The Biopsychosocial Filter, Part 1

I watch a client move. I do an adjustment, a stretch, a fascial release, then advise them to change their shoes to something that feels the floor better. I feel good — and a touch of a fraud.

The client reports straight back that they feel amazing. Plenty of clients tell me I'm amazing; my results speak for themselves. So why do I feel hollow?

Then it smashes me between the eyes in one big hit — a hit that took two years to digest, four years to implement, and until now to fully make sense of. Almost fully.

Meet 2010 John

Let me introduce him: John Hardy MSc, NASM, GIFT, GAIN, FAKTR, Stecco Level 1 and 2. I could reel off presenting highlights and famous clients too, but it's boring — and that list is exactly what I'd been resting my credibility on. A sad reflection of how reluctant I was, back then, to read without bias.

2010 John will happily lecture you on the fascial system, taping, scraping and foam rolling to "improve internal dysfunction". He'll build you a 3D assessment and make every exercise 3D. His hands-on skills are sharp. All his trainers are the best in the world, and everyone's working with TRX and Trigger Point Therapy.

The WTF moment

Despite the outside success, my academic friends kept pulling apart every technique I used. Those conversations were painful. On reflection, they didn't have a better answer either — they just knew my process was wrong, which meant my techniques couldn't be proven right.

I was lazily stitching together my gurus' information with whatever research tickled my bias and calling it a system. (Had I been even more ego-driven, I'd have called it a Method and my trainers practitioners.)

I'd come into an industry with almost no information online — no Facebook, no Twitter. Add in that I'm lazy, ego-driven and love helping people, and you get a trainer whose every client story was really about him. The client just reinforced the story. Laziness and fear plus ego make you unwilling to change. I learned to say things like: "I'm ahead of the research." "Look who my guru mates are." "It works — ask my clients."

The student who changed everything

Then I met a student called Sally. She challenged me in the right way and helped me rediscover research — the first time I wanted to read science properly, and for a reason. She probably has no idea how large an effect she had.

Reading research kicked me where it hurts and sent me back to the drawing board. It's still a challenge, personally and for the business, because making the change opened a gap between what we used to claim we gave trainers and what we actually give them now. It's painful to watch old FASTER trainers still earning off guru-combined techniques — some of them running their own education companies — when my courses stay open for life and they could have come on this journey too. Ego, fear or ignorance holds a lot of them back.

What the research didn't say

As I binned my scraping tools, my myofascial oils and my movement-testing dogma, I realised research wasn't handing me the solutions I wanted. The temptation to go back to guru certainty was huge.

Research couldn't tell me how to prevent injury, speed up recovery or predict injury — and good-quality evidence was hard to find, read and separate from the bad. I realised my most important skill wouldn't be the answers. It would be learning to ask the right questions. Research won't give you answers the way a guru promises to. Finding that out is liberating — and genuinely frightening. I now teach trainers how to find, read and interpret research on all of my courses.

The biopsychosocial filter

Fast forward to now. My courses are built around building research: finding the techniques that are statistically most likely to work.

The industry, especially in pain and injury, is focused on the biopsychosocial approach. It's popular enough to have made it into the Level 3 Diploma in Personal Training released by AIQ. And, as with everything in our industry, it's already misunderstood — used to push the agenda of different therapists rather than as a framework to understand clients.

The biopsychosocial model is a shift away from the traditional biomedical model, which looks only at the biological component of injury, illness, pain and wellness. The biopsychosocial model asks you to consider three sciences around every technique:

• Biological sciences — the influence of what's happening in the body.
• Psychological sciences — the influence of what's happening in the brain.
• Social sciences — the influence of what's happening in the client's life.

Back to me and my clients. I was convinced a better-moving foot would fire the glutes. The reality is I didn't know that. But I could engage the client socially by being an expert who sounded right; psychologically by shifting their attitude from victim to problem-solver; and biologically by giving a novel input. Through the guru and the biomedical model, I was sure my gurus were right, so I was right. Through the biopsychosocial filter, I can see I was hitting a nail with a sledgehammer and hoping.

What's in Part 2

In Part 2 I'll go deeper into the model, share the research and the application — and start explaining why the Venn diagram might not be the best way to picture it, especially for movement professionals.