The other day, in response to my earlier request that all my subscribers send me their single most important question about orthopaedics and knee pain, or arthritis in particular, for a future teleseminar, I received a question about a “frozen kneecap.” Assuming that the woman hadn’t been buried in an avalanche, or fallen into a vat of liquid nitrogen, I was forced to ask what she was talking about.
Turns out that she was asking about her patella tending to track laterally, that is, on the outer side of her knee. From her point of view, the fact that her kneecap was stuck in a lateral track, she interpreted as being “frozen.” Now, I’m not picking on this lady, who I’m sure is very nice and who, in any case, needed help. In retrospect, I can sort of see the reason she chose that word, but the point is, it makes no sense to anyone else, like me, and therefore, does not accomplish what words are supposed to–communication.
This episode reminded me of how many times I had to try to draw out of my patients what their real complaints were. Sometimes, it was like pulling teeth. I don’t mean or expect that a lay person will describe their symptoms or complaints in technical terms that I would use to another orthopod. No, I just mean plain, descriptive English that actually tells me what’s wrong. Vocabulary is one of the main barriers between physicians and their patients. It’s sometimes hard for the patients to make the doctor understand what they mean.
My father-in-law is another great example of this. If he’s asked whether he has any hip or leg pain, he replies that his leg is “numbish.” Now, you would think that this would imply some decrease in sensation, like when something is “numb.” But no, what he actually means is that he has a dull ache in his hip. This took me quite a while to pull out of him, trying different definitions, or outright guessing what he was trying to express. The point is, it takes time and effort to figure out what the problem is. And today, a lot of doctors either don’t have, or won’t take, the time to try to interpret what you’re trying to say.
“Uh-huh. Take two of these twice a day. See you in two weeks.” Bam! Out the door. Next patient.
Because you don’t share the same vocabulary with your doctors, it’s important that you be as clear as possible. DON’T try to be “creative.” Just name the part, state what you feel, describe what happens, in as simple and lucid a fashion as you can. If it hurts, say so. Then, try to describe what kind of pain it is: sharp, dull, deep, superficial; then, what brings it on, what makes it worse, or better.
It helps if you have some understanding of what the possibilities are. For example, if you’ve read my LITTLE GREEN BOOK, which you can get at http://drbillsclinic.com/eliminate_knee_pain.html you will know what the most likely diseases are, since they’re presented in the approximate order of frequency that they occur.
In the case of the woman who wrote to me about her “frozen kneecap,” her problem was really a lateral tracking syndrome. This is usually due to weakness of the VMO (vastus medialis obliquus) muscle, the only one of the quadriceps that attaches directly to the inner, upper margin of the kneecap. When that muscle is weak, the other muscles pull the kneecap outward, and over time, the soft tissues contract and become tight.
To correct this, you need to stretch the outer soft tissues by massage, and sometimes by using a brace. You also want to build up the strength of the VMO, with the specially modified exercises I teach at http://drbillsclinic.com/exercise_eliminate.html None of this can occur if the problem isn’t first accurately defined.
So, what’s in a word? Everything.
That’s my word for today. Hope all is well with you. Til next time my friend.
Yours for a pain-free tomorrow,
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
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Copyright, 2008 by William Thomas Stillwell, MD
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