A Case For Individuality

As a natural product of existing, moving throughout our days, and engaging with the outside world, our bodies will experience aches and pains. Some that are transient and some that persist. Whether or not these are considered injuries is based upon how they affect the individual who is experiencing them and how those affects influence their ability to meet the functional demands that are important to them in their life.

This leads to the topic of individuality.

On a regular basis I get asked to provide “quick tips,” or “just tell me how to…” from strangers sliding into my DMs or inbox, and even friends and family, with respect to their aches and pains or exercise programming. Unfortunately, but really fortunately, I can’t, and I won’t, do that.

This is like asking someone “what’s the best way to lose 10lbs,” or “what shoe is best to run in.”

Without knowing your age and weight, previous diet history, medical history, activity level, etc., and without knowing how many miles you run a week, what type of running you’ll be doing, what your feet look like, and what shoes you’ve tried in the past, I can’t provide you with information that will specifically and optimally help YOU.

My answer is always: “It depends…” and I would be doing the individual a disservice, and possibly even providing the wrong information, by giving them “something off the top of my head,” without getting a full history, doing a head-to-toe evaluation, and working with them over the course of a few sessions, or a few weeks, to ensure what I’ve prescribed is helping them meet their goals.

I’ll use the example of anterior knee pain. Sure, you might have seen 101 ways to fix “knee pain” put out there on the internet for free, but without really knowing the underlying cause of the knee pain, providing a generalized “quick fix,” likely won’t help in the the long run and trying 25 of those 101 tips before finding something that miraculously works is a waste of time.

Case 1: Alex presents for an evaluation with complaints of right anterior knee pain of insidious onset for six months when she squat cleans, low bar squats, high bar squats, front squats, does wall balls, box jumps, and goes up and down the stairs. Upon evaluation she appears to have a slight scoliosis, leg length discrepancy, and a discrepancy in end range knee extension in standing and passive joint play. Additionally, she presents with right hip weakness and a hip shift in her squat. By addressing the posterior capsule extensibility in her right knee, providing a small lift under her short leg while she squats, and employing muscle re-education to condition her to achieve full knee extension at lock out on each rep, as well as overall technical execution of her back squat, we were able to resolve her knee pain.

Case 2: Brandon presents for evaluation with complaints of left anterior knee pain with walking and knee bending activities secondary to knee fracture from a motorcycle accident two years ago. Upon evaluation he presents with flexion and extension loss of the left knee and weakness throughout the entire left lower extremity. Upon functional evaluation he demonstrates fear avoidance behaviors by ambulating with a straight leg and shifting away from his left leg significantly when asked to do a squat. Brandon’s treatment consisted of an aggressive stretching regime daily to help adapt him to working through pain and increasing his range of motion. In his PT sessions we initially utilized box squats, kettlebell deadlifts and some band work to strengthen his legs enough to transition to barbell training. His sessions also consisted of gait training and education about doing things he was fearful of. When we transitioned to full depth barbell squats the hip shift reappeared due to a fear of bending the left knee under heavier load. We implemented some tactile feedback by standing a foam roller in front of his foot to remind Brandon to bend his left knee more while he squatted. Over the course of all this treatment his knee pain resolved.

As you can see with the two cases presented above, the same “symptom” can present completely different, have entirely different causes, and thus be resolved with completely different approaches between individuals. Resolving the symptom cannot truly occur without addressing the underlying cause that is figured out through an extensive evaluation process and over the course subsequent treatments.

Asking a true clinician to give you an answer without giving them all the pertinent information (which takes time!) is like asking a detective to solve a murder mystery without looking at the crime scene and interviewing key witnesses.

I can’t tell you how many times people have come to me after implementing a “hip shift fix” they saw on YT for the squat, or 10 exercise from the Slinky Snake without resolve of their symptoms. “But this was what so-and-so said fixes hip pain.” Well, no...they don’t know what’s causing YOUR hip pain, so how can they be sure those exercises will fix it? For me to help YOU the best way possible, we need to sit down, talk it out, look it over from head to toe, come up with a plan, execute it, and adjust it over time.

Without understanding you, as an individual, from top to bottom, soup to nuts, I’m doing a disservice to YOU, and professionally. That is why I can’t, and won’t, give you a simple exercise to fix your knee pain without evaluating you. It’s also why you won’t find me putting out daily videos with “the best way to fix X,” or “THE exercise to get rid of Y.” And I certainly won’t do that when you slide into my DMs. If you’d like to get more information about my treatment philosophy you can read Treat The Issue Not the Tissue, and you can check out my rehab services here.