Why Facts and Truth Are So Important

Today I want to talk about facts and truth. Some of you may not like what you’re about to read. I’ve tried to keep certain polarizing subjects out of this blog, but as an American who cares deeply about the basic democratic principles this country was founded on, I think it’s time for more of us to speak out.

Over the past decade, we have seen big, bold lies being peddled to the American people. That would have been unthinkable 30 or 40 years ago. They include:

(1) Ukraine invaded Russia (the exact opposite of what occurred).

(2) The current president was overwhelmingly elected in 2024 by the biggest majority in history; in truth he won by a narrow margin of the popular vote.

(3) The current president didn’t really lose the 2020 election, but was the victim of widespread voting fraud. Dozens of court cases were filed alleging as much, and were thrown out for lack of evidence.

Now, to be clear, politicians and others in their orbit lie with some regularity. But these lies I just cited are not little white lies, or fibs, or truth-stretching lies. These are blatant, easily provable falsehoods. These are lies akin to insisting, “the sky is green,” when anyone can clearly see it is blue.

Why do lies matter? Why should we care if politicians, or others, blatantly lie to us? Obviously, one reason: there are gullible people who will believe the lies. Big Lie No. 3 prompted a storming of the U.S. Capitol building by an angry mob.

But beyond that, we will find ourselves in a truly bad place if we are unable, or unwilling, to parse out obvious untruths. Truth is not something that is just a matter of opinion. “Well, you may think that, but I don’t agree” is fine for certain things, like whether strawberry or chocolate ice cream is better, but not for two plus two equals four.

Using the Veneer of Science to Serve a Personal Agenda

When I tried so hard to heal my knees, I looked to scientific studies. I wanted results that had been tested in the crucible of the scientific method, objectively, without partiality to any particular thesis about healing. I wanted researchers whose papers were untainted by support from any drugmakers or glucosamine sellers.

These studies inspired me, gave me purpose, and allowed me to heal by pointing me toward a path grounded in facts and truth, not unfounded hope.

Contrast that with what we see today: a top-ranking U.S. government official just promised to reveal the cause of autism by September. This is someone who has a controversial (and minority) viewpoint on this subject. Do we really trust that a flurry of full and impartial studies will be conducted in less than six months, on this matter of significant debate, and the truth will come to light?

Or is this just a cynical attempt to pass off as “truth” someone’s opinion or agenda?

Now I want to introduce you to Hannah Arendt.

I read her while at Harvard. Arendt, who was Jewish, fled Germany in 1933, escaping before the Nazi horror truly began. She later wrote an authoritative and seminal work on totalitarianism; the power of her writing derives not only from her formidable intellectual prowess, but also (one suspects) from her analyzing a phenomenon that was unfortunately too close to home.

She said this (my emphasis added):

The ideal subject of totalitarian rule is not the convinced Nazi or the convinced Communist, but people for whom the distinction between fact and fiction and the distinction between the true and the false no longer exist.

So all those malleable people, who can no longer tell the difference between what is true and what is false—whether from ignorance, indifference, or willful blindness—are an authoritarian’s best friend. That’s something worth pondering.

That so many of us are willing to swallow Big Lies should be alarming all by itself. But there is much, much more that we should be wrestling with now. Do we really believe in Constitution-enshrined free speech, even if it might be personally distasteful or repulsive? How willing are we to defend that? Do we really believe in the system of checks and balances that our founders created?

If I Wanted to Be an Authoritarian, This Would Be My Game Plan

On Jan. 25, I tweeted a musing about how (if I were a wannabe authoritarian), I would try to take control of America.

(1) First, I said, I’d mass-fire people in the government bureaucracy and install as many loyalists as possible. This is the easiest part for the chief executive to do, as the president does have wide latitude to appoint and hire and fire workers in federal agencies. By itself, this would be quite empowering—imagine having the IRS, SEC, Justice Department, etc., under your thumb.

