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Mind your words

 •  • 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.

A fine rant here from physical therapist Sigurd Mikkelsen about a clinical experience. (And please note: the harsh language is not a transcript of his actual clinical communication, but a frustrated description of how he felt about it.)

Things that piss me off … first consultation today — a young active girl with an ACL injury. Got told by the doctor that she'd never play football again after looking two seconds on her MRI. Instantly scared the shit out of her and all her dreams about sports and becoming a police woman were brutally shattered.

Cried (out of relief) when I said this Doc should go F%&K the H#LL off and told her how Kjetil Jansrud won Olympic Gold in Super-G one year after his ACL-injury. Then went off with a 15 min continuous heroic rant about how fu&king fantastic and adaptable our bodies and minds are and threw around stories about great comebacks and insane human achievements. She felt better when she left the office.

FFS!!! Mind your words!!! They can change lives forever!

I hear stories like this on a daily basis, and I have for my entire career: patients are constantly told depressing, scary, bogus things about their injuries, based on shallow examination and the pernicious belief that we are like fragile machines — as opposed to freakishly resilient biological marvels. My inbox is full of it, like it’s coming from a firehose. And that’s why I get so exasperated when I get “don’t throw the baby out with the bathwater” reactions every time I try to swing the clinical reasoning pendulum away from structuralism and “fragilistic thinking”. The pendulum has never even come close to descending to a balance point between a biomechanical perspective on musculoskeletal medicine versus a neuro/bio one … let alone swinging too far in the other direction.

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