therapists to learn, I'm sure you'll do fine in my classes.

That, or come observe me work with the international elite runners at Grandma's Marathon in June, both before and after the race. With most of them, I have 20 minutes to make a difference that will help them perform better on race day, or to help them recover after the race. Pain science is of enormous practical use in this context.

Brent , whatever issues you've had with some individuals, that's your bone to pick. Don't bash the enormous amount of work by all of the other people who have contributed so much, and whom you will never interact with.

Like · Reply · April 3 at 2:19am

Jason Erickson How is defending the work of others a "serious issue"?

April 3 at 2:27am

Brent Brookbush I think you just missed my entire point… I am not bashing pain science, nor have I ever bashed pain science. My only criticism has been that there are fewer clear links to clinical decision making and technique selection… which is not to say there are none, just fewer.

My critiques have always been about those zealots in the "Pain Camp" who have made it there job to criticize everyone else.

You have veraciously defended pain science more than once on these posts, and missed the fact that you cannot defend the behavior that I am speaking of.

My comment about not showing evidence for their practical applications is the common tactic used by these zealots, not to say there isn't any.

What you just did is the equivalent of me criticizing terrorists in the middle east and you ranting about the positives of the Muslim religion and accusing me of criticizing such. If you can't see that, please block me.

I don't know why these zealots in pain science exist, but they do. Maybe at the next pain science conference someone can open their mouths about integration of effective practices and condemn this behavior rather than letting it continue - Jason Erickson.

April 3 at 9:22am

Jason Erickson I'm not defending that behavior. I actively work to change that with whatever influence I can wield.

You didn't confine your comments to that behavior. I apologize if you were offended, but it seemed that you were writing off the whole thing.

There are zealots in every field, every modality. However, I am but one of many who have spoken about the integration of effective practices at pain science conferences. Come to one, or at least watch streaming video of presentations online to see for yourself.

I agree that the behaviors you dislike are not pleasant nor helpful. We're on the same side, there.

In future, just please differentiate more clearly between the field and the behaviors of those who take extreme stances.

April 3 at 9:03pm

Brent Brookbush For sure… will do. I have actually watched many lectures, read many studies, and a few texts on pain science. We may not be publishing articles on pain science at this point, but that is a band-width issue, nothing more. I see the biggest application of pain science involving patient education and subjective exam concepts (some applications relative to neural dynamics although this is also a very mechanical modality), but as a practical education company we are focused on exercise, techniques, and objective assessment first. We will certainly be adding fascial and neural techniques once we round out joint based techniques and special tests, and then we will start tackling subjective exams. One step at a time.

I do use pain science concepts daily, and find it as supportive of a movement impairment approach as it is some of the other approaches I have seen it applied to. If you decrease afferentation, decrease painful range, increase pain free functional movement, and support the patients psychological and social needs to feel better you also reduce reinforcement of centralization.

Thanks for bringing a different approach.

April 3 at 9:53pm

Nicholas Rolnick " If you decrease afferentation, decrease painful range, increase pain free functional movement, and support the patients psychological and social needs to feel better you also reduce reinforcement of centralization." Exactly This.

April 3 at 9:55pm

Jason Erickson Here, join this and dive into the deep end of the pool:


April 3 at 2:25am · Edited

Brent Brookbush You first - BrentBrookbush.com



April 3 at 9:23am

Brent Brookbush To be clear, my point of posting my website is two fold.

Every post by you, regardless of the topic we have discussed has shifted to pain science (talk about the confirmation bias that the zealots love to throw in everyone's face), and then the tone becomes condescending…. really, "deep end of the pool"… is that to say I am the "shallow end". The only logical road to optimal practice is the integration of all effective practices, eventually the comparison of those practices, in the pursuit of best practice, and a system based on those practices.

A myopic view of intervention based on pain science alone…. now that's the shallow end of the pool.

So to reiterate… when you are ready to integrate everything you have learned, and think about pain science, human movement science and various techniques… you can jump into the deep end of the pool, because that's what we are doing at the Brookbush Institute.

