Pains ? Health struggles ? Ask a Surgeon anything

[FreakyThomas]

Thanks for the response!

In helping develop chronic pain solutions, I've learned that most people's pains are neuroplastic.

Very few people have pains rooted in structural issues, though neuroplastic pain does limit mobility and bring about structural issues.

I'm curious about what you referred to as "malfunctions".

Can you please elaborate on what you mean by that? Why/how would developmental processes develop "malfunctions" which lead to pain?

And lastly, if pain is a trigger across neural tissues, is pain physiologically measurable in say voltage gradients? Is pain that's felt in the neck a result of neurons in the neck misfiring? Or is the entire system dynamically linked across the CNS, in which case can the "pain" be localized?

I'm sorry, I don't think I have a better word than "malfunction". When the pain is not proportionate anymore related to the sensation that causes it, it's a malfunction. CRPS, fibromyalgia are some exemples. But we still don't know exactly the root causes of those diseases. We just know that it's not entirely psychological.

You can't really "measure" pain, because it is a conscious construct, happening in the brain. Therefore it is very subjective. It explains why the tolerance to the same pain is wayyyy different between two people. We see it all the same in surgery, for exactly the same procedure, some people won't have any pain, and some will need morphine to get through. However modern imagery like functional MRI should help to understand better how pain works, but it's still a field of research.

Frontiers | Brain Imaging Biomarkers for Chronic Pain

The prevalence of chronic pain has reached epidemic levels. In addition to personal suffering chronic pain is associated with psychiatric and medical co-morb...

www.frontiersin.org

Today, in my humble opinion, the best solutions to treat chronic, neuropathic pain not associated with a precise, curable medical condition, are not in the classical medical methods (opioids,...) , which are very disappointing, but rather in the psychological methods, such as, mindfulness, meditation, accepting the pain and giving it a meaning, etc. This is not, again, a scientific facts but my opinion forged by seeing the patients and their experiments to live with chronic pain.

 

Dislike ads? Remove them and support the forum: Subscribe to Fastlane Insiders.

[FreakyThomas]

Hi @Thomas Chauvet , thanks so much for this thread!

What kind of shoulder stretches would you recommend?
Should stretches be done before, during or after workout?

I love doing lots of pull ups, vigorously.
Then the next day I feel sore.

Should I work through pain, or let muscles rest, and for how long?

Are full extension pull ups ok?
I've heard it could be too much strain on shoulders.
I bring myself to a starting position, fully extended hands after each pull up.

I think it's okay, and even, good to bring yourself to this starting position, given that you're still in control of the movement (slowly) and not "falling" into this position after every rep. I'm sure you understand what I mean.
Regarding to muscle growth, it is still debated but some say, and they may be right IMHO, that you need to keep the muscle under tension between every rep, and then, not go into this full hang position. But, overall, this hanging "stretch" has also a lot of benefits, range of motion wise, health wise, so I guess it depends on your priorities.

About muscle soreness, also called "doms" you should check Andrew uberman's stuff on youtube, he made podcasts with top of their field strength training researchers. I remember that they advised to not train, not stretch if your muscles are still sore, because it means they're recovering. If you're sore for a long time after every workout, you would probably progress faster with less intense, more frequent workouts. But again, not everyone wants to build muscle mass ; it depends on your goals. If you like to train to empty your mind, spend a lot of physical energy and you enjoy training very intensely , and you don't really care about building muscle, then as long as you don't train while still having sore muscles, I think it's ok.

Timing of stretches are discussed a lot, from a range of motion perspective, workout performance perspective, it is best to stretch after your workout ; but it may delay the recovery. From a muscle building perspective, it is best to stretch after a delay, for instance, if you workout on mornings, you can stretch on evening (plus it helps to sleep better). But don't overthink all of this ; it's better to stretch than not to stretch, so if you prefer to do it right after your workout it's okay.

Lastly,
Hanging (pull up rest position) is a great shoulder stretch, pretty intense so not adapted for stiff shoulders, but should be perfect for you.
You should also stretch internal rotation, with the sleeper's stretch (check youtube) and/or by joining hands behind you back, arm straight behind the head, and stretching this way. If you're not able to join hands, use a towel or a belt until you can.

For stiff shoulders, we recommend those stretches

View: https://youtu.be/599EaPv6D5I?si=dlrTxLxCfx2T1eVg

To recover anterior elevation and external rotation which are the most crucial ranges of motion for shoulder function. Internal rotation usually recovers by itself in parallel.
(There are 4 stretches/videos)

Thank you for your interest guys!