(2) Next, and this is harder: I’d have to bring the courts to heel. Courts are dangerous, because they deal heavily in fact and law and precedent. They will not bow to my fictions. They are often slow-moving as well, so if I aspired to be an authoritarian, their meddling and demands for evidence would slow me down. However, their slowness could be an asset: I could just move quickly, before they have a chance to respond. Another strategy: at some point, I could just ignore them. What can the courts do? It’s not like they have an army.    

(3) With the courts subdued, I would then be freer to move on to media/critics. If I have a loyalist installed at the Federal Communications Commission, I would have him investigate media outlets I don’t like and threaten to take away their license. Note that the head of the FCC said recently: “Federal law requires (Comcast’s) licensed operations to serve the public interest. News distortion doesn’t cut it.” But then who defines “news distortion”? Ah, well that would be me, the would-be authoritarian, using my own version of what qualifies as “truth.”

You may have noticed that I have left Congress out of this mock “game plan.” Sadly, our Congress is basically impotent today, and this is one reason I think many Americans are drawn to a strong ruler.

The last thought I want to leave with you: if you are an American—conservative, liberal, it doesn’t matter—who is troubled by what has been happening, speak up. Say something. Alaska Senator Lisa Murkowski said recently, “We are all afraid.”

That’s sobering, coming from a legislator who is in a position of influence, who could be a real force for change if she had the courage. But we shouldn’t be afraid. People of conscience, who care about America’s ideals, can speak with a unified voice that will not be easily silenced. Make them hear us.

Make them understand that we the people do have the ultimate power.

A Few (Hopefully) Final Thoughts on Structuralism and Knee Pain

I didn’t originally envision my recent thoughts on structuralism as a two-parter, but hey, I’m at the point now where I go with the material I get …

This blog of course is in semi-retirement, now that “Saving My Knees” is nearing its 15th birthday, and reader interest has understandably begun to wane. However, for some reason, over the last couple of months there has been a little upsurge in book orders, which always gets me thinking about the blog again.

I received a comment about my last post’s musings on structuralism. To recap, structuralism has been described as a school of thought that attributes the origin of musculoskeletal complaints to one or more biomechanical abnormalities. For instance, a structuralist may blame your mistracking patella for your knee pain (even though there are lots of people with mistracking patellas who have no knee pain).

I got a comment that raised some good, thoughtful points. Here it is, edited and notated, with some responses at the end: 

I agree with your point about structuralism. But the functional PT exercises get at something slightly different. Don't you think that the *way* we use our bodies should matter?(1) Let's say I sit at a desk all day for work. My movement patterns will probably be pretty damn different from a hunter-gatherer's. My muscle tone and activations will be different. This idea isn't about fixed (or mostly-fixed) anatomical differences, but about what muscles we use and how we use them.(2)

For example, my right knee has had issues on and off for many years. My right achilles, hamstring, and hip also have had mild injuries. It's possible it's a coincidence that everything is on the right side, but I think my body has been compensating for injuries, throwing off the whole system.(3)

In running, there are different types of running gait, some of which put more strain on the calves, others on the quads. Why do different people run in different ways?(4) There's going to be some fixed anatomical reason, but the muscle tone and activation will also influence running form. Tight ankles means someone is more likely to turn their feet outwards, for example. That can cause problems in the knee.(5)

(1) Does the way we use our bodies matter? Of course. It would be hard to find anyone sensible who would dispute that. If my favorite hobby is jumping out a 15-foot-high barn window, onto hard ground below, I’ll probably develop knee pain before long. Or, as a less extreme example, if I’m a sedentary desk warrior living in a snowy climate, and only get winter exercise from shoveling snow, I stand a good chance of developing back pain, during the cold months, from overusing flabby muscles.

(2) At least some of the ideas of functional physical therapy make sense to me. I wouldn’t argue with doing exercises that enable us to better handle everyday activities. I probably qualify as doing these myself. On workday mornings, for example, I do a few minutes of the “bird dog” yoga pose to keep my back strong. I tell people that I do exercises like this to prepare for sitting behind a desk for eight to ten hours. And I’m 100% serious.

(3) Could a body compensating for injuries cause more injuries? Absolutely. Use your body repeatedly in unnatural ways and pay the price. In the book I call these “compensation injuries.” I developed back pain in Hong Kong from sitting at work with my legs straight out, supported by an under-desk sling, in order to relieve my knee pain. That put too much stress on my back.

