If you stuck around from the last blog, the first blog in this series related to Quantum Mechanics, then congratulations.. You made it through one of the least topically relevant pieces of absurdity that quite possibly exists in the health blogging atmosphere. If you’re just tuning in, and want to make your eyes bleed, then take a look at the first instalment in this series of blogs linking Quantum Mechanics and health issues here – seriously, it might make more sense to start at the beginning.
Or it might not, because if you learnt anything from a brief introduction to Quantum theory, it’s that not much makes sense. The world is, for all intents and purposes, a non-sensical place.
It is a place where, whether you want to believe this or not, randomness and chaos are the major players in daily happenings. Your daily schedule, which may be planned out to the micro-second (or not, if you know what’s good for you), is a futile attempt to create order in a disorderly universe.
You’ve heard of the Butterfly Effect? Yes, that movie with a verile Ashton Kutcher, which came out wedged around the time he was trying to air the stench of ‘Punk’d’ from his life and just before he got some baby-mama drama with Demi Moore. Well, it’s kind of related – it does a pretty good job! If you’ve seen it, you get the premise; a small change in a system can have drastic (larger and non-linear) effects at some other point in the system. It’s actually best explained with the title of the original article written by Edward Lorenz who presented the theory, ‘Predictability: Does the Flap of a Butterfly’s Wings in Brazil set off a Tornado in Texas?’. To trace this back a step, you may want to understand a little bit about Chaos Theory. Of which, the Butterfly Effect explains one aspect; the sensitivity to initial conditions is just a nice way of saying that when you have a small change somewhere, the divergence and chaos in the natural world ensure that you get a much larger change and effect further down the line. Chaos Theory also states that as you increase the time gap in your predictions, you increase the level of uncertainty about that prediction. But, of most importance, chaotic systems should actually be predictable if you know enough about the initial conditions and variables that impact the system. The problem generally is that, in order to get a full understanding of variables and initial conditions, you need to spend a long time gathering information. There are biological applications to Chaos Theory, but in my opinion, not nearly enough about one of the most important aspects to daily human life – movement.
In order to get more immersed in the field of randomness, then you must also understand a little bit (because that’s as much as I know) about complexity. Watch this quick video explaining the Cynefin framework of determining the best course of action when you are presented with various types of problems. When dealing with a lot of natural phenomenon, we are actually dealing with complex, random systems. So the following discussion is based on two presuppositions:
Human movement is chaotic
Human behaviour is complex
Now to the juicy part and I want you to tell me; when you are dealing with patients, are you dealing with either of these problems in isolation? Probably not right.. So we need to understand the kinds of problems we are dealing with, and have an appreciation for when dealing with either, there may be different strategies to use. Lastly, what I want to get across, is that, it is our job to instil these kinds of strategies in our patients, and most importantly, we also need to help them understand these strategies for an empowered and functioning existence into the future.
Movement is unpredictable
Some background for you here, there is work into motor control and chaos theory. Mathmatical modelling in human movement is obviously not new, there are many a degree to undertake if you want to understand kinematics better. A read of Glazier & Davids (2009) review on current understanding of ‘self-organizing optimality’ may help you better understand where I’m coming from. The human movement system and performance optimisation may be best understood as a dynamic interplay between external factors impinging upon an individual. This co-ordination is self-organising, always individual, adaptive to all factors and dependent upon conscious and sub-conscious intepretation of all factors.
To put this simply, movement is an output of a chaotic, self-organising system. If you are stuck in the stone age of the ‘top-down’ motor control model, this may be a shock, but that’s a pretty simple take on a really bloody complex problem – movement – and you didn’t think it really was that simple did you!?
Some people may have read Frans Bosch and can resonate well with the idea of a self-organising system. But, he’s actually not just ‘crazy Dutch-man’ making this shit up whilst he smokes a bong and eats a pancake..
He’s actually basing a lot of his work off some hard science into investigating motor control developement by Newell and colleagues and Kelso and colleagues. Movement – and the enhancement of this movement – should be seen as non-linear, chaotic and another biological system. Not the way it is currently viewed, as linear and mechanical.
Movement and performance is chaotic; it is non-linear, it has the capacity to be modelled, but is ultimately unpredictable.
So what are we doing when we rehabilitate or train?
Why do we squat? Why do we lunge? There is no doubt that there are some common movement patterns that are commonly performed by everyone – whether athlete or not. If you read Frans Bosch, you may think of training these movements as ‘deepening the troughs’ of ‘Attractors’. In other words, making a primary movement pattern easier and more co-ordinated. This sounds pretty neurological right? Well for the most part it is, but we are doing so many other things as well, however, and if aiming for muscular hypertrophy – which in itself is an incredibly vague term – you are creating a physiological response from muscle cells to create more ‘substance’ from which to create force. I think you can tell that this topic, in particular, could go on for a very long time.. Ain’t nobody got time for that and you probably want me to get to the point.. When we train – or rehabilitate – in the typical, common fashion, are we actually achieving much when it comes to the complexities of movement and performance? With a basic understanding of ‘dynamic systems’, heck even quantum theory, do these very predictable and orderly movements actually relate to movement in real-life??