 

[AceVentures]

I'm sorry, I don't think I have a better word than "malfunction". When the pain is not proportionate anymore related to the sensation that causes it, it's a malfunction. CRPS, fibromyalgia are some exemples. But we still don't know exactly the root causes of those diseases. We just know that it's not entirely psychological.

You can't really "measure" pain, because it is a conscious construct, happening in the brain. Therefore it is very subjective. It explains why the tolerance to the same pain is wayyyy different between two people. We see it all the same in surgery, for exactly the same procedure, some people won't have any pain, and some will need morphine to get through. However modern imagery like functional MRI should help to understand better how pain works, but it's still a field of research.

Frontiers | Brain Imaging Biomarkers for Chronic Pain

The prevalence of chronic pain has reached epidemic levels. In addition to personal suffering chronic pain is associated with psychiatric and medical co-morb...

www.frontiersin.org

Today, in my humble opinion, the best solutions to treat chronic, neuropathic pain not associated with a precise, curable medical condition, are not in the classical medical methods (opioids,...) , which are very disappointing, but rather in the psychological methods, such as, mindfulness, meditation, accepting the pain and giving it a meaning, etc. This is not, again, a scientific facts but my opinion forged by seeing the patients and their experiments to live with chronic pain.

Thanks for the explanation doc.

It's what I've come to learn about pain as well - I just needed to run my hypothesis against a surgeon's perspective.

What do you make of the following relationship between posture and pain? A maladaptation of the erect posture is measurable from the standpoint of the response time of the teleceptors as well as the general carry of the head. A maladaptation of the erect posture invariably affects the general tonus of the rest of the body and indirectly controls pain. It can act as a proxy for assessing pain.

From this standpoint - pain can be indirectly measured.

I also agree with you on treatment.

 

[runnaboi]

Thank you for this thread!

Do you have any recommendations for treatment or specialists for severe adhesions and gastroparesis? Have had 3 peritonectomies, once with HIPEC, and various parts removed. Now have occasional bowel obstruction, and have to stick to low fibre low residue diet. Pain and nausea are a daily thing, currently looking for any top specialist around the world to give me a 5th opinion on how to improve things! The last surgery for disection of the adhesions was very messy, and don't want that again.

Cheers!

 

Dislike ads? Remove them and support the forum: Subscribe to Fastlane Insiders.

[FreakyThomas]

Thanks for the explanation doc.

It's what I've come to learn about pain as well - I just needed to run my hypothesis against a surgeon's perspective.

What do you make of the following relationship between posture and pain? A maladaptation of the erect posture is measurable from the standpoint of the response time of the teleceptors as well as the general carry of the head. A maladaptation of the erect posture invariably affects the general tonus of the rest of the body and indirectly controls pain. It can act as a proxy for assessing pain.

From this standpoint - pain can be indirectly measured.

I also agree with you on treatment.

You're welcome.

I'm not sure posture can be used to measure pain directly. It is related to a ton of other metrics, like morale, fatigue, and even individual morphology.

To me, today the best way to measure pain is essentially just asking the patients if he's painful using a dedicated scale, for instance the visual analog scale :

The patients moves a small mark along the scale, and on the other side of the sheet, the doctor can see the number (like in the numeric rating scale) at the level of the mark.

Of course, it's not perfect, but it's the best we have, and it fully considers the subjective dimension of pain.

Thank you for this thread!

Do you have any recommendations for treatment or specialists for severe adhesions and gastroparesis? Have had 3 peritonectomies, once with HIPEC, and various parts removed. Now have occasional bowel obstruction, and have to stick to low fibre low residue diet. Pain and nausea are a daily thing, currently looking for any top specialist around the world to give me a 5th opinion on how to improve things! The last surgery for disection of the adhesions was very messy, and don't want that again.

Cheers!

Hey ! That's a tough one. I'm not really a specialist in visceral surgery, but I know it can indeed cause your symptoms, and it's not easy to deal with.

The problem of adhesiolysis surgery is that it can release some adhesions on the short term, but it will generate new scarring tissue, and probably new adhesions in the future, so it can even make things worse. Getting multiple advice from experts is a good thing, but it can also bring some confusion if they contradict each other. If I were in your place, I would try to look for articles in pubmed regarding this or related to this problem, for instance :

adhesiolysis - Search Results - PubMed

adhesiolysis - Search Results - PubMed

pubmed.ncbi.nlm.nih.gov

You may need to try a lot of different medical keywords to find valuable information, relatable to your case.

