4 ms·

The desperate patient causes the desperate clinician to do desperate things

49 points by ropable 7y ago

airbreather 7y ago
Recognise the power of the white coat (to most) and use it wisely.
aflag 7y ago
And we never found out what happened to Paul :(
- ptah 7y ago
  I think the writer is fishing for comments from people wanting more paul :)
  - jacobush 7y ago
    I’m desperate to know!
Aromasin 7y ago
I can attest to being a slave to "treatment" for a while. I used to clock into my local physician, who'd have a go at my back with manual therapy (post-op fractured vertebrae, ruptured vertebrae, and massive scar tissue from surgery) until we got "rid of all the knots" and I'd leave, skipper as anything - until they came back over the course of the next two weeks. Eventually, after about 6 months of this bi-weekly physical therapy, I quit going because I knew it wasn't doing anything to deal with the underlying problems. I swapped to a different physio, who I complained to about having to go to physio so regularly but nothing changing. He gave me a list of exercises and told me "You want to cure your back pain? Do these until you can touch your toes. Don't come here back till then." Came back after breaking that hurdle. He gave me a new list, and said "Do these until you can touch your hips to the ground in downward-dog". Next one "Do these until you can hold a bridge for a minute." Rinse and repeat, until 18 months later, after about 10 appointments, I no longer had any back pain. If you're struggling with injuries, I highly recommend shopping around for physiotherapists until you find something that works for you. I'd have been getting manual therapy on my back for the rest of my life if it weren't for testing the waters.
- wayoutthere 7y ago
  Most white collar workers have very weak “core” muscles from sitting all day. This is basically everything between the bottom of your ribs to your thighs — abs, obliques, and everything in the pelvic area. It’s pretty obvious how changing from a life that requires us to stand / walk / run to one where we sit for long periods of time would work those muscles FAR less than sitting at a desk. Weakness in your core leads other muscles — like those in your back — to overcompensate. For me, it started as hip pain, for others it’s knee pain (yup, weak core muscles can cause knee issues too!) But back pain is probably the most common, and is usually caused by weakness in the obliques putting the weight of stabilizing your head / torso almost entirely on your back muscles. Fortunately treatment is easy. Bridge poses, crunches, kettlebell workouts (particularly good for the obliques) and yoga are probably the best exercises to work your core. Consider your PT a personal trainer: one your health insurance carrier is more than happy to pay for given the link between physical fitness and overall health.
  - agent008t 7y ago
    Barbell squats and deadlifts are probably a more direct and effective way of making your muscles stronger, including your "core" muscles.
    - maxxxxx 7y ago
      I know you mean well but let’s not optimize too much. If you do something, really anything, you are already way ahead.
    - wayoutthere 7y ago
      Right but those require a lot more equipment. Deadlifts and squats all day if you know how to do them safely.
    - leksak 7y ago
      Well, not necessarily. If you have a muscular dysfunction then performing a big compound lift might just exacerbate the issue. I'm speaking from experience. Hanging out on HN, it is not surprising that I have a desk job. And, I do have a very weak core (despite having a very short back). Why? Because I have tremendous trouble activating it as other muscles take over. Case in point, whenever I started doing back squats my hips would start (still happens sometimes - which is when I reincorporate my rehab/prehab-exercises) to hurt. Specifically my right side, near my hip flexor. After visiting numerous physios that just told me that back squats probably weren't for me I found one that identified that I wasn't flexing my abdominal muscles properly during the movement and instead my hip flexor was trying to take over and stabilise my core at that point. I could have continued with deadlifts and squats, but would probably have torn something. With exercise, I find that we need to adopt several modalaties to see the greatest benefit. Kind of like how we should have a varied diet, your training should include strength, mobility, and activation work. Yoga is dope, it'll open up your thoraic spine, which will let you do overhead squats. Just trying to do overhead squats if you lack the prerequisite mobility is not ideal...
coldcode 7y ago
This also shows how easy it is for people (and medical people) to imagine there is some magical potion that will make everything perfect again, even if it is imaginary. I think in software we do things repeatedly thinking they are making thing easier or better when in reality the machine isn't even turned on.
deleted 7y ago
[deleted]

49 points by ropable 7y ago

airbreather 7y ago

Recognise the power of the white coat (to most) and use it wisely.

aflag 7y ago

And we never found out what happened to Paul :(

ptah 7y ago
I think the writer is fishing for comments from people wanting more paul :)
- jacobush 7y ago
  I’m desperate to know!

