Simple Is Hard

This post and other science related content has moved to a new home at The Science PT website.

Photo credit: arbyreed

Photo credit: arbyreed

If you can’t explain it simply, you don’t understand it well enough.
– Albert Einstein

Something I have noticed over the years is that physical therapists like to make things a lot more complicated than they really need to be (strength coaches are very guilty of this too, by the way). Why is that? I think a lot of the issue has to do with the relation of simplicity to knowledge and experience. Let me explain this by talking about sourdough and my friend the baker.

Have you ever tried to make sourdough?

Sourdough is an interesting kind of bread even though it is conceptually very simple and cheap. By definition, sourdough requires a starter. Basically you put out a water and flour mixture on your counter and let wild yeast and bacteria begin to interact with the concoction. There isn’t much to do as you wait. A couple times a day you check it to stir and “feed” the mixture with more flour and water. After a few days you will have a yeast/bacteria colony from which you can steal a small sample to use as the active ingredient of your bread recipe. This gives sourdough its distinctive taste. You can keep this colony going forever as long as you tend it, stealing samples for loaf after loaf of bread.

The remaining ingredients are just more flour and water plus some salt. Crazy-cheap and simple. My friend who is a baker can do it in his sleep. He uses no measuring cups or spoons. He just grabs some water, throws in a little flour, and tends the thing for less than a minute a couple times a day. A quick look and a sniff and he knows when it is ready. He then slaps together some dough and bakes a bunch of loaves early every morning.

So why do people pay him $10 for a loaf that is made up of less than ten cents worth of material and is so simple to make?

Funny thing about that simplicity – I suck at making sourdough. I read books, I measure, I fret. My starter turns into a festering science project. Although it is possible that I created sentient life in that bowl, the one thing I did not create is a usable starter. Honestly, I just don’t have time for it.

It is simple to my friend because he understands the science behind it. He spent years as an apprentice and has made thousands of loaves. In other words, his knowledge and experience is MASSIVE and nuanced. When we pay him $10 for a loaf, we are not paying him for the materials and the effort required for what is to him an insanely simple task. To him, any idiot could do this. All he is really doing is mixing things in a bowl and throwing it into an oven. We are paying for WHY it is so simple TO HIM. When I watch him do what he does, I am immediately confused and daunted.

I have been told that my approach to physical therapy is that of a glorified health-club personal trainer. “All you’re doing is strengthening. It’s too simple.” Two things:

1. Strengthening IS elementally simple. Load and adapt. Duh. Just like mix and heat for sourdough.
2. Comparing me to a simple health-club personal trainer is like comparing an orthopedic surgeon to a neighborhood butcher.

It’s like weight loss. Calories in/calories out. Duh. (Don’t argue with me on that or so help me I will come at you with a handful of gluten.) But is that the sum of a registered dietician’s (RD) training? Imagine a college classroom on the first day of becoming an RD:

“Thank you for coming today. I hope everyone found the place ok.” Turns around and writes “Calories in/calories out” on the whiteboard. “Any questions? Great! You can grab your diplomas at the back of the room on your way out.”

It’s the WHAT, WHEN, WHY, WHERE, HOW that makes things so simple.

My knowledge base and experience when it comes to strengthening injured people is MASSIVE and nuanced. And no, this doesn’t mean that I have this immense repertoire of complicated circus-like “functional” exercises. (Don’t argue with me on that or so help me I’ll come at you with a squat rack – I know that doesn’t make sense.) I have to consider pain, fear, sensitivity, tissue healing, etc, etc, etc. Rarely do I come across a situation where a provider didn’t get fancy enough. It is almost always that they didn’t do the simple stuff very well.

We often forget that what is common knowledge to us, is arcane and complicated to others.

“So all of that education and training and all I’m doing is putting people through a workout?” Yep. Just like all that education and training to simply make a perfect loaf of bread. All of that education and training to simply help a patient understand the best way for them to achieve calories in/calories out. All of that education and training to perform an ACL reconstruction again and again.

Notice that I said the knowledge and experience is massive but I did not say it was complicated. Knowledge develops in layers of very simple truths, ask any scientist. The simplicity is what makes the ideas testable which is also what makes them scientific.

When the understanding is deep, the execution is simple.

Don’t undervalue something just because it has become simple to you. Do the simple well and you’ll be surprised.

This post and other science related content has moved to a new home at The Science PT website.

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