Then I would try to find one or two experts that authored several scientific papers on this subject. Then I would try to get an appointment with them.

It's difficult to publish a paper, especially in a good journal (check for journal impact factor, or h-index to assess the quality of a journal. It's not a perfect assessment, but it can still give you an idea). So if you find someone who has written and published many papers on the subject, it means he probably knows what he's talking about, and he's up to date.

There are great surgeons who never publish, so that's a negative of this approach, but I guess you already used word to mouth for your previous appointments.

In some complex and specific conditions, often overlooked by the medical community, such as yours, you may need some time and trials to find the person able to help you. Sometimes the best you can do is accept the after-effects. But make sure to do your homework first before giving up, because you sound like this problem have a very important impact in your daily life.

Hope this helps a little.

 

[EngineerThis]

Hey Thomas, I've been dealing with an odd knee pain for 3 months now. Only on my left knee, and only after repetitive motion like walking, jogging, bicycling a mile.. On the outside of my knee I get a dull pain, and stiffness in that tendon.
Interesting thing is I can weightlift, totally fine and pain free (Squats/deadlift).
I did first notice the pain after a sparring session of TKD...
Would a small tear in my miniscus cause these symptoms? And would surgery be required? I'm fairly against non-life threatening surgeries...
Thank you!

 

[FreakyThomas]

If this pain bothers you, you should ask your GP for knees xrays, and check with an orthopaedic surgeon specialized in knee surgery to get a proper clinical and physical examination, in order to determine what exactly causes this pain.
Surgery like this, even when it's indicated, is never mandatory, so don't worry, nobody will jump on your knee.
Most degenerative meniscus tears are treated conservatively, with a good success rate.

 

Dislike ads? Remove them and support the forum: Subscribe to Fastlane Insiders.

[AceVentures]

I'm not sure posture can be used to measure pain directly. It is related to a ton of other metrics, like morale, fatigue, and even individual morphology.

You can measure pain subjectively using questionnaires sure.

You can also observe the maladaptation of a person's structural organization from a physical standpoint.

What you call morale, fatigue and even individual morphology are shaped by dynamic elements of a person's development from childhood.

The state of a person's development can be measured vis-a-vi their sensory-motor adaptation, which is inseparable from how they've matured into being in this moment.

The more efficient your skeletal organization, the more of your nervous capacity is available for learning.

Your response time IS your ability, or inability.

My contention is that daily neuroses people deal with is inseparable from their sensations of pain, which is inseparable from how they organize themselves for action daily.

I don't claim to be a pain expert, but I've spent an ungodly amount of time thinking through it and appreciate an opportunity to discuss it.

The word "pain" alone we can't quantify yet it physically impairs so many human beings potential.

 

[EngineerThis]

You can measure pain subjectively using questionnaires sure.

You can also observe the maladaptation of a person's structural organization from a physical standpoint.

What you call morale, fatigue and even individual morphology are shaped by dynamic elements of a person's development from childhood.

The state of a person's development can be measured vis-a-vi their sensory-motor adaptation, which is inseparable from how they've matured into being in this moment.

The more efficient your skeletal organization, the more of your nervous capacity is available for learning.

Your response time IS your ability, or inability.

My contention is that daily neuroses people deal with is inseparable from their sensations of pain, which is inseparable from how they organize themselves for action daily.

I don't claim to be a pain expert, but I've spent an ungodly amount of time thinking through it and appreciate an opportunity to discuss it.

The word "pain" alone we can't quantify yet it physically impairs so many human beings potential.

I'd contest that pain is a choice, since it's subjective.

 

[Adam256]

Hey Thomas,
I was wondering if you knew anything about pelvic floor therapy? I have had ongoing issues with my stomach and digestion for over 6 months, and I have tried different types of elimination diets but none have removed the symptoms I am having effectively. Lots of people around me believe its IBS, but personally I don't think so, and it really seems to me like a pelvic floor issue as many of the symptoms align.
Thank you!

 

Dislike ads? Remove them and support the forum: Subscribe to Fastlane Insiders.

