Clinical Practice in Athletic Training: In the Eye of the Beholder

Depending on the day or time, athletic trainers and athletic training students encounter an array of injuries and medical conditions in their various patient populations. As such, there are a variety of approaches we can take to assess and treat our athletes. The athletic training profession has many tools, some of which are controversial in the current evidencebased culture. Therapeutic modalities (eg, cold-water immersion and ultrasound) are often the subjects of criticism by skeptics who point to a lack of conclusive, high-quality experimental evidence to support their effectiveness. If we cannot verify a clear, consistent, and physiological effect for a particular intervention, is it justifiable to keep that strategy or technique in our clinical toolkit and continue to use it despite the lack of clear, objective evidence? Many of us have encountered evidence-based medicine debates surrounding our clinical practices, sometimes in our local clinics and increasingly in the virtual debate halls found on social media platforms. These debates vary widely in both civility and relative expertise of the participants, but there is often a unifying theme to the conversations. On one side of the debate are individuals who rely on experimental evidence. For these professionals, treatment or intervention strategy “x” is “bunk” if it lacks reliable support from high-quality randomized controlled trials that conclusively demonstrate its effectiveness. The focus of such evidence-based clinicians is almost entirely on clinician-oriented outcomes, which are those best suited to objective measurement and quantification. However, this perspective fails to appreciate the nuances and complexities of the many human factors associated with live clinical practice. If we are completely honest with ourselves, we will admit there are often more “gray spaces” and gaps in our clinical knowledge and evidence than we might care to admit. Accepting this premise, it might be wise to appreciate and incorporate an element of “epistemic humility” into our clinical toolkit if we are going to avoid such rigid adherence to decisions backed by hard data. Clinicians know that the effects of many common therapeutic interventions vary from person to person, potentially altering the intended effects for different patients, and even for the same patient on different days. Such variance has been found with the application of therapeutic ultrasound.1,2 Additionally, we know that patients respond differently to various interventions due to mulClinical Practice in Athletic Training: In the Eye of the Beholder