April 3 at 10:29am

Leon Chaitow Having at times been the recipient of condescending & abusive responses to sincere attempts at dialogue - my ultimate defence has been to withdraw from threads, or to block individuals. This seemed to me a self-preservation strategy since there was nothing I could offer that wasn't dismissed with contempt. A feeling of being intellectually bruised and helpless - as those on the attack waited for capitulation and acknowledgement of the truth - i.e. their version of how the therapeutic relationship works. Pain science - and associated areas of inquiry - is sadly contaminated in this way. Well done Brent for ploughing a different furrow

April 3 at 9:54am

Brent Brookbush Leon Chaitow, I have you to thank as much as anyone. I was lucky to find mentors early on (including your texts) that used "eclectic" approaches. There is so much great stuff out there, I just don't understand the zero-sum thinking that poisons our industries - Just because you’re right, doesn’t mean I’m wrong

April 3 at 10:05am

Yvette Figueroa Brent Brookbush boom

Like · Reply · 2 · April 3 at 10:24am

Sue Hitzmann Well, I think you have to remember a theory or hypothesis is developed by learning, studying, and applying other people's theories, research, and application. I mean, coming up with ideas out of thin air are really rare and I find most ideas aren't new, they are merely improved or re-used theories and ideas of others. I've based my method on what I've learned and applied over 25 years, then got New Jersey Institute of Technology to embark on putting MELT up to the scientific basis to measure outcomes we hypothesized would occur. Well, it was better than I could have imagined but anyone doing anything to help others live a better life is already a good idea. Being able to quantify and measure the outcomes to explain why it helps is what doing research is all about. When we came up for our interview with the IRB they flat out asked me, "Well what if the research shows your MELT Method doesn't do what you think it does." My answer, "Isn't that the point of doing research? To measure the outcome no matter what it is? If it doesn't do what I think it does, it's doing something so we would just do more research to figure it out. That's the fun of it. I'm not doing it to validate the method. I already know it works. I'm doing research to quantify and measure the method because that's what any ethical practitioner should do. Put the method up to the test to see if it can be measured." And we did. And we found MELT can reduce the thickness of the thoracolumbar fascia by over 30% in 4 weeks… and we don't touch the low back or roll on it at all. Either way, back to your point here, you can develop a framework off of other people's research and ideas but at some point, you must develop a foundation of your own to allow it to grow roots and develop into something you can call your own.

April 3 at 6:09pm

Jason Erickson Integrative thinking in action:


Dermoneuromodulation - based Training


April 3 at 11:07pm

Brent Brookbush Hey Jason Erickson,

So this video is a good example of why the fighting we were talking about is garbage. That looked very much like a Janda protocol (pronation distortion/postural dysfunction - see Douglas Paige's text), could have just as easily been called a "stabilization" approach to his issue (Grey Cook/FMS - Athletic Body in Balance)… and at the end of the day - release of the plantar flexor and long toe extensor, ankle mobilization, and lengthening of the plantar flexors would have gone a long way toward increasing his dorsiflexion, which was still lacking significantly at the end of the video.

My point being… I just don't get where "pain science" was even applied in that video. You treated a movement/mechanical problem with movement and mechanical interventions.

If we are going to talk about how you used the BPS or the MOM models to influence his perception of pain for a chronic injury (something I do everyday as a PT), then I would have been able to grasp how you and I treat different.

I am sincerely not trying to criticize or bash, I just don't understand… please help.

April 4 at 9:57am

Michael Adam Clark There's always givers and takers in this world. When critics want to take away a concept, then I recommend that something better should be offered in return. I think it is also important to point out that questions are great. No person or theory is above question. The key is mutual respect and openness to be questioned. I've talked with you enough Brent Brookbush to know that you don't have a problem with people asking challenging questions. As the saying goes, "There's more than one way to dig a hole".

April 4 at 8:01am

Brent Brookbush Exactly Michael Adam Clark… it's the challenging questions that drive my company, and make teaching fun… but the respect has to be there.

Your point about critics is perfect. Someone who seeks to destroy without re-building or replacing is a nothing more than toddler on a rampage. I personally despise those who hold themselves up as "critics" (Siskell and Ebert included). If you have never done or built the thing you criticize, try getting your hands dirty.

"It takes a great man to build a barn, but any asshole can come and kick a hole in it"

© 2016 Brent Brookbush

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