[FreakyThomas]

Hey Thomas,
I was wondering if you knew anything about pelvic floor therapy? I have had ongoing issues with my stomach and digestion for over 6 months, and I have tried different types of elimination diets but none have removed the symptoms I am having effectively. Lots of people around me believe its IBS, but personally I don't think so, and it really seems to me like a pelvic floor issue as many of the symptoms align.
Thank you!

Well I don't know much about it,
But what's for sure is that having a strong pelvic floor can only be a good thing, so I think if you're interested in it, you should give it a try (for real like several weeks) and see how it goes. It can't do any harm.
Another you may want to look at is SIBO. It's underdiagnosed because many physicians don't know about it, but it can explains symptoms for a lot of people who are diagnosed with IBS.

 

[FreakyThomas]

You can measure pain subjectively using questionnaires sure.

You can also observe the maladaptation of a person's structural organization from a physical standpoint.

What you call morale, fatigue and even individual morphology are shaped by dynamic elements of a person's development from childhood.

The state of a person's development can be measured vis-a-vi their sensory-motor adaptation, which is inseparable from how they've matured into being in this moment.

The more efficient your skeletal organization, the more of your nervous capacity is available for learning.

Your response time IS your ability, or inability.

My contention is that daily neuroses people deal with is inseparable from their sensations of pain, which is inseparable from how they organize themselves for action daily.

I don't claim to be a pain expert, but I've spent an ungodly amount of time thinking through it and appreciate an opportunity to discuss it.

The word "pain" alone we can't quantify yet it physically impairs so many human beings potential

I'd contest that pain is a choice, since it's subjective.

I'm sorry guys, I don't really agree we you. I think you have taking some shortcuts.
Pain is a signal that your body is giving you. Of course, sometimes, what you say can apply.
But some other time, pain is "mechanic". It's like putting someone in a burning desert and then say to them that feeling heat is a choice, since he's subjective.

You can't measure the feeling of heat, and different people will have different reactions ; but after a certain temperature and excluding the syndrome we talked about earlier, everyone will feel some discomfort regarding to this heat, will start sweating, etc. It's the same for pain.

I've seen people with broken legs every week, some have little pain, some have a lot of pain, but they all do feel some pain. It's mechanical.

You can measure pain subjectively using questionnaires sure.

You can also observe the maladaptation of a person's structural organization from a physical standpoint.

What you call morale, fatigue and even individual morphology are shaped by dynamic elements of a person's development from childhood.

The state of a person's development can be measured vis-a-vi their sensory-motor adaptation, which is inseparable from how they've matured into being in this moment.

The more efficient your skeletal organization, the more of your nervous capacity is available for learning.

Your response time IS your ability, or inability.

My contention is that daily neuroses people deal with is inseparable from their sensations of pain, which is inseparable from how they organize themselves for action daily.

I don't claim to be a pain expert, but I've spent an ungodly amount of time thinking through it and appreciate an opportunity to discuss it.

The word "pain" alone we can't quantify yet it physically impairs so many human beings potential.

What you say can be true, for some kinds of pain, but surely not applicable to every pain, in my humble opinion.
If someone have a scoliosis, it's genetic, their posture and "structural organization from a physical standpoint" will be messed up, but they are still able to live pain free most of the time.

I think you're confusing pain and a psychological feeling of distress or depression. They can be intertwined, but they are not the same.

I also don't agree with you that "The more efficient your skeletal organization, the more of your nervous capacity is available for learning.". It may be correlated a bit, but we have many counterexamples, for instance Stephen hawking who had a very, very physically debilitating disease, and who still managed to become one of the greatest physicist of all time.

I saw people with depression who didn't feel any pain, but rather, did not feel anything at all.

I see your point, and I'm the first person to think that there is a strong correlation between body and mind, but certainly not an absolute relation. Interesting debate !

 

[AceVentures]

I'm sorry guys, I don't really agree we you. I think you have taking some shortcuts.

I never made the claim that pain was a choice - that was somebody else.

What you say can be true, for some kinds of pain, but surely not applicable to every pain, in my humble opinion.

Absolutely agree - didn't make the case that it was. Pain is structural as well as neuroplastic. The below quotation was what I initially brought to your attention:

A maladaptation of the erect posture invariably affects the general tonus of the rest of the body and indirectly controls pain. It can act as a proxy for assessing pain.

From this standpoint - pain can be indirectly measured.

If someone have a scoliosis, it's genetic, their posture and "structural organization from a physical standpoint" will be messed up, but they are still able to live pain free most of the time.

