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Connect the Dots: Musculoskeletal Evidence & Houston Astros

I wanted to blog about baseball’s Houston Astros’ cheating scandal. But, how does a chiropractor in Toronto justify blogging about baseball? Here’s how: I’ve attempted to connect the smugness of the Astros’ owner to the apparent lack of knowledge in healthcare regarding the best approach to musculoskeletal care. It’s a stretch (pun intended), but here it goes:

The Houston Astros baseball team was recently caught and punished (depends on your interpretation of punish) for cheating during the 2017 baseball season – the season they ‘won’ the World Series. They cheated by using a camera to spy on which pitches the pitcher would throw, relaying this information to the batter by banging on a trash can inside their dugout. I won’t bore you with the details of how each player’s disingenuous ‘apology’ boils my blood. I also won’t bore you with examining whether the suspensions levied against the team’s General Manager and Coach were enough to send the right message to other coaches, managers, players, fans, and aspiring baseball players. What really bothered me (albeit a worthy watch for a laugh: click here), was the Astros’ owner, Jim Crane, stating, during his ‘apology’, that the cheating may or may not have actually given them an advantage. WHAT!?!

Some context: Professional baseball hitters are the best at what they do. And, to be great, you need to succeed 30% of the time (that’s why a good hitter has a batting average of .300 or higher). The hitter not only has to hit the ball into the field and reach base safely, but has to do so by outthinking the pitcher. The pitcher and catcher choose to throw a fastball, curveball, slider, change-up, etc. on any given pitch. The batter has to predict which pitch is coming to give him the best chance at hitting it, and hopefully reaching base safely.

Now, imagine if the batter KNEW which pitch was going to be thrown. Advantage?   Yeah, I’d say so. The Astros hitters KNEW which pitch was coming whenever they played games in their home ballpark. But, can we prove that the cheating gave them an advantage? Not conclusively. Some have attempted to compare the 2016 and 2017 team’s batting statistics at home and on the road. But, because the players on the team were also different, the results are inconclusive. But, c’mon. In particular moments (for example: 3 balls, 2 strikes, runners on base, game on the line), how can KNOWING WHAT PITCH IS COMING not help? Even when the data is inconclusive, it takes a lot of nerve to say that your team’s cheating did not give it an advantage? If it didn’t, why were they cheating?

So, the early data does not speak conclusively as to the advantage. But, we don’t have to ‘wonder’ if the Astros had an advantage. They did. And they won. Having more data can help. I suppose, having more data can hurt too. For example, if the batter is relying on his teammates to signal the pitch type, he is playing differently than he was trained which might hinder his skills. But, still, wouldn’t you rather know, than not know.

The reason Jim Crane’s smug comment, “let’s leave it at that”, after his non-apology bothers me so much is that it reminds me so much of the science in musculoskeletal care. Time and again, a healthcare practitioner ignores/doesn’t know the data regarding the best care approach for a particular musculoskeletal complaint. We’re supposed to be better than this by now. We have ample research to prove that treating injured joints (knees, shoulders, spines, hips, etc.) with manual therapy and exercise is safer and outperforms surgery in most situations. Yet, doctors continue to order MRIs, refer to orthopaedic surgeons, and inject corticosteroids as a first line approach to care. Informed consent is rarely done, let alone education, reassurance, and sharing of the evidence and options. How to best manage a patient’s musculoskeletal complaint is not guess-work anymore. It is rooted in the data – data that has fairly conclusive healthcare ramifications, such as:

  • Recovery measurements at 6 months, one, five, and ten years
  • Return to sport timelines
  • Re-injury rates
  • Safety rates (including complications of surgery vs exercise, addictive medications vs joint mobilization)

Don’t ‘leave it at that’ when your body is injured and needs the best, evidence-informed care you can receive. Get the data. Understand the data.

Jim Crane had over a month to prepare his ‘apology’, and yet apparently did not even care to read the data. His team was not only better, but the best, because it had a distinct advantage when hitting at home.

When a patient injures their knee or back, do they know the data? I’m assuming not. But, it’s not their job. It’s their doctor’s job. Don’t assume your doctor is giving you the best approach to recovery. Don’t assume your physiotherapist or chiropractor are giving you the best non-medical approach either.

I will never let you assume. I will educate and share all the relevant data with you so that you can make an informed decision about the direction of your recovery (and then I’ll do my best to help you through the process).

I hate the Jim Crane’s of the world who act as though they know more than us. They don’t. They know less, but act as though they know more.


For The Record

For the record, I do not agree with Major League Baseball’s punishment of the Houston Astros. I think they should strip them of their 2017 World Series. The $5 Million fine should be much higher. And, I think the players should have been suspended.

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