Seriously.
I was thinking yesterday about why physical therapy latched on to its muscle fixation, when it comes to treating bad knee joints. You know the tired old song: Strengthen the quads to overcome the pain from ailing, balky knees!
Of course (as so many here can testify), the quad exercises end up further hurting the knee, which isn’t healthy enough to tolerate the force needed to strengthen the muscles. I had this frustrating experience myself and only started getting better when I rejected such catastrophic advice.
But where did the advice come from in the first place, and why did it prove so popular?
I can’t testify to its origins, but one thing I have noticed about physical therapists: they tend to be young, perky, athletic people. They like to stretch too. They eagerly acquire new stretches.
And it seems none of them have had the chronic knee pain that they are advising you on.
Is experience of a thing a necessary condition for advising on that thing? We don’t require a medical doctor to have lived through every problem he’s giving recommendations on, certainly. Nor should we.
But a certain humility and awareness of mortality and open-mindedness to alternative solutions comes with age, at least in the realm of physical ailments. This, I think, is a good thing when faced with the intractable problem of chronic knee pain. As a patient, I wouldn’t mind a little genuine empathy – if not with my knee pain, then perhaps with the fact that the body does betray its owner sometimes in mysterious ways, and can bring any of us low with pain that has no clear source and no clear solution.
That’s why I’d welcome more 60-year-old physical therapists who have had bad knees, bad elbows, bad feet – who have fought the good fight for months with a condition only to have it recur, then to subdue it, again and again, and finally win in the end. I’m not saying all physical therapists have to be mature adults, with hair shot with steely gray, but wouldn’t it be nice if a few more of them were?
A very astute observation. I'd have to agree.
ReplyDeleteIt's probably another reason Doug Kelsey is so different. He seems to have overcome quite a few injuries, including joint problems. He's had the "opportunity" to test much of his approach on himself. You can't learn that in a classroom.
I've stayed with my primary care physician for all these years because he's a wonderful mix of study, constantly reading, and our personalities clicked from the start. I generally only see him once a year, but he always begins by spending time asking about my kids and how I'm doing. As the years have passed, he's gotten older and wiser, grown in compassion and sense. Whenever I move, he'll be someone I will truly miss.
ReplyDeleteI'll also add my take on it for whatever it's worth. Unfortunately my "success story" is still very much a work in progress.
ReplyDeleteMuscles do play a roll in how the knee handles force.
I think the "Strengthen the quads" comes from the belief that there's nothing else to do since cartilage "has no metabolism and can't heal".
I feel like a shill for Doug Kelsey every time I reference his material, but it just makes the most sense to me. The Runner's Knee Bible was pretty useful to me even though the exercises are too advanced for where I am now.
The first half of the book has great information though.
I like his theory (similar to Dr. Dye's envelope of function) that includes a "functional zone", "adaptive zone", and "failure zone". The adaptive zone where the joint surfaces strengthen rather than just function.
I wanted to add that while muscles are involved in how the knee handles force, they are not the primary problem.
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