The Arsonists & Cowards at Chesterton’s Fence

By Jack Chew

Philosopher GK Chesterton posed a principle for reformers in 1929 [1]. He described a fence which does not appear to do anything and two types of reformer; one who would tear it down and another who would first seek to understand why it might be there.

Applying this principle inspires what is known as second order thinking [2]; what will the consequences be? What might be lost? What are the trade-offs associated with the decision?

In MSK practice we tend to have to have a decent habit of considering such things clinically. Readers of this glorious mag will be especially considerate of what their treatment, advice or interventions might lead to. However, when it comes to education, operational processes and policy making we have a very different shared instinct. Along MSK’s various fences we have squabbles between arsonists keen to burn them down and luddites trying to retain fences without any justification.

A couple of examples. For the last 20 years we have been humbled by evidence demonstrating that our hands aren’t the magic scar-tissue-melting tools we once thought we owned. But tear the fence down and avoid touching patients altogether and it’s likely to have some less than ideal consequences. But of course, no one of any profile is advocating such an extreme hands-off approach so it’s as much the fault of the frothing mouths keen to preserve every element of their favourite fence that the sensible debate never gets going.

For my sins, I sit on the Chartered Society of Physiotherapy’s elected Council and for approaching a year we’ve been lobbied hard by some members who wish to end decades of CSP neutrality on the Israel-Palestine conflict. Are we so naive as to think that there wouldn’t be consequences to weighing in on something so complex? But are we so rigid in our thinking that we won’t consider the huge ethical challenges associated with this war?

We need calm heads, not radicals and brave leaders, not cowards.

Speaking of which…in this month’s issue the chair of Physio First Katie Knapton gives her reflections on the MSK CPD scene, Mike Dare details how to mitigate nocebo when it comes to scanning, Ben Wilkins makes the case for his favourite elixir (water!), Emma Green reminds us of the complex human attached to every tennis elbow in her piece on central sensitisation and Katie Bell has the CHEEK to claim that being called Jack will stifle your clinic’s success!

So a final thought from me; please take after these legends and thoroughly evaluate the fences you encounter. The field of pain and injury depends on it!

Jack Chew

Editor in Chief

[1] Chesterton’s Fence - Don’t Destroy What You Don’t Understand (2023) -

[2] Second-Order Thinking: What Smart People Use to Outperform (2021)

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