Of Breakdown Points and Discontinuities in Healing, Part I

Now for something completely different.

During the many months when I had no job, when my sole focus was on fixing a pair of bad knees -- could it really be done? -- I did a lot of thinking. Not surprisingly, much of it was about damaged knees. My internal dialogues became more interesting when I realized my personal experiment was succeeding -- I was getting better -- even after a doctor (and not any doctor, but the best of the four I had seen) told me my knees were a lost cause.

At that point I could stand back (in a metaphorical sense) and survey the long timeline of my recovery. And one thing that struck me as curious was how incredibly lumpy it was, even though I was steadfast, meticulous, careful, diligent.

There were ups. And downs. All over the place.

So I began pondering more deeply what was going on with wear-and-tear injuries, and the long-term healing process, and I had the following thoughts:

STRUCTURAL BREAKDOWN POINTS

Say there's an old country bridge over a river with a five-ton weight limit, and the limit is absolutely, precisely real. And say a dedication ceremony for a park on the river's north bank is held on the bridge, because of the astonishing scenic view from there. Dignitaries and various paraphernalia are packed onto the structure.

Soon the bridge is supporting 9,999 pounds, but no one appears worried. Indeed, it seems stable. Then someone remembers a two-pound cake he forgot and rushes off, then returns with it.

And the bridge collapses.

Or consider a ceramic cup that's held x inches off the ground. If you drop it, you've got a dirty cup -- but nothing worse. Hold the same cup x + 4 inches off the ground, drop it, and you've got pieces of a cup.

So there's a point at which an object or structure breaks. When it does, it undergoes a significant change of state -- in the case of the cup, from "whole" to "pieces."

What's happening at the pre-breakdown point? What's the bridge like, a few pounds shy of its weight limit, or what's the condition of the cup on impact when dropped from x inches, not x + 4? Outwardly, either appears fine. However, both may be very stressed internally. Further, the unseen stresses may contribute to an overall weakening of either (next time you drop the cup at x inches, it may break instead of just getting dirty).

SO WHAT DOES ALL THIS MEAN?

What I think is a fascinating paradox lies at the heart of these observations:

(1) Small factors can have huge consequences (a two-pound cake causes a bridge to collapse).

(2) Small factors don't really have huge consequences (that two-pound cake becomes a problem only if you've unwisely loaded the bridge with 9,999 pounds of other stuff).

Our knees are structures, of a biological sort (the distinction is important, because they're not brittle, in the same way a concrete bridge is, and they have a capacity for self-repair, but I still think the analogy broadly holds).

If you have a wear-and-tear or overuse injury that results in knee pain (as opposed to having knee pain from a sudden, traumatic accident), there is probably a crossover point where your joint goes from being extremely stressed with no pain to being extremely stressed with pain. It could be a slender crossover point, that is covered quickly, leaving you suddenly wondering, "Why do my knees hurt today? What did I do wrong? What should I do now?"

EARLY DELUSIONS WITH KNEE PAIN

Okay, here's the point of these musings:

To me the idea of breakdown points, and the central paradox of them (outlined above), suggests that many of us suffer two delusions early on with knee pain.

(1) Delusion #1: "I must be in pain because of that hike (or whatever) yesterday, so I'll just take it easy for a week or two, and I'll feel better."

So you blame a proximate cause for the breakdown. But that's like saying the two-pound cake brought down the bridge. It did, but it really didn't when you look at the larger picture.

Based on this delusion, you reason that a week or two will suffice to fix a sore knee. This is a short-term fix to a long-term problem. It usually doesn't work.

The problem is, you've deluded yourself into thinking the problem is smaller than it is. Why? Because, during the preceding months, when your joint was being quietly stressed and damaged in small ways, you still hadn't hit that breakdown point and crossed the pain threshhold, so you never realized how close to trouble you were.

(2) Delusion #2: If you're lucky enough that your knees do feel better in a few weeks, you think, "Phew! They healed. Glad that's over!"

But what if you just crossed that threshhold from pain to no pain in a small way, and the truth is the accumulated defects and stresses in the joints are just waiting to cause more problems? Two months later, you feel pain and say, "Darn, my knees again."

But it's not again. It's the same problem as before. Instead of trying to fix it with a long-term plan, you hoped it would go away. And now it's back.

Part II (in a few weeks -- I'm off to Florida on vacation next week ;)) will look at the mirror image of this concept. If there are such things as breakdown points with our knees, might there also be "mending points"? If so, what implication does that have for the healing process?