I can't rule out that for one reason or another an unfortunate baby can be born out of the vagina with a crooked spine, but I'm confident 99% of cases of scoliosis aren't due to genetic defects.

Scoliosis is a maladaptation of the spine, which is part of the developmental process.

Children who don't crawl and are made to walk by eager parents typically end up with varying cases of scoliosis.

Being right-handed and sitting 8h/day for 12 years in school also causes varying degrees of scoliosis.

An inhibited posture results in an inhibition in action - no debate about that.

If you ask someone with a scoliosis to look over their tight shoulder, they won't be able to do it without pain. Every time they will feel the same pain.

That's what I mean by using posture as a proxy for pain.

You can pinpoint exactly where and how and due to what anatomical reason someone might feel pain (if it's not structural due to immediate injury)

I also don't agree with you that "The more efficient your skeletal organization, the more of your nervous capacity is available for learning.". It may be correlated a bit, but we have many counterexamples, for instance Stephen hawking who had a very, very physically debilitating disease, and who still managed to become one of the greatest physicist of all time.

This is an interesting case.

Yes he was a great physicist, but his capacity for learning was still debilitated.

Could he learn how to cook?
How to jump?
How to dance?
How to draw?
How to sing?

Obviously his capacity for learning was affected - perhaps so much so that he could only target his nervous capacity towards means which required little to no physical action.

 

Dislike ads? Remove them and support the forum: Subscribe to Fastlane Insiders.

[FreakyThomas]

Then we don't have the same definition for learning capacity. I get what you mean, I just don't agree with you and it's okay!

You think 99% of scoliosis aren't due to genetics, that's an opinion. You state that pain and posture are directly and absolutely correlated, and that by measuring posture, we can measure pain. But as a someone with scientific training, I don't believe in opinions, but in data. To my knowledge, the data doesn't show this.

I totally agree that determinism and the environment have a lot of impact of everything in our lives. But certainy not 99% (that's just my opinion).

I'm curious of why do you want to measure pain related to posture? Are you considering a product or something in this scope? I'll be glad to know more and see if I can be any help.

 

[AceVentures]

You think 99% of scoliosis aren't due to genetics, that's an opinion.

But as a someone with scientific training, I don't believe in opinions, but in data. To my knowledge, the data doesn't show this.

Show me the data which demonstrates scoliosis is a genetic condition.

It can definitely be inherited, but inherited as in the infant learned from the parent's maladapted movement patterns and habitual movements instead of a genetic protein encoding.

99% isn't an exact number you're correct. But my point is that by and large, scoliosis isn't a genetic condition.

You state that pain and posture are directly and absolutely correlated, and that by measuring posture, we can measure pain.

You keep repeating that, but I think maybe you can't read or English isn't your language.

I have said since the beginning that pain can be indirectly measured since posture demonstrates the anatomical structure of a person, which implicates their self-organization, which is inseparable from their sense of pain.

Tell me what exactly what you disagree with about the below quoted which I originally wrote to you.

What do you make of the following relationship between posture and pain? A maladaptation of the erect posture is measurable from the standpoint of the response time of the teleceptors as well as the general carry of the head. A maladaptation of the erect posture invariably affects the general tonus of the rest of the body and indirectly controls pain. It can act as a proxy for assessing pain.

From this standpoint - pain can be indirectly measured.

I totally agree that determinism and the environment have a lot of impact of everything in our lives. But certainy not 99% (that's just my opinion).

You're right that the number likely ins't exactly 99%.

Consider this: immediately after birth, absent any major defects, most newborns have the same immediate functional abilities. Therefore development shapes what happens to them on day 2 and onwards.

How many of scoliosis cases were identified on day 1 of birth?

How many people have scoliosis which was only observed at a later stage in life?

How can you account for those cases? Genetics?

In the case of many chronic pains, it is a neuroplastic pain which inhibits people, and this inhibition is development, it is learned, and it is linked to posture and movement.

 

[FreakyThomas]

Show me the data which demonstrates scoliosis is a genetic condition.

It can definitely be inherited, but inherited as in the infant learned from the parent's maladapted movement patterns and habitual movements instead of a genetic protein encoding.

99% isn't an exact number you're correct. But my point is that by and large, scoliosis isn't a genetic condition.



You keep repeating that, but I think maybe you can't read or English isn't your language.

I have said since the beginning that pain can be indirectly measured since posture demonstrates the anatomical structure of a person, which implicates their self-organization, which is inseparable from their sense of pain.

