What if you're wrong?
I recently had a client who was told by her doctors that her knee was bone-on-bone and she had no cartilage left in her knee. Her doctors and her both bought into the idea that the lack of cartilage was the reason for her constant pain.
 X-ray showing a bone-on-bone arthritic knee joint. |  Knee joint anatomy. |
But she wasn't ready for a knee replacement. She was referred to me by a good friend. She understood that her posture imbalances made her movement less efficient. She also understood that those imbalances might put increased pressure on her knee. And she even entertained the idea that maybe those posture imbalances were the reason her knee cartilage wore out in the first place.
But of course a total knee replacement surgery was the only thing that could "fix" her knee and allow her to be pain free again. Unless it wasn't. What if that line of thinking was wrong?
But of course a total knee replacement surgery was the only thing that could "fix" her knee and allow her to be pain free again. Unless it wasn't. What if that line of thinking was wrong?
 X-ray of an artificial knee joint replacement prosthesis. |  Photograph showing a knee after having knee joint replacement surgery. |
What if, not only was her posture imbalances responsible for causing the cartilage damage in her knee in the first place, but that her posture imbalances were responsible for her knee pain also. And what if, correcting her posture imbalances would not only fix the underlying cause of her cartilage damage but also bring complete pain relief?
Well, as I said earlier, she was willing to at least give it a try. She figured doing some exercises only took a little time and effort and would have no negative side effects, so she might as well do them. I took her through her first menu of posture exercises (e-cises) and the results were better than she ever expected.
After 2 e-cise menus and two weeks of doing personalized posture exercises her knee pain was 100% gone. She was pain free. These are her words: "My knee pain is completely gone! Thank you!"
But wait a minute...I thought the reason she had knee pain was because she didn't have any cartilage left in her knee? I mean, her doctors told her that her knee was bone-on-bone! How could she have no cartilage and no pain?
Well, as I said earlier, she was willing to at least give it a try. She figured doing some exercises only took a little time and effort and would have no negative side effects, so she might as well do them. I took her through her first menu of posture exercises (e-cises) and the results were better than she ever expected.
After 2 e-cise menus and two weeks of doing personalized posture exercises her knee pain was 100% gone. She was pain free. These are her words: "My knee pain is completely gone! Thank you!"
But wait a minute...I thought the reason she had knee pain was because she didn't have any cartilage left in her knee? I mean, her doctors told her that her knee was bone-on-bone! How could she have no cartilage and no pain?
Correlation doesn't imply causation. All statisticians know this. Just because two events are occurring together does not mean one is causing the other. See my client and her doctor were using logical fallacy or a false cause. It's very common in medicine and healthcare. But it's illogical. It's a flawed assumption. (To really see how ridiculous this line of thinking is read this.) We all hear it all the time:
None of this is true. Sure they are correlated. But one is not causing the other. Everyone who thinks this has missed the most important piece of the puzzle. Posture and function.
Poor posture and bad biomechanics cause both the herniated disc and the back pain. Surgery to "fix" the herniated disc might give temporary pain relief to some people, but what happens a year or two later? The pain returns. And they often either re-herniate the same disc, or the one above or below the original disc. Why? Because they never fixed the postural imbalances that were responsible for the original disc herniation and the pain.
But what about arthritis? The person with hip pain goes to the doctor who X-rays or MRIs their hip and says "Yep, you have osteoarthritis in your hip, just as I suspected. You need to have a hip replacement." They get a hip replacement but several months later are still suffering from hip pain. And they're still limping. And the doctor says the hip replacement was "successful". Why? It's the same story...poor posture and bad biomechanics caused the hip cartilage to slowly wear away. The body's response to imbalanced posture and inefficient movement patterns was arthritis and pain. A hip replacement did nothing to correct the faulty posture and movement patterns which is why the pain and limping never went away.
But a bone spur, you have to do surgery to remove the bone spur! That's obviously what your foot surgeon thinks because they recommended surgery to do just that. But if you listen to them and have surgery, what happens a year later? Your pain returns and guess what? So does the bone spur. Why? Genetic flaw? No. Bad posture. Your postural imbalances are changing your gait and the altered gait is putting compression, tension, and/or shear on your foot at the point where your bone spur is forming. The compression, tension, and shear is the reason the bone spur forms. It is a bony callus. The body's response to your gait. Surgery to shave the bone spur off does nothing to improve your posture and gait and thus the bone spur will reform. Fix your posture and the bone spur and pain go away.
Ok fine...but that can't be the case with patellar tracking issues right? Almost every physical therapist you talk to will tell you your patella isn't tracking correctly because your VMO is weak. (VMO is short for vastus medialis oblique - the inside quad/thigh muscle just above your knee) They believe that your weak VMO isn't pulling your patella inward enough and thus your vastus lateralis (outside quad/thigh muscle) is winning the war and pulling your patella outward. A knee surgeon will suggest confidently that they can do a patellar realignment surgery and fix the problem. But both of these treatments miss the underlying cause of the problem. Your femur is internally rotated. Internal femur rotation combined with the resultant external tibial rotation (your body's way to try to keep your body moving forward) causing the patella to slide out of it's groove. This alignment also puts your VMO in a position where it can't contract thus causing weakness from disuse. The real problem starts in the hip. It is your weak hip musculature that is not doing it's job to keep your femur aligned and the chain reaction is what your PT and surgeon are trying to treat (unsuccessfully might we add).
