Why you are suddenly having pain now

Posted on August 16, 2013

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Jon has always been an active guy. He played sports in high school, intramurals in college, regularly works out, has done a few 5ks, etc. During one of his runs he suddenly got some pain on the outside of his knee. Afterwards he iced it, took it easy for a bit, then went back to his normal routine. But that pain on the outside of his knee, the pain he never had before, is still there. And it’s been there for two years now. Why did he suddenly start having issues?

This is actually a common phenomenon: Feel pretty good for a long time; all of a sudden one day have acute pain; that acute pain turns to chronic pain and lingers forever.

It’s always tough to say what the original cause was. Many times a person has been moving with crappy form / biomechanics for a long time, but there’s only so long they’ll get away with it. An eventual hitting of a threshold if you will. This is often where people go “I’m getting old.”

However, it’s not really they’re getting old, it’s their body has hit the point where it’s going, “Nope, this isn’t healthy, we’re not doing it anymore.”  A toddler punching you in the arm is no big deal. After an hour though? Big deal. (Hitting of a threshold.)

It may have taken a specific event to put the person over the line, but regardless, that line has been crossed. Much like an alcoholic: Their liver will be fine for a long time, but eventually, it will breakdown. It might not happen until that one more night of drinking, but eventually, it will happen. For some that’s after a few years, for others (the Irish) they’re still waking up to a screwdriver at 75 years old.

In a way, age doesn’t matter. What matters is the amount of time you’ve been fucking yourself up. If you’re 25 but you ran into people as fast as you possibly could (football) for 20 years, your body doesn’t care you’re only 25. It cares you’ve been beating the shit out of it for 20 years.  If you’re 30 but you’ve been pounding alcohol for 15 years, your liver doesn’t care you’re only 30.

This is well understood in the heart disease world. An obese person presenting with arteriosclerosis at 50 years old isn’t approached in the manner of, “Your arteries randomly clogged up recently. We need to clean em up and you’ll be on your way.” No, it’s understood the person has, over a period of time, caused this clogging. Their arteries didn’t suddenly clog one day. That last night of drinking isn’t what put you in the hospital, it was the 20 years of drinking before it. The last night just put you over the threshold.

This is why you so often see people have injuries from ostensibly harmless activities. You pick up your kid’s toy and twist your ankle, you tie your shoes and throw your back out. Tying your shoes is the event which put you over the threshold, but not taking care of your back the last decade got you close to the threshold to begin with.

It’s not so much what caused the string to break; it’s more what caused it to fray?

String fraying

Back to Jon: What typically happens in a case like this is doctors and orthopedists will be scheduled, X-Rays and MRIs will be done, and often nothing is seen. So, Jon keeps going off running because he’s told he’s fine, but really, he’s still moving poorly.

Eventually, he goes “That doctor is an idiot. SOMETHING is wrong!” So he sees someone else. Perhaps a physical therapist. They have you tug on some bands, ice and stim, stretch what’s “tight”  and strengthen what’s “weak.” But they never correct how Jon moves. They don’t work on how he goes up stairs, how he sits, how he squats, how he runs, whatever it is.

So Jon decides “PT doesn’t work.” Back to his running he goes. “I won’t let this beat me.” Believing he can out will his pain.

During one run he really feels some pain.

He sees another doctor. “I heard this guy is good. Hopefully he’ll figure out what’s wrong.” He does some more imaging and sees something inside the knee. “We need to perform surgery. Clean up that knee and you’ll be feeling good.”

“FINALLY!” Surgery sucks, but at least now he knows what’s wrong.

Really though, because Jon never corrected how he moves all this time, nothing has changed. The only reason something may now pop up on an MRI is all that faulty movement has finally caused some visible degeneration in the knee. But, the degeneration isn’t the original cause of the pain, so getting rid of it, “Shaving and cleaning up the knee,” is unlikely to get Jon, or you, anywhere. You’re still not addressing what initially caused the degeneration.

I once had a guy who was 78 years old and could hear his bones from 3 feet away. Watching him move made me hurt. The first time I asked him to squat I went, “Bob! Bob! Bob!” (His hearing was poor.) “Stop moving! Doesn’t that hurt?!” His response, “No, I feel fine, why?” The thing was, his squat form was good -he moved well. So, his knees felt pretty good while squatting.

It wasn’t until 2 years later he came to me again -after a year of not having him- and goes “Yeah, my lower back has really been bothering me.” He told me he recently had an MRI and according to the doctor there was some degeneration in his spine, so that’s what was causing his pain. 3 years previously I could HEAR this guy’s degeneration when he moved. He didn’t suddenly have degeneration in his spine, it was likely there years ago. Like 3 decades ago. It wasn’t the degeneration, it was the fact his lower back was moving very, very poorly. (He was twisting it all the time while playing racquetball.)

It’d be like getting the 50 year old obese person and saying, “Yeah, your arteries are clogged, which is causing your health problems.” The doctor is also going to say, “Um yeah, you’re obese. That’s not healthy.” You can clean those arteries all you want, but if the person doesn’t change how they eat they’re likely going to be back in the operating room / dead in no time.

For injuries: You can get all the surgeries you want, but if you don’t change how you move you’re likely going to be in the operating room again / disabled in no time.

Let’s change how you move. 

For a more technical discussion of “hitting a threshold,” read about central sensitization.

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Posted in: Miscellaneous, Pain