Tell me what exactly what you disagree with about the below quoted which I originally wrote to you.






You're right that the number likely ins't exactly 99%.

Consider this: immediately after birth, absent any major defects, most newborns have the same immediate functional abilities. Therefore development shapes what happens to them on day 2 and onwards.

How many of scoliosis cases were identified on day 1 of birth?

How many people have scoliosis which was only observed at a later stage in life?

How can you account for those cases? Genetics?

In the case of many chronic pains, it is a neuroplastic pain which inhibits people, and this inhibition is development, it is learned, and it is linked to posture and movement.

Scoliosis is a growth related problem, so of course it's impossible to identify it on birth. It will happen during growth, not before, not after. It's like saying puberty won't happen when you're old or a baby... Of course it won't.

Would you say eye color is genetic ? It is. But, we can't identify eye color on newborns. It's exactly the same for hundreds of other characteristics, that are genetically determined, but will express later in life. Scoliosis may be a bad example, and it's real origin is yet to be proven, but if it's determined by the environment like you say, how do you explain it concerns mostly girls (10 : 1 sex ratio) ? This is data, not an opinion. May be now you'll say something like "we treat girls differently than boys", yeah, right...

Of course most newborns does not have the same immediate functional abilities. There are differences right from the start ! Some of them are environment related (food the mother ate, if she had alcohol, ...), and some of them are genetics related.

I'm very careful about those kind of thoughts. You're basically saying that if people get scoliosis (or any other condition of your choice, like chronic pain if you wish) it's their fault (or their parents' fault, or whatever). You're dangerously overestimating the control we exert on some stuff, and it can make things worse by adding guilt to an already difficult condition to live with. People who spread these kind of thoughts doesn't know shit about this and are a plague. It's very easy to judge from outside. Probably a part of the medical community underestimates the control we have over this stuff, but I will definitely combat the thought that it's determined by the environment only. And believe, I'm first to think that " God helps only those who help themselves. " It is true, but only to a certain extent.

I sense a bit of aggression, and sorry if I did respond aggressively back too. I don't really want to pursue this conversation (and we're getting off topic). So I'll just answer your question and move on :

"Tell me what exactly what you disagree with about the below quoted which I originally wrote to you."

What do you make of the following relationship between posture and pain? A maladaptation of the erect posture is measurable from the standpoint of the response time of the teleceptors as well as the general carry of the head. A maladaptation of the erect posture invariably affects the general tonus of the rest of the body and indirectly controls pain. It can act as a proxy for assessing pain.

From this standpoint - pain can be indirectly measured.

To me, what you're saying, is like saying you can measure time by looking at the ambient light. Of course, in some cases, for instance if you're outside at night, you'll be able to give an approximation of the time, because there's no light. But there are a lot of cases where you will be incorrect, because other factors will affect light, without affecting time. So, some times, you may be right if you measure pain with erect posture, but I think you will be wrong a lot of the time too.

 

Dislike ads? Remove them and support the forum: Subscribe to Fastlane Insiders.

[Oso]

Hello, doctor!

I'd like to begin by giving you a shout out because, damn man, this entire thread is literally just you dropping knowledge left, right, and center. Thank you for providing so much value, and answering so many questions!

Now, if I may give you another one to answer, lol...

I've been struggling with my right knee. About 7 years ago, I got attacked in a public restroom. At one point during the altercation, I fell directly onto my right knee. Ever since then, occasionally when I bend my knee, it almost feels like a nerve/ligament "pops out." When it happens, there's no pain at all, but there's a massive amount of pressure. It's almost as if my brain knows "hey, if this thing snaps, THEN you'll be in a LOT of pain."

I don't think I broke my knee as I can still do everything. Sprint, workout, etc. My right knee cap does appear to bulge out a bit more than my left (and I can feel a little "extra space" around the base of it, so it feels a little "open," I guess?), but as I said, it's still functional. Anyway, I didn't have an x-ray done as the doctor here that I've seen told me if I can still sprint, etc. then I should be fine, but to go slow with working out for the next 6 months.

So, my question: is it logical to believe it is a ligament issue, and not a "I broke my knee cap and it healed wrong issue? My biggest concern is something tearing while working out, or learning 5 years from now that it DID break, and I have to have surgery + a metal rod to fix it, which means I'm in PT for 3+ months. At the moment, I've been wearing a knee brace for every workout (I attached a pic.). It has seemingly done wonders, and if anyone has knee issues, I cannot recommend these products enough.

