What "Evidence-Based" Actually Means at Boreal

By Dr. Michael Minenna D.C., B.Sc., SFMA, FMS

"Evidence-based" is one of the most overused phrases in health and fitness. It's stamped on everything from supplements to gadgets, often as marketing rather than meaning. We use it a lot too — it's central to how we practice — so it's worth being clear about what it genuinely means, and what it doesn't. It's a more interesting and more demanding idea than the buzzword suggests.

Three things, not one

The classic definition of evidence-based practice isn't "we only do what studies prove." It's the thoughtful integration of three things: the best available research evidence, the clinician's own expertise and judgement, and the individual patient's values, goals, and circumstances.¹ All three. Lean too hard on any one and you've lost the plot.

Research evidence alone can't tell you what to do with the specific person in front of you — studies describe averages, and you are not an average. Clinical experience alone can drift into habit and bias. And patient preference alone, without evidence and expertise to inform it, can lead to choices that feel right but don't help. Good care lives at the intersection.

Why research evidence matters

Starting from the best available evidence keeps us honest and current. It's how we know, for example, that most low back pain doesn't need imaging or rest, that exercise is the backbone of treatment for most musculoskeletal pain, and that many "tears" on scans are normal age-related findings rather than the source of someone's symptoms. Without that anchor, it's easy to keep doing things simply because they're familiar or because they were taught a generation ago. The research is what stops practice from calcifying.²

Why clinical expertise matters

But evidence is a starting point, not an autopilot. A study can tell you that a given approach helps people with a condition on average; it can't watch you move, feel how a joint responds, or judge how to adapt a general principle to your particular body and history. That's clinical expertise — the skill of applying evidence intelligently to a real person. It's also what lets us recognize when you're the exception to the rule. Evidence without judgement is a recipe followed blindly.

Why your values matter most of all

The third pillar is the one that's most often forgotten: you. Your goals, your life, what you're willing and able to do — these shape the right plan as much as any study. The "best" evidence-based treatment is worthless if it doesn't fit your life or doesn't get you toward what you actually care about. Whether your goal is running a marathon, gardening without pain, or keeping up with your grandkids changes what the right plan looks like, and that's exactly as it should be.³

How it shows up in your care

In practice, evidence-based care at our clinic means we lead with approaches that have strong support — active rehab, progressive loading, education — while using our judgement to tailor them to you and building the plan around your goals. It's why our guiding principle is a flexible one: there are no bad exercises, only too much too soon. That's evidence (load management) and judgement (your specific dose) and your values (the activities you're building toward) all in one sentence.

It also means we'll be honest about uncertainty. The evidence doesn't have a clean answer for everything, and a good clinician says so rather than overclaiming. At Boreal Spine & Sport, "evidence-based" isn't a slogan we put on the wall — it's a discipline: stay current, think carefully, and keep your goals at the centre. That's the care you deserve.

References

1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71-72.
2. Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79-86.
3. Hoffmann TC, Montori VM, Del Mar C. The connection between evidence-based medicine and shared decision making. JAMA. 2014;312(13):1295-1296.