Some deals not up for debate

Channel 4’s Deal or No Deal was my guilty pleasure in University. An early finish on a Wednesday and home for a fix of Noel Edmunds coaxing people to change their mind over the box with the unknown sum of money inside that they had been randomly allocated. Probability and statistics, calculated risks – so these were the real life scenarios we spoke about in Leaving Certificate maths class. “Deal. Take it. For God’s sake take it.” But much like Theresa May’s Brexit deal there was no half way house here. You were all in or all out.

British Deal or no Deal

There are numerous things worldwide we just can’t seem to agree on: Religion, climate change, policies and politics, and even medicine and healthcare. But we’re making progress with the latter and there is much to be proud of in how much of that evidence can now be presented. We now ‘know’ the best way to manage certain conditions. Before this we just ‘had a fair idea’. We’ve also been wrong on lots more (See previous post on occupational injuries and back pain). But this ability to acknowledge mistakes based on new evidence and evolve is what I love about my profession. Thanks to randomised control trials, systematic reviews and consensus statements we can view all of the high quality research out there, disregard the flawed and biased data, and acknowledge that some of the ways we went about things were wrong and conclude from the evidence what is best practice.

For decades clinicians have struggled with the diagnosis and treatment of groin and hip pain. Varying labels from Gilmores groin and Athletic groin pain to osteitis pubis have floated about with nobody sure what they really meant let alone how to manage them. Most were just referred for surgery and told to rest. In 2014 twenty-four international experts from 14 different countries came together carrying out systematic reviews to give an up-to-date synthesis of the current evidence on major topics concerning groin pain in athletes. They reached an unanimous agreement on the terminology giving less uncertainty and more direction on how to manage the condition. Further confusion existed on the management of Femoral Acetabular Impingement (FAI) or hip pain in athletes (see previous post on FAI). The Warwick Agreement outlined the best management of this condition with emphasis on education, modification of training and correction of movement strategies as the priority rather than surgical intervention. And what better topic to further demonstrate evidenced based practice than that magic pill we call exercise. We all know of the benefits of exercise but hot off the press in 2019 comes a Consensus Statement on Physical activity in older adults giving us the exact benefits of exercise as we get older. Physically active older adults, compared with older inactive adults, show benefits in terms of physical and cognitive function, intrinsic capacity, mobility, musculoskeletal pain, risk of falls and fractures, depression, quality of life and compression of disability. We’ve probably all been aware of these benefits somewhere in the back of our minds but work like this solidifies those thoughts. These benefits are not debatable.

Despite all this, in some ways the world of sports medicine and physiotherapy is in just as much disagreement as the Brexit debate. That or else some or just a bit slow with the take up. While the evidence is clear some just refuse to move with the times and the best available evidence. Therefore it is down to the professionals who do implement best practice to myth bust at every available opportunity (e.g. It is OK to bend your back. You don’t need a scan. Running is not bad for your knees. You are not “out of alignment”. Surgery will not fix your back pain and neither will bed rest – just a selection of my favourites).

So unlike the masses in the UK who voted to leave Europe be informed with your decisions. Ask questions. Understand your problem and if you don’t ask more questions. There are things we do not fully understand. But unlike Brexit there is no longer room for negotiation with how we manage certain problems. Somethings are no longer up for debate. And if like the Brexiteers there’s been mistakes made in the past accept that being wrong is OK. What’s not OK is continuing to do the same thing knowing that it’s wrong.  Get informed about the best up to date approach and move forwards.

For more information on any of the issues addressed throughout this article please contact Rob via email at, Twitter @mccabephysio, Facebook at McCabe Physiotherapy or visit

Rob McCabe MISCP

Chartered Physiotherapist

Orchard House, Moorefield Rd, Newbridge, Co. Kildare

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