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2nd edition of patellofemoral pain e-book, co-authored with Tony Ingram

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

The 2nd edition of the patellofemoral pain syndrome e-book is now available, after many months of collaboration with a new co-author, Tony Ingram of Mind & Movement (the similarity in our surnames is just a fun coincidence). The book has been updated many times over the years, but the new edition thing had to wait for this. It’s longer by about 5000 words and a few dozen footnotes, and there are scads of other improvements. Mostly it’s just better, but there is one important thing that’s different

It’s probably time to reboot my 6-year-old cover design. But not this week! Tony & I had plenty enough to do getting the new edition out the digital door.

“I need to turn you around on exercise”

I must be doing something right, because a guy like Tony is a catch of a co-author: he’s a physical therapist and a researcher in hot pursuit of his PhD. We’ve been working on the new edition since late last year, and most of the work went into a strong new (and overdue) emphasis on the evidence-based value of exercise — reversing my grumpy anti-exercise position. That’s the biggest change to the book.

Practically the first thing Tony said to me when we got down to work was, “I have to turn you around on exercise.” And he did. Getting my mind changed on a key point or two was the whole point of teaming up with him — more about that below.

Tony also did his masters thesis on anterior knee pain, and has the credibility of someone who has pushed his body to new limits as a dancer. Few people can combine serious academic credentials with that kind of athletic experience.

About the collaboration

It has been an interesting and successful collaboration. Although Tony was a fan of many aspects of the previous edition, he did challenge me on several points. I think he sent some of his early criticisms with great trepidation! Although our preliminary conversations had all been promising, you just don’t know how someone is going to cope with criticism until it’s happening. But I’m an old hand at this, and I couldn’t possibly be any kind of a success as a writer if I didn’t know how to shut up and listen attentively and humbly when a real expert is talking. Time and again, I think Tony was relieved when my responses to his emails came back calm and appreciative. I like being corrected. The alternative is to be wrong and not know it.

The tables were turned near the end when I had to ask Tony, “Where’s the beef?” about one of his new sections — a matter of editorial expertise more than knee knowledge. Tony looked a little startled at first, but he took it like a scientist, and proceeded with a significant upgrade to that section. It was my turn to be relieved!

Effective writing and publishing partnerships are rare, and I’ve had many of them fall through or just fail to thrive. But Tony and I had a great time on this first project, and we’re like to expand our collaboration. Stay tuned!

More about the exercise change

Making the 2nd edition more positive about exercise has been a great example of responding to new evidence — and a good example of a treatment that works, but probably doesn’t work how most people think it works. I was anti-exercise before because the evidence just wasn’t there for it yet, and too many professionals fancied that they were prescribing exercise to change biomechanical parameters (e.g. patellar tracking) that correlated poorly with the condition. Such prescriptions tended to be overzealous: too much exercise, too soon for patients suffering from what is fundamentally an overuse condition. And this kind of prescribing is still common.

Now there is good evidence that exercise is effective — Hallelujah, some much-needed good news! — but dosage and timing are key, and the biomechanical rationale still needs to be taken out with the trash.

The new edition explains it all in the signature style of it’s detailed but sassy and whimsical, a pleasure to read if you’re remotely interested in the subject.

Not just one guy’s theory any more

The previous version of the book had a significant weakness, a major idea about the nature of the beast (basically the whole “it’s the homeostasis, stupid” theme). My idea was plausible and elegant, but lacked adequate scientific support for an important basic point of the book. One advanced reader complained:

I didn’t buy your book so I could get one guy’s theory about how patellofemoral pain syndrome works. Not even if it’s a good theory.

Good point. She went on to say that it probably was a pretty good theory, just cringe-inducingly unsupported. Simple as it is, that’s one of the best constructive criticisms I’ve ever received. And it’s one of the major repairs in the 2nd edition: Tony and I agreed early that my basic point was sound, but badly needed some scientific and expert support — and now it has that. And much more.