Thank you ahead of time.

Cheers!

 

[FreakyThomas]

Hello, doctor!

I'd like to begin by giving you a shout out because, damn man, this entire thread is literally just you dropping knowledge left, right, and center. Thank you for providing so much value, and answering so many questions!

Now, if I may give you another one to answer, lol...

I've been struggling with my right knee. About 7 years ago, I got attacked in a public restroom. At one point during the altercation, I fell directly onto my right knee. Ever since then, occasionally when I bend my knee, it almost feels like a nerve/ligament "pops out." When it happens, there's no pain at all, but there's a massive amount of pressure. It's almost as if my brain knows "hey, if this thing snaps, THEN you'll be in a LOT of pain."

I don't think I broke my knee as I can still do everything. Sprint, workout, etc. My right knee cap does appear to bulge out a bit more than my left (and I can feel a little "extra space" around the base of it, so it feels a little "open," I guess?), but as I said, it's still functional. Anyway, I didn't have an x-ray done as the doctor here that I've seen told me if I can still sprint, etc. then I should be fine, but to go slow with working out for the next 6 months.

So, my question: is it logical to believe it is a ligament issue, and not a "I broke my knee cap and it healed wrong issue? My biggest concern is something tearing while working out, or learning 5 years from now that it DID break, and I have to have surgery + a metal rod to fix it, which means I'm in PT for 3+ months. At the moment, I've been wearing a knee brace for every workout (I attached a pic.). It has seemingly done wonders, and if anyone has knee issues, I cannot recommend these products enough.

Thank you ahead of time.

Cheers!

Hi Oso, thank you so much for this kind introduction !

It's difficult to give you a precise answer without any physical exam. If I understood right, starting after a traumatic event, with you falling down directly on your knee, you now feel a painless tension in your knee when you bend it, and your knee cap is moving more compared to the other side. You can do whatever sport you like, but when you're wearing a brace, it makes your knee feel even better.

1st, don't worry, even if you had a fracture, it would totally have healed by now, or you would definitely know it. So of course, no need for rods or stuff like this ; your bones are holding well and won't crack.

There are many things that can cause this. but my first guess would be that you dislocated your knee cap. It often relocates instantly, but the ligaments heals a little less tight than normal after the 1st episode. It's not a very bad condition. Often, if you keep a good Vastus medialis (the part of the quadriceps and is in this inside of the thigh), it will compensate well for the slight laxity of the MPF ligament, and you'll be fine ! You may start to feel some pain in your knee if you loose too much muscle so try to avoid that. The brace (with a central role) is helping in the same way by recentering your knee cap, and a stronger Vastus medialis can have the same effect and after rehab (for instance, squats with toes pointing outward) you may be able to feel the same, without the use of the brace.

My second guess would be that you kept a small stiffness from the original injury (it's possible that you have both, btw). Can you stretch both knees the same way, or is your injured knee in tension much sooner when you stretch your quads ? If you feel an asymmetry, I would suggest stretching to recover full range of motion. Even if it's not the main problem, it can't hurt ! For stretching I recommend 1 min stretch, 5 reps in a row with a small pause in between, up to 5 times a day (once is already great, if you're not too stiff).

Either way not a big deal and not something I would worry about, but again, if you really want to be sure, you can always check with a competent knee surgeon and get a real physical exam. If you're stressed about your knee, it can reassure you.

 

[AceVentures]

People who spread these kind of thoughts doesn't know shit about this and are a plague. It's very easy to judge from outside. Probably a part of the medical community underestimates the control we have over this stuff, but I will definitely combat the thought that it's determined by the environment only. And believe, I'm first to think that " God helps only those who help themselves. " It is true, but only to a certain extent.

I sense a bit of aggression, and sorry if I did respond aggressively back too.

I’m exploring the relationship between anatomical self organization and pain.

I’m incorporating dynamic systems analysis to the development of cognition and action as it relates to the perception of pain.

It’s rigorous work and I thought you would be open minded enough to explore some of these ideas with me. I was clearly wrong.

I said nothing about guilt or fault or responsibility.

The aggression you smell in the air is the aggression you project onto others who disagrees with you.

 

Dislike ads? Remove them and support the forum: Subscribe to Fastlane Insiders.

[FreakyThomas]

I’m exploring the relationship between anatomical self organization and pain.

I’m incorporating dynamic systems analysis to the development of cognition and action as it relates to the perception of pain.

