Saturday, April 28, 2012

Of Breakdown Points and Discontinuities in Healing, Pt. II

At last, I get around to finishing this post.

In Part I, I looked at the concept of a breakdown point and the implications for knee pain sufferers. In an example I gave, a two-pound cake triggers the collapse of a bridge with a five-ton weight limit. But is the cake really to blame, and what mistakes do we make by focusing too much on proximate reasons for knee pain that has been setting up in our joints for a long time?

Today is the curious mirror image of that discussion, the movie reel played backward, if you will. In one direction, the bridge falls apart into hundreds of chunks, while in reverse, the pieces knit back together to form an intact whole again.

Crazy stuff, as applied to bridges, certainly.

But a living, biological structure has the capacity to heal. So might there be points -- call them “mending points” -- where healing suddenly seems to accelerate? As a bridge has a catastrophic moment when it crumbles -- and your knees have a point when they lurch from highly stressed with no pain to highly stressed with pain -- might there be a healing point, or points even, when you feel considerably better than you’d expect from the preceding day?

And what does this tell us about what to expect during the healing process?

Well, here’s a scenario: You seem to be stuck in a rut for two or three months. You’re doing all the right “smart knee” things. But you don’t think you’re getting better -- or much better. Then, one day, you wake up  and your knees feel much improved. It’s like you went from being a “4” to a “7” overnight.


Chances are, you’re actually at a very dangerous point in your recovery. You may be delirious with joy, thinking, “What’ll I do to celebrate? Go for a run? Climb a mountain?” But if the theory I’ve outlined here is true, your gains are fragile indeed. You haven’t healed. You’ve merely taken a step toward healing. You have to focus on “locking in your gains,” you might say.

The idea of mending points might help explain one thing: why healing damaged knees is so hard.

Just as you might be tempted to blame the two-pound cake for taking down the bridge with a five-ton weight limit, in trying to figure out why you feel better, you might also tend to overcredit recent activities. You might falsely attribute your improvement to the lakeside stroll you took two days ago, when in truth, the healing has been a slow, cumulative process that you didn’t notice until you reached a “mending point.”

What’s unfortunate is that, if this is indeed how long-term healing happens, our effort to link cause-and-effect becomes that much more complicated. As I’ve noted repeatedly, it’s hard to make definitive cause-and-effect linkages when analyzing knee pain, because cartilage has no nerve endings, so symptoms are often delayed. If healing is lumpy and non-linear as well, that makes charting a path to recovery -- and staying on it -- hard.

Still, it can be done. It's just good knowing the challenges going in. :)

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