How well you recover from chronic pain or injury really comes down to how good you are at managing probability. If you understand the hard science and statistics really well, you can definitely can maximise your chance of success. If you don’t, it’s pretty much a gamble. Your results will come down to how well you place your “bet”.
You choose your chiropractor based on biases
We like to think we make rational decisions but, all things considered, we don’t. We make decisions that best fit our biases and they are not necessary the best choice.
Earlier this evening, an ex-client shared that they changed orthopaedic surgeon to one who is more progressive. The benchmark for progressiveness, from what I understood from the conversation, comes down to the advice given.
The first orthopaedic surgeon suggested no weight lifting. Just swimming and yoga so that the hip replacement can be delayed.
The second orthopaedic surgeon suggested not doing heavy squats and also not squatting past parallel.
The ex-client continued care with the second ortho.
From an outsider’s perspective, the ex-client’s biases does align better with the second ortho’s recommendation. This ex-client (still) exercises five times a week and loves high intensity training. It is no wonder they find the latter surgeon more “progressive”.
When choosing a chiropractor, you may think you are choosing the better one. That’s objectively, unlikely to be true. You most likely choose a chiropractor based on your biases or perhaps how well they align with your values.
This is no different from how we choose our exercises based on our personality fit with the exercise.
Being told what you cannot do is not the same as being told what you can do
For the everyday individual, it is probably unclear that the two orthopaedic surgeon’s advice are not comparable. The first orthopaedic surgeon made a recommendation to what the client should be doing. The second orthopaedic surgeon, however, made a recommendation to what the client shouldn’t do.
In this case, the first doctor is actually clearer in giving a recommendation. He endorsed two exercises that the client can participate in.
Interesting, the second doctor did not endorse any specific type of exercises or training volume. He did say not to squat heavy and not to squat past parallel. But yet he did make no mention if squatting lighter weight (but how light is lighter) or to parallel is actually good for the ex-client’s condition.
I did specifically ask the ex-client if the second surgeon did explicitly endorse their exercise routine (i.e., five times per week, including high intensity workout like CrossFit). The surgeon did not.
In this case, the client made an assumption that their workout is okay because the surgeon said not to squat to parallel and not to squat heavy weight. And they did not do that. But that does not mean their training programme is endorsed by the surgeon!
Always be explicit when asking for advice
I kinda did allude to that rich details matter in the previous post about how to run with knee pain when you really shouldn’t be running. When you receive advice or recommendation, make sure the person giving the advice is explicit and specific about their recommendation.
For example, if a surgeon’s recommendation is to not squat heavy, your follow up questions should be:
- What is considered heavy?
- If I were to squat X kilogramme (where X is below what constitutes heavy), how much and how often can I squat?
Remember, load management is always a function of stressor versus volume (and frequency.
It may sound very obvious but it is not. A popular 5×5 routine (e.g., Stronglifts) adds up to only 25 repetitions in total. The German Volume Training, however, will involve performing exercises for 10 sets of 10 repetitions. That’s a whopping 100 repetitions!
What is normal to you is strictly what you are used to. Not what is objectively normal. It is highly dependent on social context and environment.
Distinguish between regulating loss versus true progression
Broadly speaking, there are two types of advice when it comes to recovery from chronic pain.
- What is the best thing I can do to improve my condition?
- What can I do without making the condition worse? Or, what is the worst thing I can possibly do without making my condition worse?
They are both “can” questions but they come from completely different perspectives!
Going back to this ex-client, expound more into the second surgeon’s advice. When the surgeon advise against squatting to parallel or squatting heavy weight, which perspective is he coming from? Is this about not making the condition worse? Or is this about making the condition better?
What do you think?
What is regulating loss
Regulating loss for most part is about preserving what you already have. If you have a serious condition and a hip replacement is inevitable in the future, the best thing you can do now is to regulate loss.
It is a proactive effort to stop your condition from worsening. It is no longer a case of how far I can push it before things get worse. When the inevitable outcome is a hip replacement, the natural trajectory is decline.
To emphasise again, the condition is going downhill (all things constant). For you to stop it from getting worse or to reduce the rate at which it worsen is going to take effort.
In these situations, what is the worst thing you can possibly do without making the condition worse is not a logically sound question. Because, even in doing nothing, the condition is still going to get worse.
Discouraging as it may be, it is something to hold tightly in the mind. Because without this reminder, you may accidentally or unknowing accelerate the deterioration of your condition without realising it.
Being conservative is not a lack of progressiveness
The outcome of this ex-client is very specific. It’s about delaying a hip replacement, with the assumption that a hip replacement is inevitable. It is a controversial stance to take, but for the purpose of discussion I am willing to accept that.
If we were to go back to the beginning of my blog post, it is about probability. The question really comes down to what is the best thing you can do for yourself to delay a hip replacement. If you tell me swimming and yoga, I can get behind that.
But will avoiding squatting heavy and avoiding squatting past parallel help me delay a hip replacement? I doubt it. Sure, it can help me reduce the risk of the condition deteriorating but it certainly is not going to be more helpful.
In this case, asking the ex-client to consider swimming and yoga only is about being conservative. But it is not necessarily a lack of progressiveness. In fact, one could argue it is progressive advice since it does maximise the most positive outcome possible.
The don’t squat heavy and don’t squat low advice, however, is neither conservative nor progressive. It does not, in any shape or form, promote meaningful improvement (i.e., too vague). Risky? Yes. Controversial? Yes.
Progressive? No.
What is my job as a good chiropractor in Singapore?
If you genuinely want to make progress or the best of an inevitably worsening condition, you must be willing to examine your own biases and consider what are you truly willing to do for the desired outcomes.
Everyone who seeks help wants to be pain-free. I don’t know anyone who has proactively sought help who don’t want to be pain-free. But pain-free is not something that is going to just land on your lap. It takes hard work, subject matter expertise, and, almost always, money.
My job as a chiropractor is to guide you along the way. If you want freedom from pain, my job is to figure out how you can get there – often through exercise and lifestyle change. When you are deviating from what is necessary, it is my job to tell you so.
In telling you so, I am not trying to blame you for not trying hard enough or how you have fallen short or whatever not. It is to give you a reality check so you can either work harder or modify your goals so it is something that is congruent with the work you are willing to put in.
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