“Empirical evidence, data, or knowledge, also known as sense experience, is a collective term for the knowledge or source of knowledge acquired by means of the senses, particularly by observation and experimentation.” (Wikipedia)

Empirical evidence has a special place in my heart and my practice. My passion and excitement for therapy are increased when I am working with a new idea. There is great curiosity, creativity and genuine interest when I encounter a problem that does not make sense. In therapy, outcomes are usually very predictable: A + B= C. What happens when it does not equal C or it is C ½, not quite the outcome but similar? If you can make sense of the discrepancy, you can then manage that problem the next time you encounter it. This means we are gathering and using empirical evidence every day.

Norman Doidge tells a story in The Brain’s Way of Healing that demonstrates the power of creativity (and sometimes luck). It is a beautiful example of empirical evidence benefiting our profession and our patients.

Neuroscientist Michael Moskowitz studied chronic pain. He was satisfied with the current state of chronic pain management until he started having chronic pain himself. He injured his neck and for the next 13 years fought neck pain and dysfunction. He tried all of the conventional and nonconventional methods of managing pain with no avail. Luckily, as a neuroscientist, he had access to imaging and so he began to study brain scans.

Moskowitz looked at scans of acute pain, chronic pain and no pain and found a significant difference between the three. Chronic pain had an abnormal pattern in the brain. The areas that were active in acute injury were also active in chronic pain, but there was more. The active regions had grown and were seeping into other areas of the brain that should not be activated with acute injury. He developed a theory that acute pain is meant to protect a person, but when there is no current injury and the pain persists, the brain has somehow become misguided. It keeps the injury alive.

Moskowitz posed the question, “If the brain is the cause of the chronic pain, then how do I change that?” He hypothesized that if he were to visualize the pain map in his brain and then imagine it decreasing, it would then decrease his pain levels. He chose visualization because of the size of the visual cortex and ease of accessing visual input. He performed these exercises every time his pain increased. He did not notice any change until 3 weeks in when he started to have 5-10 minutes of pain relief. It took four months to get complete pain-free periods and about a year to have no pain at all. These time frames are not that different from successful physical therapy.

This story grabbed me because here you have an individual that took a new idea and successfully tested it. He then tried it on some patients, without any research or acceptance of peers that this was an appropriate treatment. He now has developed his own treatment process that is very successful in helping this population. In physical therapy, when we try to be creative or innovative the main question that I receive is, “Where is the evidence or research?” Many times we discredit empirical evidence before it is even given a chance. In my experience, my patients have benefited just as much or more from empirical thought rather than just depending on published research alone.

When we create a culture that defines evidence as published research, we choke out innovation and undermine our belief in our own ability to evolve the profession through our practice. The two must work in concert or we will stagnate. My guess is that many therapists are using empirical evidence. They are observing and they are experimenting every day. What they are not doing enough of is sharing.

I perform a technique you have never seen before and you see significant improvement, usually more than you have ever seen.  Why would I not do this?  It is my job to give the best care no matter what it is.  I will use what works, it is up to me to give this information to the researchers to get it “evidence based.”  Until then, I use what works.  Evidence is there, you have to just change your definition of what evidence is.

What new idea might you share if you were guaranteed not to be asked the question, “Where is the research?”

-Rajesh Khemraj

Clinical Fellowship Instructor

The North American Institute of Orthopaedic Manual Therapy

About the Author

Rajesh is a Physical Therapist, who is passionate about health and wellness. He is interested in all aspects of general well being including fitness, nutrition and mindfulness. He continues to learn and grow from the profession he loves.

If this article is helpful to you or you would like to get more information, please do not hesitate to contact him at superflypt@gmail.com