Complicated? Yes and no. Basically what a patient, a client, or someone in pain needs to do is always ask the next question. The why, what, where, and how questions work well. Why is the disc herniated? What caused L5 to herniate and not L4 or L3? What caused the osteoarthritis in my knee? Why is it only in my right knee? What else is involved? How come everyone my age doesn't have the same problem? Who it is genetic if I only have arthritis in one knee and not the other? Where did the bone spur come from? How will surgery fix the problem? What if that doesn't work? What if after surgery the bone spur reappears? What then? Where else could the problem be? If you ask enough questions you will be able to get to the truth. If someone can't give you an answer that makes sense, move on and find someone else to ask. Your goal is to find answers that make perfect common sense. That's what my client did...
- You have back pain. You also have a herniated disc. The herniated disc is the cause of your back pain.
- You have hip pain. You have arthritis in your hip joint. The arthritis is the causing your hip pain.
- You have heel pain. You have a bone spur on your heel. The bone spur is the cause of your foot pain.
- Your patella doesn't track correctly. Your vastus medialis is weak. The vastus medialis weakness is the reason your patella doesn't track correctly.
None of this is true. Sure they are correlated. But one is not causing the other. Everyone who thinks this has missed the most important piece of the puzzle. Posture and function.
Poor posture and bad biomechanics cause both the herniated disc and the back pain. Surgery to "fix" the herniated disc might give temporary pain relief to some people, but what happens a year or two later? The pain returns. And they often either re-herniate the same disc, or the one above or below the original disc. Why? Because they never fixed the postural imbalances that were responsible for the original disc herniation and the pain.
But what about arthritis? The person with hip pain goes to the doctor who X-rays or MRIs their hip and says "Yep, you have osteoarthritis in your hip, just as I suspected. You need to have a hip replacement." They get a hip replacement but several months later are still suffering from hip pain. And they're still limping. And the doctor says the hip replacement was "successful". Why? It's the same story...poor posture and bad biomechanics caused the hip cartilage to slowly wear away. The body's response to imbalanced posture and inefficient movement patterns was arthritis and pain. A hip replacement did nothing to correct the faulty posture and movement patterns which is why the pain and limping never went away.
But a bone spur, you have to do surgery to remove the bone spur! That's obviously what your foot surgeon thinks because they recommended surgery to do just that. But if you listen to them and have surgery, what happens a year later? Your pain returns and guess what? So does the bone spur. Why? Genetic flaw? No. Bad posture. Your postural imbalances are changing your gait and the altered gait is putting compression, tension, and/or shear on your foot at the point where your bone spur is forming. The compression, tension, and shear is the reason the bone spur forms. It is a bony callus. The body's response to your gait. Surgery to shave the bone spur off does nothing to improve your posture and gait and thus the bone spur will reform. Fix your posture and the bone spur and pain go away.
Ok fine...but that can't be the case with patellar tracking issues right? Almost every physical therapist you talk to will tell you your patella isn't tracking correctly because your VMO is weak. (VMO is short for vastus medialis oblique - the inside quad/thigh muscle just above your knee) They believe that your weak VMO isn't pulling your patella inward enough and thus your vastus lateralis (outside quad/thigh muscle) is winning the war and pulling your patella outward. A knee surgeon will suggest confidently that they can do a patellar realignment surgery and fix the problem. But both of these treatments miss the underlying cause of the problem. Your femur is internally rotated. Internal femur rotation combined with the resultant external tibial rotation (your body's way to try to keep your body moving forward) causing the patella to slide out of it's groove. This alignment also puts your VMO in a position where it can't contract thus causing weakness from disuse. The real problem starts in the hip. It is your weak hip musculature that is not doing it's job to keep your femur aligned and the chain reaction is what your PT and surgeon are trying to treat (unsuccessfully might we add).
Complicated? Yes and no. Basically what a patient, a client, or someone in pain needs to do is always ask the next question. The why, what, where, and how questions work well. Why is the disc herniated? What caused L5 to herniate and not L4 or L3? What caused the osteoarthritis in my knee? Why is it only in my right knee? What else is involved? How come everyone my age doesn't have the same problem? Who it is genetic if I only have arthritis in one knee and not the other? Where did the bone spur come from? How will surgery fix the problem? What if that doesn't work? What if after surgery the bone spur reappears? What then? Where else could the problem be? If you ask enough questions you will be able to get to the truth. If someone can't give you an answer that makes sense, move on and find someone else to ask. Your goal is to find answers that make perfect common sense. That's what my client did...
My client now understands that her posture imbalances are the reason why her biomechanics changed. She understands those altered biomechanics over time wore the cartilage in her knee down eventually to the point where her knee was "bone-on-bone". My client knows her knee pain was a message from her body that her knee is not working correctly and a call for help. She realizes that correcting her posture imbalances allowed her knee to work biomechanically correctly again which eliminated her knee pain even though she still lacks cartilage in her knee joint. And my client is excited to continue doing new menus each week and working on constantly improving her posture and function. All of this allows her to enjoy peace of mind.
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