Faulty Causation Reasoning

damienhowellpt.com

Faulty Causation Reasoning

FaultyCausation Reasoning - Correlatioon Does Not ImplyCausationThe Declaration of Independence states “We hold these truths to be selfevident”. Most will agree it is self evident that finding solutions to problems startswith identifying the cause. As a clinician I believe identifying the cause of arepetitive use injury is a potent way toaddress the problem. I spend a greatdeal of time looking for the potential cause of repetitiveinjury. One of thebenefitsof being a seasoned clinician is havinghad the opportunity to developwisdom, which can be clever euphuism for having had the opportunity to learnfrom mistakes. Not having the intellect of genius, I strive to keep things simplestupid. Over the years I have developed a theoretical frame work whichattempts to identify in a simple approach to identify the potential causes ofrepetitive use injuries.The theory is repetitive use injuries arecaused by one or more of three things, firstrepeating a motion too much, too fast, too soon; secondly having ananatomical structure whichh is funky, and thirdlyy doing it funky, that is moving inan uncoordinatedd manner.As an example, I’ ve observed runnerswho have shin splints often strike theground with the heel first, and when the injuredrunner was asked to consciouslymodify their running form and to strikethe ground with their whole foot insteadof the heel first they either diminishedd or alleviated the symptoms.This is anexample of “doing it funky” ”.Correlation does not imply causation is a phrase used in science and statistics toemphasize that correlationbetween two variables does not automatically implythat one causes the other. However correlation is necessary for causation andcan indicate possible causes or areas for further investigation. There is a lotmore toproving causationthan a simple correlation or relationshipbetweentwo things. This is why we’ve got to be very careful reading news stories, blogsor evenpeer reviewed medical journals that purport to show that A causes B.© DamienHowell PT, DPT, MS, OCS– 804‐965‐9990 – www.damienhowellpt.com


likely to produce solutions with consequences worse than the original problemsthemselves.Treatments can be effective and symptoms can get better without the effect oftreatment. Injuries can get better because of “Tincture of time” or the naturalhistory of the disease or injury. Injuries can get better because of placeboeffect. The bias or beliefs of the clinician who is measuring the patient’s signsand symptoms can influence or explain why the treatment has been assessedas being effective.The riddle “who is buried in Grant’s tomb” has been used as an allegory in whichthe question provides the answer. What causes running injuries? The answer isin the question, running causes running injuries. However human movement iscomplex therefore it is likely that the cause of repetitive use injuries is complexand multi-faceted. A richer understanding of what causes running injuries isthere to be explored given an open mind. Recognize that treatments that work,in whatever form they might come, even if we do not know why the work, andyes, even if we cannot prove that the treatment is causing the cure. Sometreatments may work because of “tincture of time” or the natural history of thedisease or injury.Bottom line:It is important to look for the causeCorrelation does not imply causationIt is important to have an open mind to consider alternativesTreatment should be based on individualized evidence and carefulthought processing© Damien Howell PT, DPT, MS, OCS – 804‐965‐9990 – www.damienhowellpt.com

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