By Ben Csiernik
Bertrand Russell was a religious philosopher, and in fact, not a musculoskeletal therapist. However, I do think had he chosen a different career path, he would have loved to discuss his treatment philosophy with all who would listen. Bert is famous for his thoughts on teapots, and more specifically, one teapot. Russell is known for declaring that it is not the responsibility of skeptics to disprove theories or dogma, but instead, the burden of proof falls on the person making the claim to prove it (1). Russell’s famous analogy is as follows:
“If I were to suggest that between the Earth and Mars there is a china teapot revolving around the sun in an elliptical orbit, nobody would be able to disprove my assertion provided I were careful to add that the teapot is too small to be revealed even by our most powerful telescopes” (1)
Now I’m not an astronomer, but I am fairly confident that this teapot doesn’t exist. But, if Russell anecdotally says that it’s there, neither you nor I should have to waste our time trying to disprove it. Instead, we should patiently wait for him to present scientific proof to show that he is correct, and is not just spouting an anecdote. This is Russell’s Teapot.
If we begin to extrapolate this idea to rehabilitation and managing pain, we can quickly realize that many teapots exist. We can look at cupping, acupuncture, friction massage, vibration guns (hell I even have one of these that hasn’t been used in 12+ months), and patiently wait for adequate and methodologically sound research to be presented. It shouldn’t be my responsibility to demonstrate that acupuncture doesn’t reduce pain more than a sham (2,3), that cupping doesn’t change blood flow or outperform sham (4), that SI joint manipulation doesn’t change joint positioning (5), or that vibration guns prime muscles. It is the responsibility of those who utilize these interventions to bring forth the best available evidence; evidence that is reproducible and not riddled with bias.
As we all know, the entire scientific method is based around the idea of the null hypothesis, that nothing works until it is demonstrated that it does. For this reason, I like to think that we should all try and be medical conservatives, a term coined nicely by Mandrola, Cifu, Prasad, and Foy in 2019 (6). Their lens comes from allopathic medicine (you know, real medicine and science), and they eloquently state:
“The medical conservative, however, recognizes that many developments promoted as medical advances offer, at best, marginal benefits. We do not ignore value… The medical conservative adopts new therapies when the benefit is clear and the evidence strong and unbiased” (6)
New and promising research is exactly that, new and promising. It is under researched, under developed, and under tested. Though this sounds like nihilism, it is actually far from it. I think we need to look at what treatment has proven and established evidence, and we need to continue to look at how we can implement this in the best way we can. For this, I suggest you all check out J.P Caneiro’s work here, as him and his co-authors efficiently and effectively articulate how we can be medically conservative, and still implement best practice care. At the end of the day, I encourage all of us to keep anecdote for it what is: personal stories and experiences. They are not robust and methodologically sound research projects, and thus, should not be represented as such.
New, fancy, and promising quick fixes will continue to present themselves, and even old unsupported opinions will continue to be proclaimed. It is our responsibility to challenge these claims, but it is not our responsibility to disprove them. I encourage everyone to continue standing up to bad science, and demanding the best out of health care practitioners, strength coaches, hell, everyone. So the next time someone wildly claims something based on anecdote, I want you to remember Bertrand Russell, and I want you to remember his teapot.
1) Van Inwagen, P. (2012). Russell’s China Teapot. The Right to Believe: Perspectives in Religious Epistemology, 11-26.
2) De Meulemeester, K. E., Castelein, B., Coppieters, I., Barbe, T., Cools, A., & Cagnie, B. (2017). Comparing trigger point dry needling and manual pressure technique for the management of myofascial neck/shoulder pain: a randomized clinical trial. Journal of manipulative and physiological therapeutics, 40(1), 11-20.
3) White, P., Bishop, F. L., Prescott, P., Scott, C., Little, P., & Lewith, G. (2012). Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture. Pain, 153(2), 455-462.
4) Lauche, R., Spitzer, J., Schwahn, B., Ostermann, T., Bernardy, K., Cramer, H., ... & Langhorst, J. (2016). Efficacy of cupping therapy in patients with the fibromyalgia syndrome-a randomised placebo controlled trial. Scientific reports, 6, 37316.
5) Tullberg, T., Blomberg, S., Branth, B., & Johnsson, R. (1998). Manipulation does not alter the position of the sacroiliac joint: a roentgen stereophotogrammetric analysis. Spine, 23(10), 1124-1128.
6) Mandrola, J., Cifu, A., Prasad, V., & Foy, A. (2019). The case for being a medical conservative. The American journal of medicine, 132(8), 900-901.