Who thinks we can link scarfing down tacos and low back pain???
Updated: Jan 9, 2020
What if there was a group of scientists who’s hypothesis was that high taco consumption was the cause of diabetes? They have small RCTs, case studies, and case series that show some promise of positive correlation between taco consumption and increased rates of diabetes. There exists several large cohort studies and a few high-quality systematic reviews of the data, which reveals no correlation. The tacoists (as they like to be called) are undeterred. They know, in their hearts, that there is a correlation and they have a belief that there is a causal link, because they have witnessed the effect of taco restriction in their clinics.
Tacoists then alter their hypothesis and propose there is a subset of the population that have excess taco consumption as the cause of their diabetes. Now they must try to define what that subgroup is. They are certain their new hypothesis is accurate and need to find the appropriate subgroup so they can target a reduction in taco consumption to solve that group’s diabetes. They have seen clinically that some people can manage their diabetes and sometimes permanently return their blood glucose levels into a normal range when their taco consumption is reduced, but it doesn’t help everyone. WHY???
There is an alternative hypothesis that overall calorie consumption has a more specific impact on type 2 diabetes. The tacoists can accept that overall consumption is a contributor, and may be the major problem in some cases, but there is still a subgroup that would benefit specifically from a taco restricted diet.
Does this seem like sound reasoning to hold so tightly to a hypothesis in the face of a more robust hypothesis that is applicable a larger, and perhaps the entire population?
I don’t think so either.
I used to be a tacoist, I told people that they needed to
“Reduce your tacos”
“Maybe eat burritos or quesadillas?”
“If you want to get better, we need to eliminate the tacos!”
“Let’s see if we can modify the tacos to find the specific aspect of the taco that is specifically important to you. I have this new information about more subtle changes that is a more accurate in identifying the problem”
When the concept that diabetes is more complicated than just tacos, it can be a revelation. You goal doesn't have to be to discover the correct combination of fish, beef or chicken OR elimination of tomatoes/lettuce, OR mild/medium/hot sauce, soft or hard… Tacos may be one of the foods that has an impact on my patients, but it is not the only thing to change. I may be able to change their diabetes AND they can still eat tacos?!?!?
We know that biomechanics can play a role in non-specific low back pain. (I am aware some people dislike the term (NSLBP) because they believe ALL back pain is caused by patient specific mechanical loads and if you can't identify THE ONE, it is because you are a not a good enough diagnostician).
Isn't it foolish to continue to pour money into a search for "THE" screening test that will allow us to determine what biomechanical “fault” needs to be identified in order to understand who will benefit from an intervention like SMT. I feel it is imperative to reject the hypothesis that there IS a subset of people with a specific cluster of identifiable biomechanical signs that will respond best to SMT.
The reason I use the term imperative is that I have seen patients who have been significantly harmed by this narrative. I mean, DEBILITATED….. on long term disability with such a narrow sliver of a life, that they can barely care for themselves. Not to mention, their inability to engage with simple joys in their life such as their children or rest of their family and feel they are a burden to these same people. It is heart breaking!!! I have witnessed this exact scenario…
An alternative hypothesis based on the biopsychosocial model suggests there is an intersection where the patient’s beliefs, expectations, and experience, blend with the practitioner’s confidence, perceived competence and engagement. This intersection is where the variability lies. Those varied aspects meld in a powerful mixture that results in those that respond and those that don’t respond to a particular intervention.
To be put simply...
Don’t be a tacoist.