Rod Harris: When Competent Trumps Expert

Ask just about anyone and they will tell you that competent means good and expert means better.

Have you ever stopped to ask yourself if this is true?

Does being an expert mean you are actually better at your job, or just one small slice of your job? We do expect an expert to have a lot of detailed knowledge but, of course, more detail means a narrower focus. And it’s always assumed that the expert must have been competent BEFORE they chose to specialize. In other words, they had a broad level of knowledge first and then narrowed the focus.

But what if being an expert means that you became incredibly focused at one aspect of your job too soon? In other words, you went for depth long before you had enough breadth. Or maybe you have focused for so long, you can no longer see the big picture? In either case, being an expert may well mean missing something important.

These same principles are of course just as relevant to the strength and conditioning coach as they are to the clinician.

Let’s take a simple example. What if we took two coaches, each with decades of experience coaching power lifters, except one coached no athletes other than power lifters while the other still coaches a handful of athletes from different sports or at the very least still stayed abreast with current best practice through a network of other coaches.

So now we have two specialists but there is a chance that one coach has become so narrowly focused, he/she is brilliant in the power-lifting field but unable to recognize when an athlete needs a totally different approach.

We are seeing the same thing happen in the manual therapies today. No longer can practitioners rely on just their traditional skills from the modality they originally studied, be it physical therapy, osteopathy or chiropractic practice (just to name a few examples). Narrowing your focus to become an expert in a particular technique, sub-set of patients or body part may result in missing the best approach for the patient in front of you.

Let’s take the example of a clinician who specializes in treating dancers. It’s true that dancers do have some very sports-specific requirements – extreme plantar flexion for ballet dancers is an obvious one. It’s also common for clinicians treating dancers to assess the dancer’s “core strength.” But it’s all too easy to make the assumption that because the dancer can perform an isometric contraction of their core while lying on their back, this is indicative of how they will use their core when they are actually dancing. These are two different motor patterns and require the dancer to use a different strategy to complete different tasks. The first is performed under conscious control while not moving and the second, unconsciously with everything moving!

If our expert dance clinician just passively checks specific range of motion with no objective assessment of the control over that motion and uses only a supine isometric contraction to assess core function, then our expert really does need to change their approach to improve their competence.

Expert doesn’t automatically imply broad based competence.

We’ve already seen a great example of this in the development of Mixed Martial Arts as a sport. In the USA, fighting sports were largely grouped into strikers (think kick boxing, karate, kung fu etc) and wrestlers. Practitioners from these two groups never competed against each other. Australia was similar, but at the time, judo was the more common grappling art. However just as with wrestling in the USA, there was little focus on the submission side of the sport.

The Brazilians on the other hand had been using traditional submission style judo for decades and testing this in a system of combat with more open rules. (BBJ practitioners, please don’t get upset that I don’t run with the usual line that BJJ invented their own system. They didn’t, the Gracie family was taught by a kodokan judo expert, Mitsuyo Maeda.) What made the Brazilians different however was that they noticed that in open combat, the ground aspect of the game was really important and got very, very good at it.

The Brazilians became experts in that one aspect of the fight game. And for a few years, this was enough. It really didn’t take long however for competitors from other countries to catch on. Just three years after the first UFC cage fight, a fighter from the USA – Don Frye, proved decisively that competence across all ranges of the fight game, trumps expertise in any one area. In fact, another Brazilian fighter – Marco Ruas, also with a more well-rounded fight game, proved this around the same time.

What the Brazilians did was truly revolutionary in the fight game. They forced experts from other aspects of the sport to change their approach and learn a wider variety of approaches outside their existing skill set. In other words, to broaden the base of their competence.

For the clinicians, let’s just get this out of the way right now:

Everyone thinks that the modality they learned is best.

Sure, each one finishes their education with some specific advantage over the others, but by the time you get to competent, there should be a LOT more in common than apart. In Australia, I teach the SFMA (Selective Functional Movement Assessment) with a physical therapist and a chiropractor and, although I am an Osteopath, I can tell you we have WAY more in common than we do apart. Actually, any time we get together, we teach each other. This helps fill our gaps and lifts the competence level for all of us across the board, despite the fact that each of us has areas where we are more specialized than the other.

Do you have a preference for one technique or approach over another? If you are choosing manipulation as your technique of choice for every musculoskeletal condition you see, then I agree you are likely more of a manipulation expert than me. However, if the patient in front of you isn’t responding and you keep manipulating, then your expert skills don’t matter any more because you’ve already reached the limit of your competence for that patient. In this instance, you need another approach.

