I read the abstract “Patellofemoral Pain: An Enigma Explained by Homeostasis and Common Sense” and found myself nodding along…
overload and/or injury produces pain. Bone overload and synovial inflammation are common sources of such pain.
Patience and persistence in nonoperative care results in consistent success. Surgery should be rare”
I agree with all that. I’d classify it as common sense as they say in the title.
But after reading the article a couple of times I don’t feel the authors were saying anything new.
Our Hypothesis: Loss of Homeostasis Causes Pain
We hypothesize that pain is the result when load applied to musculoskeletal tissues exceeds the ability to maintain homeostasis. Loss of tissue homeostasis from overload and/or injury produces pain.
which the authors are describing as “loss of homeostasis”. The use of “homeostasis” feels unnecessary.
Injury/overload = damage. simples.
However, the inflammatory processes are anything but simple. Inflammation is a rabbit hole I avoid looking to deeply into, I’d be lost for a very long time!
Pain anterior knee. —a consistent set of symptoms, signs, and test results—that does not exist.
I agree with this, and it happens to fit with my ‘individual trauma imprint’ explanation for pain-related symptoms. What our bodies have been subjected to, the damage sustained. With innumerable positions the body has a massive capacity for adaptation. As damage builds up, patterns of symptoms will emerge throughout the body but we’re all a bit different.
Emotions play a role in pain as well, and somatization resulting in knee pain is a well-known phenomenon, particularly in adolescent women related to stress or even abuse.
I checked the article’s references for more details about somatization but found nothing listed. (I also noted the references are mostly to other articles by the authors.) Whilst I do believe emotions and the physical body are intertwined, this statement feels more like a dismissal of knee pain when reported by the young and female. Adolescent women being told “it’s all in your mind” when nothing shows on exam or standard imaging. I wonder how often adolescent men with knee pain are told it’s due to their emotions too, or do they get a “diagnosis” of patellofemoral something or other? I didn’t find anything to back up this as a “well-known phenomenon”.
I say: The knees are joints that are under a lot of stress with little slack so problems appear here first when the body is not aligned and fully balanced. Stress/abuse affects positioning of the body.
Poor positioning can be subtle but it takes its toll. Knee pain—slight adjustments in the joints above and below i.e. hip and ankle to avoid the pain. It affects the whole leg, which then affects the body-whole over time. The body is very adaptable, able to cope with a lot of misusage and abuse but the imbalance and misalignments are cumulative.
The treatments listed: activity modification, cold therapy, anti-inflammatories, physical therapy. are (or at least should be) standard protocols. I’m cringing at the thought that surgery might be pushed in some parts of the world (without good reason), and thankful I wasn’t prescribed opiates as a teenager.
I was going to comment more on cold therapy but I thought I’d check some things I’d always been told, turns out it’s an another rabbit-hole to go down.
Some comments on Dr Scott Dye’s failure-of-homeostatis model:
I read the abstract “Patellofemoral Pain: An Enigma Explained by Homeostasis and Common Sense” and found myself nodding along…
I agree with all that. I’d classify it as common sense as they say in the title.
But after reading the article a couple of times I don’t feel the authors were saying anything new.
Overload/injury = stresses beyond tolerable levels --> damaged tissues & inflammatory processes,
which the authors are describing as “loss of homeostasis”. The use of “homeostasis” feels unnecessary.
Injury/overload = damage. simples.
However, the inflammatory processes are anything but simple. Inflammation is a rabbit hole I avoid looking to deeply into, I’d be lost for a very long time!
I agree with this, and it happens to fit with my ‘individual trauma imprint’ explanation for pain-related symptoms. What our bodies have been subjected to, the damage sustained. With innumerable positions the body has a massive capacity for adaptation. As damage builds up, patterns of symptoms will emerge throughout the body but we’re all a bit different.
I checked the article’s references for more details about somatization but found nothing listed. (I also noted the references are mostly to other articles by the authors.) Whilst I do believe emotions and the physical body are intertwined, this statement feels more like a dismissal of knee pain when reported by the young and female. Adolescent women being told “it’s all in your mind” when nothing shows on exam or standard imaging. I wonder how often adolescent men with knee pain are told it’s due to their emotions too, or do they get a “diagnosis” of patellofemoral something or other? I didn’t find anything to back up this as a “well-known phenomenon”.
I say: The knees are joints that are under a lot of stress with little slack so problems appear here first when the body is not aligned and fully balanced. Stress/abuse affects positioning of the body.
Poor positioning can be subtle but it takes its toll. Knee pain—slight adjustments in the joints above and below i.e. hip and ankle to avoid the pain. It affects the whole leg, which then affects the body-whole over time. The body is very adaptable, able to cope with a lot of misusage and abuse but the imbalance and misalignments are cumulative.
The treatments listed: activity modification, cold therapy, anti-inflammatories, physical therapy. are (or at least should be) standard protocols. I’m cringing at the thought that surgery might be pushed in some parts of the world (without good reason), and thankful I wasn’t prescribed opiates as a teenager.
I was going to comment more on cold therapy but I thought I’d check some things I’d always been told, turns out it’s an another rabbit-hole to go down.
https://www.physio-pedia.com/Cryotherapy
https://thesportjournal.org/article/the-r-i-c-e-protocol-is-a-myth-a-review-and-recommendations/
Cold—good or bad? It does numb the area for a while but what’s the deeper effects on the tissues...