The Biopsychosocial Filter – Part 1

As I watch my client move, and then I perform an adjustment/stretch/fascial release / FMR followed by advising my client to change their shoes, preferably to something that feels the floor better, I feel good, yet a touch of a fraud.

The client reports back immediately that they feel amazing, and I think to myself that a lot of clients tell me that I am amazing, my results speak for themselves, so why am I feeling a little hollow with all this?

<BANG> Then it smashes me between the eyes in one big hit. One big hit that takes two years to digest, four years to implement and until now to make sense of entirely. Well almost make sense of.

Let me explain; I am 2010 John, John Hardy, John Hardy MSc, John Hardy MSc, NASM, GIFT, GAIN, FAKTR, Stecco Level 1 & 2, I could go on and talk about my presenting highlights, my clients of fame and so on. However, it is a little bit boring, and also what I am resting almost all of my credibility on, a sad reflection of my reluctance to read without bias at the time.

At this point, John 2010 will happily lecture you on the fascial system, taping, scraping, foam rolling to improve internal dysfunction, I can show you how to build a 3D assessment and make exercises 3D. My hands-on skills are all upright and in movement. All my trainers are the best in the world, and we are working with TRX and Trigger Point Therapy!!

WTF Moment
Despite the success on the outside it kept coming back to me that my academic friends were pulling me apart for every technique I applied. It was painful to have the discussion with them, and on reflection, I do not think that my academic friends had much more than they knew my process was wrong, so my techniques could not be proven or right!!  Essentially I was lazily putting my guru’s information together, with selected research that tickled my bias, and calling it my system (if I was more of an ego-driven trainer I would have called it my Method, and people Faster practitioners).

The problem is that I came into an industry with little to no information available via the internet, no facebook, no twitter etc. Also, the other problem is that I am lazy, ego-driven and love helping people. With every client at that point, the story was about me, and the client was reinforcing my story. Lazy and scared combined with ego help build an unwillingness to change.  I learned to say things such as “I am ahead of the research, look who my guru mates are, it works ask my clients, according to my mate who is a Doctor, why do other people use it?”

When I met a student called Sally, then things changed, she challenged me in the right way by helping me rediscover research. In fact, it became the first time I wanted to read science correctly and for a reason.  Sally is still an inspiration for the changes I made in my business, I am not sure she is aware she had such a large effect on me.

Reading research kicked me in the trainer bits and made me go back to the drawing board with everything. Finding the research is something I am still handling personally and on a business front, as making the change created a gap from what I claimed we gave trainers to what we actually give trainers.  It is painful to see old FASTER trainers making a living off of guru combined techniques, some with their own education companies, especially as I keep courses open for life, so they could have come on this journey too. If I had a wish, it would be to get the trainers I trained who are now stuck in the cure people guru mindset, to come back and learn about what we know now.  Unfortunately, a lot of them (especially the ones with their own education businesses) are stuck with ego, fear or ignorance holding them back.

What the research didn’t say
While binning my scraping tools, myofascial manipulation oils, all my movement testing information, I started to realise that the research was not helping me to find solutions. The temptation to ignore it and go back to the point where I had the certainty of a guru telling me stuff and showing me selective research that backed them up, was huge.

The research could not tell me how to prevent injury, increase the speed of injury recovery, predict injury and more importantly, it was challenging to find, read and identify good quality from bad.

I quickly realised that as well as being able to decipher the good from the bad research and to let go of my preconceptions of the answers, my most significant skill would be to find out how to ask the right questions.

Research won’t give me the answers in the way I want them, or the way that Guru’s told me they would, but it is so liberating to find this out. It is also really frightening.

I now teach trainers how to find, read and interpret research on all of my courses.

The Biopsychosocial filter
So forward on to now, my courses have changed and have a focus on building research. The goal is to find the best techniques to use based on what statistically is most likely to work.

The industry at the moment, especially in pain and injury, is focussed on the Biopsychosocial approach. It is so popular it has made it into the Level 3 Diploma in Personal Training, released by AIQ last year.

As with everything in our industry, it appears to be misunderstood and is now used to push the agenda of different therapists, rather than used as a framework to help understand clients.

The Biopsychosocial model is a shift in thought from the traditional biomedical model of working with a client. The biomedical model looks at the biological component of injury, illness, pain, wellness etc. It excludes the influence and requirement to understand the other sciences related to the Biopsychosocial model. In the Biopsychosocial model, three sciences should be considered around every technique.

Biological Sciences – the influence of what is happening in the body
Psychological Sciences – the influence of what is happening in the brain
Social Sciences – the influence of what is happening in the client’s life

Okay, so that is a simple break down, but Part 2 is about the science of this and I will share the research at that point. If the Biopsychosocial approach is correct, and it seems to be, then the when you interact with a client you need to consider how you affect the client on three levels.

Ponting back to what was happening with my clients and me, although I was convinced a better moving foot would engage the glutes better. The reality is that I did not know that, but I could engage the client through a social effect of being an expert sounding right. Then on a psychology level by changing the client’s attitude towards their injury from victim to working on the problem. Finally, I was providing a novel input from a biological level.

Through the guru and the biomedical model, I was convinced my gurus were right, and so I was right. Through the filter of the Biopsychosocial model, I can see that I was hitting a nail with a sledgehammer and hoping.

In part 2, I am going to show a little bit more of the Biopsychosocial model, the research and the application. Plus I am going to start to discuss why the Venn diagram might not be the best visual representation of the model and its use, especially for movement professionals.