Here’s what I think; I think there are some movements you need to perform well. These are our ‘attractors’; a non-exhaustative list is:
A squat pattern
A hinge pattern
A single leg squat pattern
A single leg hinge pattern
A horizontal push patternA horizontal pull pattern
A vertical push pattern
A vertical pull pattern
These are well established as primary movement patterns and comprise the basics of any comprehensive program. These movements basically just help you load someone up in a movement that someone else has designed an exercise around. It’s easy because unless you wanted to spend hours and hours trying to account for all variables in a skill and create each exercise based on that, these put simply just save time. Allow some physiological adaptation, but aside from that, I think they’re pretty useless. Most of our job needs to be to consider elements of unpredictability as these elements of ‘challenge’ mimic the real world and allows the system to self-organise. I think we need to be more aggresive and early with our ‘real-world’ challenges. It’s a lot to hold in your head, as you do need to understand tissue healing, strength training principles and periodisation but once these basics are fulfilled, there needs to be a real focus on increasing challenge on the system to create a more efficient self-organisation. I don’t think this challenge always has to be load either, I think we need to get creative with exactly how we are adding complexity and randomness to things.
So, do we achieve normal?
What is normal? You can prepare the body into any ‘perfect form’ that you wish, but ultimately what are you ahieving? The perfect biomechanical picture in many cases is not actually predictive of anything much except an projected idea of ‘normal factors’ gained from a ludicrous cherry picking of various aspects of movement that we know about, which have been arbitrarily linked – at best a retrospective causative analysis – in a controlled fashion. The obvious problem here is that retrospective causation does not prove prospective risk, because the future is ultimately undeterminable. This is especially true with something as complex as movement. There are countless example of ‘abnormal’ biomechanics being not only useful, but the most efficient:
I know what you’re going to say here, ‘but Connor, you’ve railed against that logical fallacy in the past – the absence of evidence is not the evidence of absence- yadda yadda..’ And I would say ahaha! Right you are sir, but I’m not saying that we should all start to teach over-pronation and valgus in our squats, I’m saying that our practice of always avoiding things that we determine as ‘biomechanically incorrect’ is probably really flawed. We use these ‘biomechanical’ markers on a massive scale, with religious vigour, when it should only ever be another element to consider. If someone’s self-organising system has determined the best way for them to perform the action, is achieving ‘normal’ something that we need to spend much time on? Maybe we just need to have the basic pattern there and then start challenging the system (with load for example). In short, are we actually preventing anything if we get someone to do the perfect squat 100 times over? I want to add to this, that I really don’t know here, and think that the answer lies somewhere in the middle of ‘perfect form vs natural form’, but I also think we are a long way from the answer at the moment with our current practices. If we follow the Cynefin framework, we are trying to achieve stability in our interventions in a chaotic problem like movement. We want to force the system to create stability in different ways to avoid large ‘butterfly effects’.
So, do we prevent injuries?
If a system is truly chaotic, there is a limited chance of predictability, and therefore prevention of events. That doesn’t mean there are things we can do to protect ourselves against randomness. Understanding that most stable systems have very nuanced, multi-layered adaptations that have evolved to reduce disorder and create stability is a start. To reduce disorder is what we need to do and implementing things that do this is important like, reducing spikes in load – after all that is a disordered challenge on a stable system. I am particularly interested in taking the ‘prevention’ and reduction of disorder one step further. This is where we bring in the concepts of anti-fragility and durability.
Anti-fragility and durability
If a system is designed with minimal variables, then any change in one will have a catastrophic effect to the output. Movement is no exception, if we keep movement simple, then any change is inherently going to destroy the output that we want. For example if you only ever practice a squat with a box, and are then asked to perform this same movement free-standing with a bar across your back, you will have buckley’s chance of doing it right. This is a simple example, but if you extrapolate this to running and cutting like in a game of football, then you can see the issue. If you always practice with no challenge, then you sure aren’t durable.
So exposing the body – and motor output – to challenge is key to ensure more variables are incorporated to force stability. Once again, I think we need to be more genuine and thoughtful in our approach here. Enough challenge to force stability over time rather then to over-challenge is key. Because we will never approach any kind of worthwhile prediction in a chaotic system, interventions that challenge the system enough to stabilise and reduce the effects of further randomness are king.
In applying this to every day athletes or patients, it probably doesn’t matter how much they can bench press or deadlift after a certain point, what is key to being a more durable person is exposing yourself to a multitude of different movements, forces and situations.
Taking durability a bit further is then speaking about being ‘anti-fragile’. The concept comes from some of Ido Portal’s work and Nassim Taleb’s book of the same title. Essentially, in some systems, those that improve with disorder are then more ‘anti-fragile’ and resistant to failure. Common training programs do pretty much the opposite of improving your capacity to deal with disorder – they train you in repeating the same simple movement task over and over.
We need to start to think this way in performance optimisation and rehabilitation. And once again, we want to start thinking this way earlier in the piece to improve our outcomes. Exposing yourself to random movement is a good way to, at least, be prepared for the unexpected future. It is the opposite of ‘chasing normal’ and needs to be practised. But, I do think that once again, the answer lies somewhere in the middle; always practising random movements leaves no room to get genuine physiological adaptations for other key movements. These are our key exercises that we can use to apply basic strength trianing and overload principles. Once we have the basics covered, we need to force stability in other areas.
I do have some bias here, and you can probably tell. But I don’t think it is a bias that prevents the discussion about the reality of human movement and the natural world. We live in an unpredictable, random world and human movement is one chaotic system designed to reduce disorder and create some kind of output. If put in terms like this, I think the only way to produce a better output is to create a more stable system, and being logical the only way to create a more stable system is to force it to reduce disorder, force adaptation and expose it to more randomness. Not less. Our job should be to improve the capacity of individuals to appreciate this and learn to expose themselves to different movement, varied movement and continue a practice of anti-fragility.
Thanks for reading, and you wouldn’t believe it, but there’s more where this came from in the next instalment about quantum mechanics and the complex problem of patient behaviour. The underpinnings of perception – reality or just their reality?