Saturday, May 5, 2012

The Frustrating Puzzle of Cause and Effect

Recently I’ve been thinking about cause and effect.

As I wrote in Saving My Knees, one of my doctors once more or less shrugged and said about my knee pain, “You’ll have good days and bad days.” The more I thought about it, the less his comment satisfied me. It represented a philosophy of hopelessness. It sounded too much like knee pain strikes in a totally unpredictable way. My goal was to heal so I sought to isolate what helped -- and harmed -- my knees.

It’s not easy though figuring out cause-and-effect relationships with bad knees. A skeptic recently asked how I was sure I had cartilage damage, and how did I know it was causing my pain symptoms? Well, I’m pretty sure that it was somehow contributing to my pain, as I explain here, but am I 100 percent certain? No, of course not. But a treatment plan designed around this assumption worked, when a traditional approach failed.

What I found interesting about this skeptic was that he seemed little inclined to turn his skepticism inward. Could there be a flaw in his own Structuralist model that has its own understanding of cause and effect when it comes to knee pain?

A week or so ago, I came across an interesting knee pain story that seems relevant to this topic. Someone was talking about how she (I recall it was a she, though forgot to bookmark the page) beat knee pain by basically relearning how to walk. I don’t remember the specifics, but there was some biomechanical issue she blamed her pain on -- how her heel landed or toes pointed or some such -- and she slowly trained herself to walk properly, over the course of some months.

A victory for Structuralism! Structuralist diagnosis and treatment validated, right?

Maybe. Maybe not.

After all, what are you going to do, if you’re relearning how to walk properly? Practice a lot. And probably walk more slowly as you’re practicing.

So maybe you end up doing a lot of easy strolling -- which is kind of similar to the Saving My Knees program. But your conclusion is entirely different: you healed because you fixed your bad biomechanics!

Of course someone can argue, if cause and effect is so hard to pin down, how do I know I’m right, in my broad approach to beating knee pain? I don’t of course -- not in any absolute sense.

But I submit that my thinking is much simpler and more logical: you have knee pain because the tissues in the joint are being stressed beyond what they’re capable of. So you (slowly) strengthen them. And don’t worry that your butt muscle is too weak or your left hamstring is too strong. Chances are, that didn’t cause your knee pain.

And of course I think I’m right because my beliefs shaped my own program to heal. And, though it wasn’t fast, in the end it worked quite well.

Update: The perils of working too quickly! I never bothered to hunt down the story I cursorily summarize above. In the comments below, someone helpfully provided the link to the tale of the knee pain sufferer who relearned how to walk (turns out for starters it's a man, not a woman -- oops).

A couple of follow-up notes: It could certainly be that this person had a structural issue that he patiently corrected -- the fact that the onset of knee pain was at about age 12 suggests something other than the typical wear-and-tear story of knees breaking down over time. I'm not saying structural issues are never significant; my suspicion is simply that they're way over-diagnosed.

Also: he talks about how he used a foam roller to loosen his IT bands. As I discuss in Saving My Knees, your IT bands have a tensile strength of soft steel. So I'm a little dubious about the efficacy of that foam roller.


  1. I think the link you are talking about is this one:

  2. About the foam roller: it's a godsend for me. Never fails to reduce the pain, usually immediately.