Adam’s recent post and a post by Kyle Ridgeway at PT Think Tank have got me pondering thinking tools. What is a thinking tool? For me, this is a conceptual process that one engages to better understand a concept, experience or observation. The tool I use most often is the paradox.
A paradox is defined as: “a statement or proposition that, despite sound (or apparently sound) reasoning from acceptable premises, leads to a conclusion that seems senseless, logically unacceptable, or self-contradictory.” To put this in a tad bit simpler terms, if we accept certain statements as true then this leads to conclusions that contradict other (perhaps previous) conclusions.
A more concrete and physical therapy related example would be this:
- Some patients have pain.
- Some patients’ pain resolves without treatment.
- Some patients do not need treatment to resolve pain.
The statement: all patient’s need treatment to resolve pain is the conclusion’s contradiction.
Another example could be:
- Some people have structural asymmetries.
- Structural asymmetries cause pain.
- People that have structural asymmetries have pain.
The statement: Some people have structural asymmetries and do not have pain is a contradiction of the previous conclusion.
In the two previous conclusions (bold) we have logical statements that are contradicted by the statements listed below. The incompatibility between these two statements is a paradox.
Regardless of the content of a paradox, how can identifying a paradox help you as a clinician, student, teacher or clinical instructor? I have found this quote by the Prince of Paradox, according to him a paradox is, “truth standing on its head to gain attention.” The paradox for me is the tool I use to focus my attention on a problem that remains unresolved. The interesting thing is once you start to notice one paradox you start to see them everywhere. I would even make the assertion that truth is not defined by an absolute value but by a paradox. Expressed in the form of questions some paradoxes are:
1. Given the fact that people deviate drastically from “normal” running forms, how do they come to run at similar elite speeds? See this video
2. If people have the ability to heal from many injuries without aide why do we express pain?
3. How does the nervous system execute fast, coordinated and reactive movements at speeds much faster than our nervous system could hope to coordinate using its full capacity (this is due to limits in nerve conduction velocities in relation to movement and reaction time)?
4. If there is low likelihood of “tissue remodeling” due to a physical therapy intervention then what can we attribute to changes we see in the clinical setting?
5. Why is their a disconnect between the efficacy of the clinician and that what science shows about the effectiveness of physical therapy interventions?
The beauty of these questions, and a great many others is that there is no definitive answer to any of them. If someone says that they do know for certain, I would listen quietly and then slowly walk away. If we did know the answer to these paradoxes our clinical practice guidelines would be much clearer. This gets to the final points I want to make about paradoxes is that on their flip side they can be immensely profitable to study. Why? Because one has to examine both sides of the coin — the argument and its contradiction. Doing so keeps the mind focused in such a way that continues to spur learning and creativity.
Finally, physical therapy school teaches many things but what it does not teach is deep critical thinking skills. Perhaps this is changing as it has been some time since I was in school. Students are taught skills and techniques that follow the path of a syllabus. When the student reaches a fork in the road, the point of paradox, the teacher can’t slow down, and points of reflection are passed over, it’s on to the next topic. Fortunate for anyone who has read this far in the post they will find out that Duke University is offering a free course on developing reasoning and thinking skills. It is called ThinkAgain. I am currently taking it and find it very well produced and organized.
To tackle the challenges that face our profession we need to identify and keep our eyes focused on the paradoxes that present themselves. These skills are not inherent to our discipline but with a little effort I think we can master them for the betterment of our patients and ourselves.
Eric Kruger @Kintegrate