I thought I’d heard about every question under the sun about chronic knee pain, my experience with it, and what I learned. Then I got this question, which I found intriguing. It got me thinking:
I'd be curious to hear if you or any readers have successfully convinced their doctors/therapists that anterior knee pain is mostly mistreated. I've begun to introduce ideas like envelope of function and how a joint first approach trumps addressing biomechanic irregularities. All of my therapists entertain the discussion and do not dismiss me, which I greatly appreciate. However, none have embraced those ideas. Frankly, I understand why. It feels like the height of arrogance for a patient to tell a doctor they are mistreating people. I feel like the crazy patient sometimes. Still, I feel compelled to convince medical professionals they are treating the most common type of knee pain incorrectly. Has anyone successfully convinced their doctors? Richard, do your doctors in Asia know you wrote a popular book on the subject?
A lot to unpack here.
First, I’m not surprised your therapists “entertain the discussion” and “do not dismiss” you. This sounds much like my physical therapist in Hong Kong, as I mused about various ways to treat my pain. But I reached the point where I think I could’ve told him that aliens were beaming me messages from deep space, and he would’ve murmured with a similar understanding.
So I would counsel against mistaking superficial “understanding” with an openness to changing deeply held beliefs.
And, as for whether my doctors know I wrote a popular book on the subject: Sadly, it’s only been sort of popular (sales are a pale fraction of what Stephen King’s next novel will do). And I assume, no, they don’t know. I have made no attempt to tell them. I don’t think it would matter much if I did.
So, to get to the real question: Why not try to spread the word to doctors and therapists that there are some serious problems with their approach to knee pain?
* I don’t proselytize about knee pain. It’s a waste of time, really. When people in the real world ask me about my experience, and they seem genuinely interested and open-minded, I’m happy to share.
Also, I wrote a book, and that’s my rather long argument about knee pain. Naively, I wrote the book thinking that everyone who suffered the same kind of lingering, hard-to-treat pain would find the book a nugget of gold in a slag pile of outdated thinking.
Of course they didn’t (check out my one-star reviews on Amazon – fortunately, not too many, but there are some). I made a kind of solipsistic error, I suppose, in thinking that most people would be like me and would approach the problem the same way, with the same kind of “I’ll beat this if it takes 20 years” determination, and willingness to entertain theories that deviated from the mainstream.
* Can you really tell doctors anything? I’m only being a bit facetious. You, the patient – the one supposedly seeking advice from them – are trying to tell them they’re wrong? Because you saw something on the “internet” and Googled a few research articles? And meanwhile, they see knee pain patients day in and day out; they took the med school courses; they cut open the cadavers; they did the grueling residency.
I do believe the smarter doctors – and I think there are a good number – do realize the human body is maddeningly complex, that they don’t know perhaps as much as they wish they did, that they can learn from patients as well as pass on learning to them. I’ve had people on this blog say that they’ve shared some of my ideas with doctors, who say something like, “That makes sense.” That’s at least with regard to high repetition, low load exercises like walking.
* But they often aren’t willing to go much farther. Well, why not? Why not wonder if they don’t have an accurate picture of knee pain, and how damaged cartilage can be made healthier, or even restored?
Well, in part because I think this demands an exceptional individual, honestly. It demands a kind of radical curiosity, along with a sh*tkicker willingness to discard an accepted orthodoxy. And that’s hard. That’s very, very hard. How many people do you know who are willing to jettison a whole knowledge base – you know, put it up for intense examination, then toss it out the window if it seems flawed?
As a species, we’re invested in our narratives, our beliefs, our received knowledge.
I think stretching is a great example. My sister-in-law is a personal trainer. I think she’s a smart woman. She’s asked me about my knee pain before, and I’ve told her my story. I’ve also said that I think stretching is probably a waste of time (though, again, by all means, if you like to stretch, and it feels good and you’re not doing any contortionist stretching, it could well be fine for you or at least not harmful).
At that point, I can see her shutting me down. Stretching a waste of time? This is a heterodoxy of a high order indeed. So I could point her to studies that I’ve read, but why bother? On this point, she’s basically signaling, “Whatever you say on stretching, I’m not going to believe it.”
And why should she? Imagine you’re a personal trainer. You learn all these cool stretches. You share them with your clients. You trade stretches with other personal trainers. You are an expert in stretching! This has worth in your world. And then someone has the audacity to come along and suggest it may not be valuable after all! Why would you think about abandoning this thing you are so deeply invested in?
* I do sometimes wonder how money might be distorting all this, at least a little.
Think about it: If cartilage can heal (if slowly), why would anyone but the impatient (I suppose there are plenty of those), get a cartilage replacement? So all the surgeons trained to do those operations, all the companies that culture cartilage cells for implantation – how are they going to support themselves and be profitable?
I realize this has a deeply cynical, even conspiratorial ring to it. I don’t mean it to sound that way. But honestly, who’s looking into natural cartilage restoration? Where’s the money in that? There are financial incentives in this world, and they can at least subtly flavor how orthopedic surgeons view things.
Anyway, goodness, this has gotten much longer than expected. For me the bottom-line answer to the question posed above, I suppose, is I wrote a book. I’m immensely proud it has helped some people.
I don’t feel the need to convince anyone at this point. For a while, I did, and I was passionate (almost to the point of tears) about my story. But now, I guess my story is receding into the long narrative of my own life, as my knees have been fine for over a decade. I don’t want to get into a debate with people who swear by glucosamine, or who don’t think cartilage can get better.
Heck, just last week I saw my wife had bought some knee joint pills. If I were a zealot, I guess I’d go in and give her a long explanation why I think she’s wasting our money, and why I doubt she’ll find relief. But there’s no need to. If she wants my opinion, she knows where to find me (under the same roof). Hah!