(4) Running form is a fascinating subject by itself. I ran cross country in high school. And the guy on the team with the weirdest running form – I can still see his arms swinging from side to side – was the fastest guy on the team. Anatomy, muscles, soft tissues, I’m sure there’s an interplay between them all that explains why someone runs the way they do.

(5) So, when it comes to running, I’m sure some of my own issues stem from being a pronator. That has implications beyond wear marks on the outer edge of my shoes.

Anyway, this may come as a surprise, but part of a structural analysis makes sense to me. For instance, as noted above, I used to be a runner.

Even though I have a good body for running, it’s probably not ideal. I’ve watched the truly elite runners. Even if I had their conditioning, their weight, their ability to process oxygen, I still probably wouldn’t be able to do what they do. And it’s probably for structural reasons.

We’re not all designed to run marathons, or even 10k’s sometimes. Even with proper training, certain body types may never be able to run 60 miles a week without problems, while others can. I recall the time I ran a half-marathon in Switzerland, and all the training, and the niggling pains, and thinking, “I probably don’t want to push myself into a race beyond this distance.”

So I think that, while healthy, we do operate within some kind of overall structural limitations. But where the structuralist story falls apart for me is when a runner develops knee pain, and a structuralist physical therapist discovers tight ankles, and exclaims, Ah hah! We need to stretch out those ankles, because that’s the problem!

I think this fails because:

(1) It can be easy to confuse cause and effect. To take a different example: you may have a weak right hip along with your right knee pain. But the answer isn’t just “strengthen the hip to fix the knee pain.” As Kelsey notes, “People with knee pain will almost always have weakness of the hip on the same side as the knee pain.” What he proposes: Fix the entire hip-knee-ankle chain together, using reduced loads, instead of trying to cure the right hip “imbalance” by strengthening it in isolation.

(2) But going back to the tight ankle: it’s virtually impossible to prove that the tight ankles caused the knee injury in the first place. Lots of things could have caused or somehow contributed to that knee pain; there are many forces feeding into the knee joint. Just because a therapist finds a tight ankle doesn’t mean that that was a prime mover for the resulting pain.

(3) But let’s suppose it was. Suppose the therapist has “God’s Diagnostic Tool.” And God’s Diagnostic Tool indicates that a tight ankle, over time, basically led to this problem. Then what do you do?

I think you’re still best served by an “envelope of function” approach to treatment. You need to back off your running and keep that knee within the acceptable envelope, moving it but not pushing it too hard, until it heals. And maybe you have to accept that you need to train more carefully, or you’re not built for say marathons.

I know, at this point, the structuralist would probably jump in to say, “And stretch that tight ankle!” But personally I’m a skeptic of stretching (but a big proponent of warming up). The fact is, people run for years with their tight ankles and other little muscular and tissue imbalances and they do okay, as long as they stay within their “envelope of function” ranges and don’t overtrain.

(4) Sometimes it’s just impossible to “redress” the imbalances that are found anyway. What if the PT thinks that the imbalance to fix is a too-weak vastus medialis oblique (VMO) muscle that needs to be stronger to stabilize the patella? So he prescribes VMO-strengthening exercises.

That sounds great except … they happen to be useless, as Doug Kelsey explains here:

People with knee pain, especially patellofemoral pain, are often told by clinicians to strengthen their VMO to improve the alignment and tracking of the patella ... But, since the VMO doesn’t have its own nerve supply, you can’t isolate the muscle from the rest of the quadriceps … this isn’t just my opinion. Cerny examined this in 1995 and found no difference between the VMO activity and the rest of the quadriceps for a variety of common exercises used to target the VMO.

Anyway, at the end of the day, I’m not saying that structure, imbalances and crookedness are always irrelevant. I’m just saying that, if I’m trying to heal from an injury, I think the idea of staying within an envelope of function and slowly increasing load, while getting enough movement, is generally going to be a more successful (and logical) way to treat the problem.

There will always be exceptions, naturally. But they don’t prove the rule.