What Allen Iverson and Evidence Based Practice Have In Common

I recently was watching a documentary that was done on Allen Iverson, one of the most electric and also influential (good or bad) players the NBA has ever seen. Ironically it got me to start thinking some parallels exist with his story as it relates to evidence based PRACTICE...

As one would expect, a part of the documentary was dedicated to his famous rant about practice.

"We sitting in here -- I'm supposed to be the franchise player, and we in here talkin about practice. I mean, listen. We talking about practice. Not a game. Not a game. Not a game. We talkin about practice. Not a game. Not the game that I go out there and die for and play every game like it's my last. Not the game. We talkin about practice, man."

Now during this time there were periods of feuds between Allen and his coach Larry Brown both in games and during practice that were made public. 

Everyone assumes this whole rant was related to practices. When in fact it really wasn't!

Iverson believed in the need to practice, he would never had reached his skill level without practicing....What the media failed to play was the ENTIRE clip so that the viewers could gain CONTEXT of what the whole story was truly about.

What Allen was talking about was his best friend had died and he was having a hard time dealing with it. The murder trial for the case was actually just a few days before that whole interview went down. Here is the rest of the clip:

"I'm upset for one reason: 'Cause I'm in here. I lost. I lost my best friend. I lost him, and I lost this year. Everything is just going downhill for me, as far as just that. You know, as far as my life. And then I'm dealing with this. ... My best friend is dead. Dead. And we lost. And this is what I have to go through for the rest of the summer until the season is all over again."

Allen didn't want to talk about practice. To him, at that time, practice was the least important thing he had to worry about...

But to this day, everyone quotes that clip. But very few really understand the context and as a result it changes the whole entire story.

Now it doesn't have to change your opinion on Allen Iverson (as that can be a polarizing discussion in and of itself). However it does paint an important picture that if you do not understand the entire context of a situation then it leads to faulty interpretation.

I see this all the time with clinicians who spend their time surfing through research abstract articles.

Looking at highlights, not understanding the context. 

I also see this with everyone in the fitness or rehab industry posting countless videos of the newest exercise or mobility drill of the day.

Again, you just see the exercise....no context or reason why, how, when, and for what the exercise was used.

It's just a glimpse...

Then you spend the next two weeks including that exercise into everyone's workouts or rehab programs only to never use it again because either it was a worthless exercise to begin with or you just didn't know how to properly program and coach the activity.

Don't call yourself evidence based if you just read an abstract.

Furthermore, understand that everyone is different and responds to situations in a different manor. Put the rest of the nba in that exact same scenario as Iverson and who knows all the different responses that you would get?

This is the whole idea of when you are treating a patient, it truly is n=1. You can't always rely upon a statistical result or finding from a large population of people.

Everyone is different and we are never working with a large body of people.

We are working with an individual. So when working with a single individual you use a within subject approach. You test, and then retest. This model works well for rehab based clinicians, as individual response will defer. We are not a surgeon who if they make a mistake it could result in a very bad thing. In the rehab setting, you should be using a safe to fail approach with your intervention. That is to say, do no harm.

Interviene and monitor the response and adjust accordingly. That adjustment could be within treatment or it could be within week to week or month to month depending on the scenario and what adaptation you are trying to cause.

What remains consistent though is that the more you understand the context, the better you can start to intervene and the less trial and error you will have to utilize.

Part of what I am proud of SRE for is that it shows you exactly what we are thinking, gives you context, and allows you to ask and have questions answered! I'm ok with not knowing everything. But I'm going to keep getting better! And the environment that the SRE community is about is to allow for conversation, thought provocation, and continual improvement.

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