Happens every day. It's built into the system.
Member
An interesting consultation at the doctor's office...
Hi all,
I'm a med student in Europe and am currently on my General Practice rotation (aka local doctor - don't know if you guys use that term in the US). I was shadowing a doctor who initially trained as a physical therapist. I apologise if it doesn't meet the criteria of "Mark Rippetoe Q&A" but I want to share this story with you from this afternoon:
Today, a 42 year old woman came in with right anterior knee pain x 3 months. Her knee was painful when walking up the stairs and when squatting down to pick up items from the floor. There was creptius in her knee during knee extension.
The doctor concluded that she had patellar chondromalacia secondary to patellar-femoral syndrome/the patella not tracking correctly. The doctor prescribed her analgesia, ordered an XRay of her knee and sent her to physical therapy.
The doctor claims that her vastus lateralis is too strong for her vastus medialis. So she needs to avoid working her vastus lateralis and strengthen her vastus medalis, so the muscle imbalance will be corrected. She gave her an exercise where she turns her right foot out to a 30 degree angle, flexes her right knee while keeping her left leg and upper body straight, then extending her right leg. She needs to repeat this 10 times per day.
After the woman left, I asked the doctor if it's possible to isolate the vastus medialis. She said you can't fully isolate it but it's better to try to work it by itself. Apparently, the vastus medialis is worked maximally in the last 30 degrees of knee extension. I asked her would it be more beneficial to strengthen the entire quadriceps by squatting which would both correct any "imbalances" and further strength the hamstrings, calves, abdominal muscles and lower back which would make her stronger altogether. In her opinion, squatting is bad for the knees, and for a woman approaching menopause, we don't want to increase her risk of a fracture by getting her to lift heavy weights. Before I could respond, the next patient walked in.
I should add that this woman is from a financially disadvantaged area, has a sick child at home, doesn't have private health insurance, will have to wait 4 weeks for her XRay and will most likely pay for physiotherapy sessions privately so she won't have to wait 3 months for free sessions.
I'm not going to lie, I was pretty mad walking out of the clinic today. Does the same shit happen over in the States as it does in Europe, with regards to doctors (and a lot of PTs) knowing nothing about getting people stronger and healthier?
TMPHBITEU
Happens every day. It's built into the system.
Member
Built into human nature, I'd say. People who need help the most are the least likely to receive it, or often even want it. The world's entire elderly population would benefit the most from being stronger and hardly any of them will lift weights in their (remaining) lifetime. Same is true for injured people, and I'd say people generally.
Quite poetically, people want help the most, in the older sense of the word "want", meaning "lack", and the newer sense, both. They'll always both lack it and really need it. Because if they didn't really need it, they'd probably already have it in some form or another.
Anyway, doesn't mean we should do nothing. Glad you're a doctor who knows better.
Member
Story 1: My son was getting a physical from his pediatrician. Her eyes narrowed when my son's weight was 99 percentile (for his age of 14). She asked him if he lifted weights. He rolled his eyes and sighed yes - he knew where this was going. "How much weight do you lift?", she says with now wide eyes not really knowing any better way to ask the question. He explained that he was doing 3 sets of 5 squats over 300lbs. She shrieked out, "Why???? You don't want your heart to explode!". We still chuckle about this occasionally because if anyone in the room was going to have a cardiac event it was the doctor. I think her "heart" was in the right place but she couldn't digest that a 14 year old kid was taking a lifting program seriously. She strongly urged him to continue to lift with much lighter weightsOriginally Posted by SS2016
. When does it become ODO?
Story 2: My son was seeing a cardiologist to screen for things per recommendations of Sully (Hypertrophic cardiomyopathy (HCM) and some sort of idiopathic stenosis I think). These recommendations (which I believe to be good) rule out possible heart conditions that cause "sudden death on the soccer field" events of kids. While viewing the ultrasound, the cardiologist became alarmed and said he had a thick wall in his heart (HCM) and it could be caused by a couple of things, most of which were real bad (infection scarring, hereditary defect...). He saved the best for last and said "There's one thing we can try. Zero activity for 3 months and we take another look at the heart to see if the wall narrows." If it doesn't, he will likely need to restrict physical activity in a big way - no sports, possible medication. It was hard to keep him still for those three months and I later learned he was cheating some but was not supposed to lift and not even walk briskly. After going back in 3 months, the cardio doc said "his wall had shrunk" and was fine to continue all physical activities and declared he had an "athlete's heart". huh?!
One of the cool things we learn out of Story 2 is the adaptation of the heart to lifting - and rapid de-training when sedentary (3 months). We would have had to do more testing to learn how quickly the heart muscle thickens but it was likely less than (and maybe a lot less than..) 12 months.
✓ Member
This is crazy.
There are better ways to discern an athlete's heart from a pathological cardiac hypertrophy than quitting all movement for 3 months. In fact, if you have an athletes heart, suddenly stopping all activity usually leads to cardiological problems, which is why athletes should detrain slowly if they cease theier career. I'm not sure if the diagnosis is even correct in a 14 year old, but what do I know, I'm not a cardiologist.
I was diagnosed HCM a few years ago after and ECG. The doctor was shocked, told me the grave bad news, outlined my almost imminent death.
Then, after some examinations, like ECG under stress (bike), ultrasound, lab, 24hour blood pressure and ECG, he concluded that it was a false alarm and I just have an athletes heart. Duh. He scared me pretty good.
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