Aromasin 7y ago

I can attest to being a slave to "treatment" for a while. I used to clock into my local physician, who'd have a go at my back with manual therapy (post-op fractured vertebrae, ruptured vertebrae, and massive scar tissue from surgery) until we got "rid of all the knots" and I'd leave, skipper as anything - until they came back over the course of the next two weeks. Eventually, after about 6 months of this bi-weekly physical therapy, I quit going because I knew it wasn't doing anything to deal with the underlying problems. I swapped to a different physio, who I complained to about having to go to physio so regularly but nothing changing. He gave me a list of exercises and told me "You want to cure your back pain? Do these until you can touch your toes. Don't come here back till then." Came back after breaking that hurdle. He gave me a new list, and said "Do these until you can touch your hips to the ground in downward-dog". Next one "Do these until you can hold a bridge for a minute." Rinse and repeat, until 18 months later, after about 10 appointments, I no longer had any back pain. If you're struggling with injuries, I highly recommend shopping around for physiotherapists until you find something that works for you. I'd have been getting manual therapy on my back for the rest of my life if it weren't for testing the waters.

wayoutthere 7y ago
Most white collar workers have very weak “core” muscles from sitting all day. This is basically everything between the bottom of your ribs to your thighs — abs, obliques, and everything in the pelvic area. It’s pretty obvious how changing from a life that requires us to stand / walk / run to one where we sit for long periods of time would work those muscles FAR less than sitting at a desk. Weakness in your core leads other muscles — like those in your back — to overcompensate. For me, it started as hip pain, for others it’s knee pain (yup, weak core muscles can cause knee issues too!) But back pain is probably the most common, and is usually caused by weakness in the obliques putting the weight of stabilizing your head / torso almost entirely on your back muscles. Fortunately treatment is easy. Bridge poses, crunches, kettlebell workouts (particularly good for the obliques) and yoga are probably the best exercises to work your core. Consider your PT a personal trainer: one your health insurance carrier is more than happy to pay for given the link between physical fitness and overall health.
- agent008t 7y ago
  Barbell squats and deadlifts are probably a more direct and effective way of making your muscles stronger, including your "core" muscles.
  - maxxxxx 7y ago
    I know you mean well but let’s not optimize too much. If you do something, really anything, you are already way ahead.
  - wayoutthere 7y ago
    Right but those require a lot more equipment. Deadlifts and squats all day if you know how to do them safely.
  - leksak 7y ago
    Well, not necessarily. If you have a muscular dysfunction then performing a big compound lift might just exacerbate the issue. I'm speaking from experience. Hanging out on HN, it is not surprising that I have a desk job. And, I do have a very weak core (despite having a very short back). Why? Because I have tremendous trouble activating it as other muscles take over. Case in point, whenever I started doing back squats my hips would start (still happens sometimes - which is when I reincorporate my rehab/prehab-exercises) to hurt. Specifically my right side, near my hip flexor. After visiting numerous physios that just told me that back squats probably weren't for me I found one that identified that I wasn't flexing my abdominal muscles properly during the movement and instead my hip flexor was trying to take over and stabilise my core at that point. I could have continued with deadlifts and squats, but would probably have torn something. With exercise, I find that we need to adopt several modalaties to see the greatest benefit. Kind of like how we should have a varied diet, your training should include strength, mobility, and activation work. Yoga is dope, it'll open up your thoraic spine, which will let you do overhead squats. Just trying to do overhead squats if you lack the prerequisite mobility is not ideal...

coldcode 7y ago

This also shows how easy it is for people (and medical people) to imagine there is some magical potion that will make everything perfect again, even if it is imaginary. I think in software we do things repeatedly thinking they are making thing easier or better when in reality the machine isn't even turned on.

deleted 7y ago

[deleted]