Where Does Your Problem Live?

Problems come in levels.

They come with knowns and unknowns.

Predictability and uncertainty.

Certainly, not all are created equal. The decision to have chicken or salmon for dinner carries less weight than which college to attend. 

Do you know what realm the one you are tackling lives in? Defining this allows us to pick the right set of tools from our arsenal to manage the problem. Dave Snowden,  a researcher in the field of knowledge management and the application of complexity science, developed a sense making tool called the Cynephin framework.  

Cynefin, Klay and KD • ALTIS

Cynephin is a Welsh word for Habitat. Snowden broke problems into 4 domains. Simple, Complicated, Complex, and Chaotic. The borders between these are formed through what can and cannot be known before the fact. 

Simple is the realm of known-knowns. We have established reproducible data forming  “laws” that can guide our decision. Thus there is established best practice. Thus we can sense the state of the problem, categorize it, and then respond based on these best practices. 

Complicated is the realm of known-unknowns. We may not have all the data ourselves, but we are still working within an ordered and predictable system where the right person with the right knowledge (content expert) can surmise an answer. I know nothing about what may go wrong with a car engine but a mechanic can draw a direct cause and effect. Thus the tactic here requires sensing the problem (car is rattling), analyzing (taking the car to an expert), and responding (tighten a screw, add oil etc..)

With a complex problem we are wading in the unknown-unknowns. Here the system is disordered and unstable. Answers live in flux as small changes can have dramatic changes on an outcome. The answers here live only in the post-hoc analysis. Think of the weather. Though we have sophisticated algorithms, accurate predictability is limited until the day of as small shifts in the data creates a meaningful change in the outcome. 

Within this realm, tactically, we must first probe the system to gain more data. Apply a perturbation to see “how the defense shifts”. We next can attempt to sense an emergent pattern. We then can respond. Think here of waking up with a painful low back with no clear reason. I try to bend forward (OUCH!). I twist (OUCH!). I lay on my stomach and bend back (probe) (Ou….Ahhh). A pattern of symptom relief from extension has emerged (sense). This allows me to respond with amplifying extension and dampening flexion until a new pattern emerges (respond). This could only be known post-experiment. 

Chaos is the realm of unknowable unknowns. This is a high turbulence temporary state. The situation needs to be stabilized first. This is a plane crash, a heart attack triage. This is not the time to be seeking causation. We act first (perform CPR), then sense (perform tests), and respond (surgery/medicine/rehab).  

The domain drives the tactic. Viewing a complex scenario as simple or complicated can lead to false confidence and lead us susceptible to miss possible solutions. Viewing a simple problem as complex leads to overthinking. 

Before you decide- take a moment to understand the habitat you are operating in before reaching into the tool box. 

– Dr. Anthony Iannarino, DPT; Site Director, Rehab 2 Perform™ – Bethesda


Listen: The Level Up Podcast Episode 55: Beyond the BPS Model of Pain with Michael Ray, Sabrina Coninx, and Peter Still 

  • Our friends with the Level Up Initiative continue to put out excellent content navigating some of the gray and murky waters of clinical practice. This is a monster of an episode with some great thinkers addressing tough questions. 

Educate: Clinical thresholds for quadriceps assessment after anterior cruciate ligament reconstruction

  • With ACL rehab, quad is certainly king. With this we have to ask, what is the best way to assess it during an ACL rehab? Relative values such as limb symmetry certainly have value, but are limited by our understanding that the unaffected limb may lose strength throughout the rehab process. This article discusses some clinical thresholds and strength standards to aid return to play decision making. 
  • Kuenze C, Hertel J, Saliba S, Diduch DR, Weltman A, Hart JM. Clinical thresholds for quadriceps assessment after anterior cruciate ligament reconstruction. J Sport Rehabil. 2015;24(1):36-46.

Read: Phantoms in the Brain: Probing the Mysteries of the Human Mind. 

  • By: V.S Ramachandran, M.D., PhD and Susan Blakseslee 
  • Renowned neuroscientist V.S Ramachandran takes you on a tour of some of the mysteries of the human brain and modern neuroscience through fascinating clinical case studies and stories. A worthwhile break from orthopedics and strength and conditioning reading! 

Engage: @fit_to_speak

  • Jennie Rearick provides some excellent tips for communication and presentation skills for fitness and healthcare professionals. 
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