In one memorable scene from the Star Wars classic The Empire Strikes Back, Luke Skywalker complains to Jedi Master Yoda that his X-wing spacecraft will never get out of the swamp where it has landed. Luke has learned how to use The Force to lift stones off the ground, but “knows” that the spacecraft is too heavy to be raised out of the swamp. Yoda tries to explain that the use of The Force is not confined to such simple ideas of weight, telling Luke that “you must unlearn what you have learned.” Unfortunately, Luke still has trouble getting past what he already “knows” until Yoda raises the X-wing from the swamp himself.
In my judgment, musculoskeletal healthcare has a really difficult time with the idea of unlearning what we think we know. Whether it is manual therapists that believe that pain is driven by “stuck” or “shifted” joints, to surgeons that believe shoulder pain won’t resolve until a tendon is repaired, to academicians who can’t see past RCT procedure to realize that proper technique matters, or to exercise therapists that believe that no treatment outside of exercise/education should even be considered, all musculoskeletal disciplines share some blame with this issue; that is, advancing our favorite, outdated ideas while putting blinders on to both evidence and innovation.
I believe a good part of the reason we have this issue is that patients want concrete answers when they don’t exist. So, to fill the void, clinicians find their explanation and run with it. I think a better way to handle this is to acknowledge that we don’t have all the answers, that we are continually seeking for the best solutions, and that the patient will benefit from our continued quest for knowledge and innovation. And the best part of this approach is that we will never be guilty of failing to “unlearn.”