Oh, the cognitive dissonance

Just put together a video for the Clinical Biomechanics Boot Camp on ‘Clinical Practice Can be Deceptive’ wrestling with an issue I can’t quite get my head around. Sometimes writing about it helps me think clearer, so here goes:

Foot orthotics for Achilles tendinopathy:
Clinical experience showing they help – check
Theoretical and plausible mechanism as to how they might help – check
Lab based studies showing they do reduce load in the Achilles tendon – check
Case series and uncontrolled studies showing they work – check
Good, well controlled RCT’s showing they don’t work – damn!

Lateal Wedging for Medial Knee Osteoarthritis:
Clinical experience showing they help – check
Theoretical and plausible mechanism as to how they might help – check
Lab based studies showing they do reduce the external adduction moment – check
Case series and uncontrolled studies showing they work – check
Good, well controlled RCT’s showing they don’t work – damn!

Seen that pattern before?

Did writing about this help me think clearer? nope … damn!

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