It’s rigorous work and I thought you would be open minded enough to explore some of these ideas with me. I was clearly wrong.

I said nothing about guilt or fault or responsibility.

The aggression you smell in the air is the aggression you project onto others who disagrees with you.

You're totally right, we didn't manage to communicate in a constructive way! When someone says I can't read or understand English, I sense it as a bit aggressive , since we are discussing on an English speaking online forum.

I understood that you were working on this subject, but it's still really vague to me. May be if you were more specific I would understand you better.

If I tried so hard to point what are, in my humble opinion, the weaknesses of your thoughts, that's precisely to help you and give you my physician point of view/experience. That's actually what I wanted to do with this topic. It's up to you to learn from it or combat it. I don't claim it's valuable, that's also yours to decide.

It's true I didn't have a learning mindset either in this exchange, and I'm sorry for that. I'm a big sceptic by nature and I didn't see enough proof in your discourse that you're knowledgeable enough in this field. To me you seem to have a lot of opinions on the subject, but I don't know where they come from, what is your background, etc. You even said things that I strongly believe are false, so that makes me even more defiant about the rest, and not at all in an open minded state, that's for sure. Probably I did not understand those things as you meant it.

Hope this helps to understand better my answers. Have a nice day !

 

[Oso]

Hi Oso, thank you so much for this kind introduction !

It's difficult to give you a precise answer without any physical exam. If I understood right, starting after a traumatic event, with you falling down directly on your knee, you now feel a painless tension in your knee when you bend it, and your knee cap is moving more compared to the other side. You can do whatever sport you like, but when you're wearing a brace, it makes your knee feel even better.

1st, don't worry, even if you had a fracture, it would totally have healed by now, or you would definitely know it. So of course, no need for rods or stuff like this ; your bones are holding well and won't crack.

There are many things that can cause this. but my first guess would be that you dislocated your knee cap. It often relocates instantly, but the ligaments heals a little less tight than normal after the 1st episode. It's not a very bad condition. Often, if you keep a good Vastus medialis (the part of the quadriceps and is in this inside of the thigh), it will compensate well for the slight laxity of the MPF ligament, and you'll be fine ! You may start to feel some pain in your knee if you loose too much muscle so try to avoid that. The brace (with a central role) is helping in the same way by recentering your knee cap, and a stronger Vastus medialis can have the same effect and after rehab (for instance, squats with toes pointing outward) you may be able to feel the same, without the use of the brace.

My second guess would be that you kept a small stiffness from the original injury (it's possible that you have both, btw). Can you stretch both knees the same way, or is your injured knee in tension much sooner when you stretch your quads ? If you feel an asymmetry, I would suggest stretching to recover full range of motion. Even if it's not the main problem, it can't hurt ! For stretching I recommend 1 min stretch, 5 reps in a row with a small pause in between, up to 5 times a day (once is already great, if you're not too stiff).

Either way not a big deal and not something I would worry about, but again, if you really want to be sure, you can always check with a competent knee surgeon and get a real physical exam. If you're stressed about your knee, it can reassure you.

I can't thank you enough for your detailed response and explanation. I didn't even know we could dislocate our knees, lol, but yeah, that makes sense.

But yes, you understood correctly! And everything is pain free, I just wear the brace for "stability," really. Just to make sure everything sits where it's supposed to sit, especially while doing exercises such as squats. I don't want to risk a ligament popping out of place.

I still have full range of motion in that leg/knee as well, but I can tell my body is a little... hesitant (?) I guess to let me utilize it without thought. I suppose I just need to work on stabilizing it/strengthening it a bit more.

Thank you again for your help!

Cheers.

 

[FreakyThomas]

I can't thank you enough for your detailed response and explanation. I didn't even know we could dislocate our knees, lol, but yeah, that makes sense.

But yes, you understood correctly! And everything is pain free, I just wear the brace for "stability," really. Just to make sure everything sits where it's supposed to sit, especially while doing exercises such as squats. I don't want to risk a ligament popping out of place.

I still have full range of motion in that leg/knee as well, but I can tell my body is a little... hesitant (?) I guess to let me utilize it without thought. I suppose I just need to work on stabilizing it/strengthening it a bit more.

Thank you again for your help!

Cheers.

You're welcome! May be physiotherapy could also be useful, especially proprioceptive training

 

Dislike ads? Remove them and support the forum: Subscribe to Fastlane Insiders.