A story of alliteration gone wrong
Pain presents in so many forms and with so much baggage of its own, that it’s often ahrd to work out where the pain has begun and why it’s settled where it is.
So the easy thing is often to treat/operate/numb/rub the area we call painful and leave it at that. It’s not a bad approach. It feels nice and the result is that the pain often decreases, as pains tend to.
If it stays away then all well and good, but invariably it returns, perhaps in a different form perhaps in a different place. We call this ageing, stiffness, disease and accept it as normal.
“If I were a 28 year old elite athlete…….” says the 50 year old man complaining to the doctor about his knee pain.
“Let me stop you there,” says the doctor. “You’re not. In fact you never were. You’re a slightly overweight middle aged man with dodgy knees that one day will probably get replaced. Until then deal with it.”
For knee pain, substitute back, ankle, hip, neck, you get the idea. It’s disheartening but it’s unfair to blame age, when the bigger culprit would be the inefficient, inept and incomplete training that the doctor has undertaken.
The knee pain presentation of middle-aged man is pretty much always going to be a secondary presentation. There are all kinds of bio-mechanical assessments that we could make that would look at the position of the pelvis, the slightly flexed position of the neck and head and the compensatory aspect of the retracted scapulae/scapula, scapulahahahahaha but what if all these things are masking a behaviour that doesn’t allow itself to be tracked by such clever ‘evidenced based’ assessment techniques?
In Derek’s case it’s because he was a roadie for the famous death metal band Anarchic Skunk (made up). 14 years he spent in sound checks, bumping and crashing boxes and sets around and then being subjected nightly to a thousand decibels of ‘Eat My Groin’.
By now Derek is now moderately deaf in one ear. He refuses at the age of 49 to wear a hearing aid and instead moves, leans towards the sound he wishes to capture. At home he sits with his good ear towards the television and the radio and sits at the side of the table where he can hear his wife.
In social situations he stands with one side loaded, slightly inclining his good ear towards those speaking.
The years of gradual decline in Derek’s one ear has shifted his behaviour and his body has allowed him to do this. It has laid (or lain I’m never sure which) down fibres to support his stance, thickened tissues around his loaded hip and built tension in one side of his knee to allow more weight to be transferred.
His foot on the one side has externally rotated (slightly) which gives him more stability when he presses forwards and his opposite shoulder pulls him back from over balancing.
His knee has worn. He never was an athlete, never will be, but now his behaviour is affected further and his movement becomes more limited. In turn these limit cycles encourage a downward spiral of decline and unless he gets treated he will end up with knee surgery and probably soon afterwards a hip to boot.
Does he need treatment and is this treatment going to be effective? Yes and no or maybe. Behaviour is the driver and what needs to be identified and modified. Treatment is also necessary, but without a wider understanding of the bio-psycho social element, we will be seeing Derek regularly in our waiting room.
Derek no longer attends Death Metal gigs.