We love to blame ourselves for things that aren’t our fault. More importantly, humans are very good at finding patterns even where there isn’t one. Combine those two things, and we become very good at blaming ourselves for our current pain, even when what is happening is often a benign, normal, and fixable thing! “Common knowledge” has been no help in the past, so let’s dispel some myths that we all take for common sense that recent research has proven wrong!
1) I beat up my knees!
I totally understand where this one comes from, and like all of these, it makes a lot of sense at face value! If we were extremely active on our knees in our youth, whether as runners, wrestlers, acrobats, or jumping athletes, we are warned that in the future our knees will have been worn down by that impact and give us terrible arthritis. This is particularly bad news for me as I have participated in athletic activities that involve almost all of those areas since I was 8, and I still haven’t stopped! And it makes sense really, my body is finite, and if I use the same area over and over it will probably wear down, giving me some nasty arthritis.
So what’s the good news? Well, a really amazing study recently compared the amount of arthritis present in the knees of runners vs non runners, and what we found was actually the opposite of what we expected. The runners actually had better knees! How did this work? Well, as it turns out, our body responds to a law of imposed demands, and rather than wearing down with frequent use, it learns to try and build up to compensate for this use. This is the same principle that medical professionals all over the world work under when building strength by lifting weights, or build bone mass in patients with osteoporosis by applying direct force to those bones with specific exercises. Turns out, our joints are not too different from the rest of our bodies. When we are active on a body part, the body learns that it needs to build up that area so that frequent use does not cause injury, and it actually makes it stronger, better, and more supportive. So if you “beat up your knees” being active, you actually are probably better off than everybody else! And as arthritis is generally present in imaging on most individuals, matching your pattern of pain to what we see on imaging can be very important, as different patterns mean different things (we’ll talk even more about that soon!). So where is your pain from? It often depends on your own situation, but working with the right professionals you will often find that the cause is fixable!
2) Those heavy backpacks are killing our backs!
Another one that makes perfect sense at face value: you load someone up with a heavy backpack, whether they are 7 or 24, and eventually it’s going to cause them some nasty back pain. But, you can’t get around school, so at least there are some very supportive backpacks that can help out right?
Well, another recent study took a look at this. Comparing people with back pain and without, and determining which carried heavy backpacks and which did not, we found something really interesting. Carrying a heavy backpack made you no more, or less, likely to have back pain than the group who did not. Almost the exact same amount of people in both groups had back pain! So what gives? Again, in blaming an “obvious cause” we often overlook other factors. Strength and endurance of the local postural musculature, other activities throughout the day that might aggravate are alleviate these tissues, and one of the biggest causes of bodily pain, stress, can all get overlooked if we have a “simple solution.” And when that solution doesn’t work, our brain decides that the damage is done and it is too late! But, if we look at other factors in our lives, we can often find that our pain is, again, very fixable with the right treatments!
3) All those bulging discs from my car accident years ago are causing me a lifetime of pain!
We in the medical profession are heavily to blame on this one. For years and years we accepted all medical imaging at face value, and a bulge was a bulge was a bulge, and that abnormality meant certain doom.
Again, modern research is proving we still have a lot to learn about the human body. Studies are showing that most bulged and herniated discs actually heal on their own without any medical intervention. Along with that, another study that looked at people both with and without back pain found the same incidence of bulging discs, degenerative discs, and arthritis in both groups, meaning that it is not only possible, but likely that in many cases these abnormalities have nothing to do with our pain. Well great, does that mean I cannot trust MRIs? We absolutely can, they are incredibly accurate at identifying structures, however it is up to your doctors to correlate wither a structural “abnormality” matches the type of pain we are having, and now that we know that not all disc issues cause pain, it becomes that much more important to be specific in symptom description and location, as well as be as thorough as possible on physical exam.
To boot, we also have some compelling theories as to how chronic pain works now, and why someone who has injuries that theoretically do not match a structure, or whose injuries should have healed, may still be in pain. And the even more exciting news is that those treatments work! So not only might your discs be alright, but there might be some very straightforward fixes to pain that has plagued you ever since an accident that do not require any invasive procedures or medication side effects!
4) My shoulder is wrecked and surgery is the only way to fix it.
The word “tear” is pretty terrifying, and the immediate assumption is that the only way to fix a tear is by sewing it back up (after all, if you tear your shirt, that’s pretty obviously the only way to fix it, right?).
Well, again, this is something we’ve been looking at. And, again, we have found that if screened out appropriately, a lot of people with torn shoulders won’t need surgery at all, and can recover completely without it!
But how can that possibly work? Well, let’s look at what a tear is. If I “tear” your skin, I’ve cut it. Depending on the cut, this might heal on its own, it might need some gentle conservative care, or we might need stitches. The soft tissue inside our body works very similarly, and the degree our tissue is torn, and where it is torn, can very much affect how well it will heal on its own. Strained muscles and sprained ligaments are also words for “torn” tissue, and we usually trust these to heal on their own as well!
So how do we know when to operate and not? Sometimes the answer is very clear, and just looking at your symptom presentation and imaging will let your physician know that two things are fully detached and unlikely to grow back together, such as with a rupture. A muscle or tendon that is not fully ruptured is always harder to tell. Your physician may experiment first with therapy (statistically, you have very good odds in cases like these!) to see how you react before putting you under the knife if they are unsure, and from here communication with your practitioners and monitoring progress will help guide when, or if, you need surgery!
So what does this all mean? Well, it means that pain is rarely a straightforward thing. Your physical structure, your nervous system, and your experiences need to be thoroughly compared and examined to find out what might be causing your pain, and “simple” diagnoses are not quite so simple sometimes. It means that asking questions and looking for healthcare providers who really listen well to you and spend time problem solving and testing from a variety of perspectives can be very important to getting better faster. It means that even your doctors are still learning new things about the body all the time, but we are always looking for new and exciting ways to get you better! Finally, it means that we should always be checking “common knowledge” and “the way it’s always been done” to make sure what we’ve always known actually works well!
written by: Dr. Alec Martinez, DPT