Pain and movement are pretty complicated, right? In a sense yes. But in another sense no. Pain and movement are not complicated, they are complex, which is a different animal.
Imagine you are Elon Musk trying to send a rocket ship to the moon. What sort of thinking process, analysis, modelling, research, predictions, and methods of control would help solve this problem? How would that process be different from solving the problem of say, raising a child?
I’m sure you can think of many ways these tasks are different. For example, raising a kid requires diapers. Wait, does it really? Is that paleo? And here’s another thing: a quick google search tells me that astronauts actually wear something called a “maximum absorbency garment” on takeoff. Let’s face it, that’s basically a diaper.
But I’m getting off track here. Even if the need for diapers is not really a legitimate difference between rocket science and child-rearing, there are still many other differences that actually relate to the subject matter of this post. So here are some similar distinctions that help get to the point:
- Designing a social media platform versus getting millions of people to use it
- Building a highway versus reducing traffic congestion
- Removing a brain tumour versus maintaining general health
- Winning a war versus keeping the peace
What’s the difference?
According to an idea used by systems theorists, the first set of problems are complicated, while the second set is complex. Although these words sound similar, they describe two different systems that need different approaches to create desired change. Complicated systems are usually built from design, and include cars, computers and buildings. Complex systems were not built but evolved, and include living things, ecologies and economic systems.
Health professionals, including those working with movement and pain, often attempt to address complex problems as if they were merely complicated. As explained below, this is very much like the drunk who loses his keys in the alley but looks for them under the lamppost because the light is better there.
Read on for more information on how to tell the difference between these different systems and why it matters. The basic idea is that most problems with movement and pain are probably more complex than complicated. Surprisingly, recognizing this fact will probably simplify your approach to improving them.
A system is a set of parts that work together to perform a common function. Both complex and complicated systems have many different parts and subparts that are very interrelated so that the behaviour of one part will affect other parts and the system as a whole. But there are crucial differences.
One is that a complex system does not have any means of central control. The orderly behaviour of the system “emerges” from the interaction of all the subparts. For example, a bee colony can accomplish amazingly sophisticated tasks like building a nest, but there is no single bee that knows how to build it. Instead, each bee is just following its own simple algorithm for behaviour. The intelligence that builds the nest lives in the interactions between the bees – it is far greater than the sum of its parts. We, therefore, say that the hive’s intelligence is “emergent” or “bottom-up”, as opposed to centralized or top-down.
By contrast, a highway is a complicated project. Unlike a bee’s nest, it is built according to a central plan.
Everything is designed, predicted and controlled by experts at the top of a chain of command. These experts have the ability to gather all the relevant data about the project and order changes in every relevant variable. If something goes wrong, they can diagnose the reason for the dysfunction, and prescribe an appropriate correction. So the problem of building a highway is solved according to a very precise process, whereby proper analysis of all the parts leads to a complete understanding of the whole. (This is basically reductionism.)
Now imagine there’s traffic congestion and we want to reduce it. Can we follow a similar reductionistic, command and control process to solve the problem? No, because traffic levels depend on many factors that are unmeasurable, unpredictable and uncontrollable by any central planner: weather, accidents, and thousands of decisions by individual drivers, which are all made in relation to the anticipated and actual behaviour of other drivers and events.
Traffic congestion is, therefore, a complex problem not a complicated problem. That doesn’t mean you can’t solve it, but you do need a different approach. You can’t control the behaviour of drivers, but you can encourage it to change, maybe by building public transit, making carpool lanes or creating tolls.
The effects of these measures might be somewhat predictable, but there will always be uncertainty. It’s kind of like dealing with a toddler – some things that work with one kid will totally backfire with another. And you can’t force them to behave, but you can guide them in certain directions through changing incentives and environmental constraints.
So what do you think? Is improving movement performance and reducing pain more like building a highway or reducing traffic? More like rocket science or more like parenting?
Here’s a chart with more distinctions to help you decide.
Consider the work you do with your clients in light of these factors.
For example, does it absolutely require many years of training? If you are doing surgery or administering anaesthesia, then yes absolutely. If it’s helping someone lose weight or making someone feel better after a massage, then training certainly helps, but it is not absolutely required (and won’t guarantee success either.)
Here’s another question: Are you able to understand and solve problems by measuring and controlling all the relevant variables? Or, are there many crucial variables that are beyond your knowledge and control?
The Body Is Complex
Most of what happens in biological systems, including the human body is complex. The body is composed of billions of cells, none of which are any smarter than a bacteria. The intelligence which creates motor control, sensation, perception, including the perception of pain, emerges from the relatively idiotic interactions of all these billions of cells. There’s no one in charge. Unlike a car, the system was not built. It grew.
However! Just because the body is complex, that doesn’t mean that all problems related to the body are complex, or even complicated.
For example, a broken bone has a simple cause and a simple solution. Many other complaints that arise quickly in the body might be related to simple or merely complicated problems, such as acute injuries or even repetitive stress injuries. But many other areas of concern for movement therapists are complex.
Biomechanics is complex.
Motor control is complex.
Here’s a simple proof: World-class experts in these areas readily confess their ignorance about even the simplest matters:
- They don’t really know whether low back flexion has much relationship to low back pain.
- They don’t know whether the psoas is more of a hip flexor or spine stabilizer, or whether it creates posterior or anterior tilt in standing.
- And they don’t know the best ways to treat chronic pain. In fact, most motor control approaches perform little better than general exercise.
Given this level of uncertainty, the problems of movement and pain look more like raising a child than rocket science. Expertise is clearly useful, but (given current levels of knowledge) it does not lead to a full understanding and control of the issues, and cannot be expected to significantly outperform good common sense.
That doesn’t mean you can’t make progress reducing chronic pain! Simple common sense interventions work for chronic pain, just as they work to raise a healthy child.
- Get support from family, friends and healthcare practitioners. Go to a PT. Get a massage.
- Learn more about pain. Maintain an optimistic outlook and internal sense of control.
- Experiment or play with different ways to move. Confront your fears.
- Apply a Goldilocks level of exercise stress to the painful area to encourage adaptation without further injury.
- Exercise, sleep well, eat well and try to reduce stress.
None of these tactics are the kind of targeted, scalpel-like interventions that make highly predictable changes in complicated systems. They don’t involve the kinds of algorithms, recipes or blueprints sold by movement gurus.
But they work! Especially under the guidance of someone who is skilled in their application. And they are far simpler, cheaper, safer and honest than interventions that treat the body more like a machine than a living thing.
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