Upon these rocks.

Few tenets are held so dear in physical therapy as the notion that muscle weakness contributes to postural defects. One could argue that this assumption, along with a few others, supplies the foundation for much of our practice. This month, DiVeta, Walker, and Skibinski suggest that perhaps we have assumed too much. This is the second time Ms Walker has challenged this assumption.[1] As a co-author of her previous paper, I bring an identifiable bias to any discussion of the subject. I am therefore grateful that Dr Shirley Sahrmann has supplied such an excellent commentary on the DiVeta article. She raises important issues. Controversial articles should be discussed, their findings scrutinized, and their implications carefully considered.

The purpose of this Editor's Note is not to reflect further on the credibility or generalizability of the report by DiVeta, Walker, and Skibinski. My purpose is to discuss the implications of any research that questions the basic doctrines of our profession. Does a muscle's tension-generating capacity relate directly to the muscle's role in posture? No one reading the DiVeta article or Ms Walker's previous work is in a position to answer that with absolute certainty. The two works together, however, raise question-questions that may seem almost heretical in the context of traditional practice.

My concern is how we deal with research that challenges basic assumptions. Thankfully for DiVeta and colleagues, we no longer deal with heresy the way we did in the days of Galileo. But unfortunately for our profession, we do not seem to have improved much on that approach. We no longer burn heretics or formally excommunicate them-we simply ignore what they say. This is not just true for the original Walker article or the article in this issue; it appears to represent an unfortunate trend.

Walker's original paper appeared 3 years ago. Since that time, there has been no published report of attempts to replicate her work, criticize her work, or extend her work. Only one article, by Neumann and colleagues, has even dealt with the same general subject.[2] As a co-author of Walker's original paper, I am not in a position to be as critical as others might be, but even I know that there is room to question. There is room for doubt, and there is room for further inquiry. Why has our research community failed to follow up on Walker's original findings? Why have clinicians failed to collect data to challenge Walker's conclusion that their approaches should he reconsidered? I am further troubled because it appears that the issues raised in Walker's original paper, and now those raised by DiVeta, Walker, and Skibinski, are not being discussed in entry-level classes or continuing education courses.

In the real world, the rocks of foundations do not shatter like diamonds under a single blow. New evidence often leads us to re-examine the structural integrity of our foundations, and, if we have re-examined carefully, we may choose to replace weak elements with new ones. Such re-examinations can be slow and evolutionary processes, or they can happen rapidly. in each case, we save the structure by responding to observed deficits. In the end we may have a new foundation, or we may have preserved the original foundation, but at no time will we have risked losing all that we have built.

By continuing to ignore research findings, whether those discussed in this issue of the journal or those that appear elsewhere, we run the risk of finding ourselves amid destruction born out of our own neglect. When we ignore accumulating evidence, we are not allowing time for repair, for maintenance, for the generation of new ideas and edifices. Perhaps we have become so accustomed to bemoaning a lack of research that we have forgotten what to do once we have some. I know of no more obvious example than that provided here.

If a series of papers challenged the safety of an orthopedic implant, I would expect our surgical colleagues to reconsider their use of the implant. And if they chose to continue using the implant, I would at the least expect them to know about the literature and to be able to supply compelling arguments as to why they continue to use the implant. If they continued to use it without regard for or knowledge of the literature, and if they had no compelling argument for this use, they would undoubtedly be guilty of malpractice. Are we any less guilty when we ignore our own literature?

The use of primary research literature in clinical classes will go a long way toward preparing the next generation of therapists to remain current and scientific. It will also set a model for new generations of therapists to follow: Read, and alter practice accordingly. But this alone will be insufficient unless more of our researchers, and by this I mean primarily our academic community, become responsive to conducting research on clinically relevant questions. In most professions, and in most areas of scientific endeavor, provocative papers such as those cited here normally become the fodder for massive amounts of research. Academic communities usually respond rapidly to such challenges. Properly conducted research to follow up on controversial papers is almost always published in journals, and it often provides a sound basis for seeking grant funds.

Perhaps our academicians have become tainted by a negativity that suggests they cannot perform research within the confines of their teaching assignments. The simplicity of the papers discussed here, the ease with which they could be replicated, and the minimal amount of equipment necessary make that argument seem hollow. Perhaps our academicians have not been socialized to understand that replication, advancement, and refinement are a central part of their research role and a responsibility they have to our profession. I am surprised that over the last 3 years some department head has not suggested to a young faculty member that he or she could begin a research career by replicating the original Walker research or by following a similar line of inquiry.

The physical therapy profession seeks respect in society, in the health care community, and in the world of biomedical research, but when we do not take ourselves seriously, when we do not engage in meaningful debate about our own research and our very foundation, we send the opposite message. We do have a choice. We can choose to respect our growing body of scientific knowledge, and we can foster the development and refinement of theory. By openly and willingly engaging in the re-evaluation and renewal of our foundation, we can ensure the survival and growth of our profession.

Jules M Rothstein, PhD, PT Editor

References

1. Walker ML, Rothstein JM, Finucane SD, Lamb RL. Relationships between lumbar lordosis, pelvic tilt, and abdominal muscle performance. Phys Ther. 1987;67:512-516.

2. Neumann DA, Soderberg GL, Cook TM. Comparison of maximal isometric hip abductor muscle torques between hip sides. Phys Ther. 1988;68:496-502.