Have you got those broad skills to draw upon?

The tissue feel of the problem in front of me chooses the technique that I pull out of my toolbox. My preference has little to do with it. However, because I can rely on my competence across a number of techniques, I may well be able to treat wider variety of conditions more effectively than the expert.

I can’t count the number of times another practitioner has looked at me blankly when I talk about accurately diagnosing and changing poor motor control patterns. There is nothing wrong with not knowing, I was the same just years ago but when you wilfully ignore an unfamiliar approach and instead start to tell me how your favorite joint adjustment technique will solve a motor control problem, be prepared for me to stare blankly back at you.

It’s absolutely fine, and indeed can even be commendable, to become an expert in one particular aspect of manual therapy but you MUST remain competent at all the other aspects of your job. You know the old cliché,”if all you have is a hammer, all you see is a nail.” Focus too narrowly and you run the risk of not even knowing what you don’t know.

What does it take to be a truly competent practitioner? By this I mean the practitioners who are known for treating and managing a vast range of conditions. Using the approach that works best for each individual patient, not solely based on the narrow focus of your expert skills. One treatment to the next can and likely will look very different, not just a cookie cutter approach that looks pretty much the same regardless of the patient.

In the SFMA, we focus on three aspects to the treatment approach:
Reset,
Reinforce and
Reload.

A reset is any technique we use to enhance mobility. Generally these are the techniques that patients can’t do to themselves, it requires our input as a practitioner.

A reinforce is anything we do or any advice we give that makes the reset more effective or helps the patient manage his or her own condition more effectively. This might include taping or bracing, stretching, self trigger-point work, advice on ergonomics, sleep, nutrition or recovery. It also includes identifying pain triggers, to protect the patient from making the condition worse.

A reload is an exercise that assists the nervous system in using the range of motion available. This is not only useful where adequate range of motion is already available but also where we improved it with a reset or re-enforce technique and need to teach the nervous system how to use the extra mobility gained.

In fact many clinicians choose to specialize within these areas. A reset specialist in joint manipulation, or a reinforce expert in taping are common examples.

Some therapists go in a different direction altogether. They narrow their focus to the point where they become a “shoulder expert” or “hip expert.” My concern about this approach is where these experts are just reducing the body to a single region and do not consider this with respect to the function of the other areas of the body. I am not really sure what these “experts” do when another part of the body is driving the problem? I can’t count the number of times I have improved a patient’s shoulder problem after treating their hip. Indeed, more times by fluke than I care to admit but the point is that because I use a broad-based assessment tool, I don’t miss any influence these seemingly unrelated regions have on the presenting complaint.

And don’t get me started on therapists that think that the answer to all conditions is to “strengthen it.” Really? What if the joint simply doesn’t move in that direction? How about if the muscle is already strong enough but firing out of sequence?

Honestly, I am fine with anyone who is an expert in any particular aspect of the clinical approach, providing they are competent across all areas of assessment and treatment. The problem is that often they didn’t take this approach of going broad before going deep. Or they went deep then simply stopped staying abreast of advances outside their specific skill set.

In the past, my aim was indeed to become an “expert” in mobility reset skills, while maintaining competence with reinforcing skills.

For a long, long time in my career, I didn’t know how to reload beyond the all too common scatter-gun approach of generic exercises. I knew I was missing something but I just didn’t know what I didn’t know. I would restore mobility so the patient would have the range of motion available and then scratch my head when they couldn’t use that mobility. It didn’t matter how “expert” I was in reset techniques, I was simply NOT competent in this area of practice. And I was going to stay this way until I learned how to address this gap in my knowledge.

For these patients, any expertise I had in reset techniques made absolutely no difference whatsoever to their presenting complaint. They required a competent reload approach. Not an expert reset approach.

Knowing what you don’t know is very important part of being a clinician. A narrowly focused expert may not know when something is outside their current skill set. Indeed, the trap is not knowing why your approach isn’t working when it clearly isn’t.

Study deep and improve your expertise by all means. Just be sure that this doesn’t happen at the expense of keeping a broad range of skills.

Don’t let expert get in the way of competent.

Over the past two decades, the practice of martial arts has fundamentally changed. Many martial arts instructors ignored the need to broaden their approach, get outside their area of expertise and get competent across all ranges of the fight game. Those that did broaden their skill base (or at least encouraged their students to study more widely) are still around and relevant today. Those that didn’t are gone.

Where will you be a decade from now? Will your skills still be relevant, or will you have dropped off the radar because you let expert come before competent?

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