The cost of being evidence-based

It's been a busy month since my last newsletter, with lots of travelling and teaching across the globe and lots of interesting discussions with therapists all over the world.

One of the most common discussions I have with smart, dedicated, passionate therapists, no matter what country I am in, is around the difficulties many have in being able to practice in an evidence-based way.

Many tell me about their frustrations with the systems and institutions they have to work within, constrained and forced to do things they would rather not, and unable to do the more effective, evidence-based things instead.

And I totally understand, as I find myself in these same situations myself daily.

The facts are that being an evidence-based therapist is both difficult and challenging and comes with some pretty high costs.

Not a “dry needling courses are expensive” kind of way (although they all are). I mean in a social, societal, and professional kind of way.

And that's because evidence-based care often looks… well… cheap and underwhelming.

It’s not sexy, exciting, trendy, or dramatic. It doesn’t come with laser-guided needles, sweet-smelling incenses, or some interpretive manoeuvres on fascia.

Evidence-based practice is often incredibly simple, straightforward, without any drama, frills or fluffy stuff. 

But the systems most therapists work in don’t often reward the simple, boring-but-effective stuff.

Instead, they reward… 

• Gadgets over Gymnasiums 
• Feeling better over getting better 
• Repeat visits over Self-management 
• Stories over Statistics 
• Certainty over Honesty 

Evidence-based practice doesn’t sell well because it’s not built to sell. It’s built to work. 

Hidden Price Tag

This is the hidden price tag of ‘doing it properly’ that very few talk about.

Evidence-based care often means having to say things to patients that often don’t feel nice in the moment, and that many don’t want to hear… 

• “There isn’t a magic quick fix here.” 
• “Your scan findings don’t explain your pain very well.” 
• “Some rest and massage might help today, but it won’t help you next month.” 
• “We should look to try and build your capacity, not just reduce your pain.” 
• “You’ll probably need to do some work between sessions.

This is not as easy as saying:

• “Your leg length difference explains your issues” 
• “Your pelvis is rotated, and I can fix it.” 
• “Your glute isn’t firing, but my hands can wake it up.” 
• “You’ve got tight fascia knots, and I can release them.” 
• “Come twice a week and we’ll keep you ‘aligned’.” 

One of these approaches helps build resilience and independence. The other builds fear and dependence.

But guess which one keeps the diary full… your manager happy… your bank balance healthier? 

More ≠ Better 

Healthcare and rehab often reward more intervention, not better outcomes. In clinics, results are often measured by satisfaction, not statistics. 

This often means…

• More hands-on.
• More equipment.
• More interventions.
• More “specialist” language.
• More theatre and placebo.
• More appointments. 

It looks like care. It feels like care. It is often marketed as care. But sometimes “more” is just: 

• More billable time, 
• More reassurance through rituals, 
• More avoidance dressed up as “treatment”, 
• More dependency disguised as support. 

More care doesn’t always mean caring more! 

In fact it could just be the opposite. 

Don’t get me wrong, I think ‘more care’ is often well-intended. Lots of therapists genuinely want to help and think the more they do, the more they are helping. 

But good intentions don’t magically turn weak reasoning into good outcomes. 

The difference between “feels better” and “gets better” 

Feeling better matters. Pain relief is useful. Really useful. 

But if every session leaves someone feeling temporarily looser, less painful and “better aligned”… but in less than 24 hours they are back to square one… that’s not rehab. That’s maintenance of a problem. 

Getting better looks like: 

• Doing more with less fear 
• Increasing tolerance and capacity 
• Learning what helps and what doesn’t 
• Having flare-ups but recovering faster 
• Needing the therapist less, not more 

Progress isn’t always comfortable. It’s often messy, non-linear, and annoyingly normal. 

A quick reality-check you can use! 

If you’re a therapist trying to find the right balance here, ask yourself these key questions: 

1. Am I improving capacity, confidence, function… or just offering short-term relief? 
2. What’s the plan that makes them less reliant on me? 
3. How are we measuring progress beyond “it feels different for a few hours”? 
4. What are we doing between sessions that drives the change? 

If the answer is mostly “keep coming back and I’ll keep doing things to you”… that’s not a care plan. That’s a subscription service. 

The real difficulty with evidence-based care! 

It asks people to tolerate uncertainty. 

To be patient. 

To practice. 

To build. 

To accept that the body is adaptable, not fragile. 

It’s not flashy. It’s not always comforting. But it’s honest.

And in the long run, I think honesty is a far better treatment than gadgets and gimmicks. 

So if you are a clinician trying to do this properly in a system that makes it incredibly hard…

I see you. Keep going. 

And if you’re a patient reading this, stuck in a loop of endless “fixing”, consider finding another therapist with a better strategy. 

As always, thanks for reading, and remember… You can’t go wrong getting strong! 

Adam