Worn out trainers – Neuroscience Nugget No. 19

Stan

I met Stan today (not his real name) – he’s a skateboarder who’s getting on a bit in years. Stan presented with some serious knee pain. He had been told (by an orthopaedic surgeon sitting behind his desk looking at an MRI with his glasses halfway down his nose) that he had some “serious wear and tear” in his knee.

Stan couldn’t straighten his knee (although I could passively), couldn’t walk without limping, and was afraid he would end up with a Total Knee Replacement.

I started of the session with some education and explanation – some information on danger signals, some details on sensitive nerve endings, and, how his thoughts and fears could actually contribute to both.

He nodded, but I noticed he just wasn’t getting his head around it.

Nothing feels as comfortable

Suddenly I noticed his completely worn out trainers. I asked him why he was still wearing those trainers – they were torn, nearly worn through in places and had completely lost their original shape.

He looked down, smiled as if looking at an old friend with whom he had shared life’s ups and downs and replied, “Nothing feels as comfortable as these old trainers – my wife hates them! She’s made me go out and buy new ones at least twice, but no matter how much I wore the new pairs, they just never sat as comfortably as these”

Aha-Erlebnis!

I had a little Aha-Erlebnis moment (I always like it when I start thinking In German during a therapy session)!

I asked Stan if there were any negative aspects of wearing the old trainers, “Sure” he said, “There certainly is. They’re full of holes and they leak in the wet and when it rains”.

“Why don’t you just throw them out then” I asked, “Because they’re SO DAMNED COMFORTABLE” he replied with a look on his face that suggested I had just asked him to get rid of a member of his family…

The nugget

This is what I was angling towards of course – here’s the nugget:

“Ok then Stan, let’s think about your knee like your worn out trainers – it’s been with you forever, has gotten you by, comfortably supported you through all the ollies, grinds and boardslides, and, like your trainers, is showing some signs of all this use over the years. Now, just like your trainers are leaking, you’re getting some signals about your knee – it’s hurting. Now I’m not going to get all ‘wifey’ and ask you to get a new knee, I’m going to help you keep your knee, the one you’ve relied upon all your life and the one that has looked after you all this time. You’ve used ‘shoe goo’ before right? (skaters love this sticky shit) We’re going to use some shoe-goo on your knee – it’s called exercise, and we’re going to patch up those leaky bits”

Stan was laughing, but I could tell that he was getting this, and was very happy to be getting some good news about his knee for a change.

“But even better than just patching up some old shoes with shoe-goo, the right exercise and activity will help your knee get healthier, lubricate the joint, strengthen it, and it help to feel really comfortable once again. Your knee might be showing some life related changes, but like your trainers, you’ve got many years of comfortable use left yet! I think we can keep those damn comfortable trainers after all!”

He was quite relieved –  lets see how he goes…

-Wouter Ramboer

Physiotherapist, West Flanders, Belgium

Wouter is a very active Twitter user and can be found by his Twitter handle @neuromanter, where he will be regularly posting links to some of the latest and most interesting articles related to pain and neuroscience, and discussing the future of the physiotherapy profession with others from around the globe.