Rehabilitation is not Prevention

I decided to revisit an old video done by the McKibbin Brothers called “Knee Pain Explained and How to fix it“. In this video, the brothers go to a place called Sports Academy Biomechanics, and jump on a force plate to measure the impact they’re having on the plate (which they assume is what’s going on in the knees). The explanation of force is incomplete (which I tried to rectify by explaining the physics of landing impact). For one thing, they didn’t have both brothers jump to the same height – I’ll suspect that the measured force will be directly proportional to the height. But she did go on to talk about how “absorbing” the landing will reduce this force, describing it as some kind of bending in the hips and knees. If you rewind, you’ll see that they are doing that already. And if this does reduce the force, they should repeat the jump with the “proper” form – and there should be a measurable reduction. An easily accomplished experiment to test the hypothesis.

But they didn’t. Instead it goes on to a series of exercises that supposedly will “fix” the knee pain.

The problems with these regimens is that interchangeably mix injury prevention and rehabilitation. The former addresses how to avoid getting hurt in the first place, and the latter details what to do now that the athlete is already hurt. The knee pain – jumper’s knee or patellofemoral pain – is multifactorial, and can arise from a number of situations, but we do know that repeated impacts will cause it. The exercises can help athletes deal with the pain, but don’t necessarily address the cause. Consequently, athletes can continue to reinjure the joint even as they perform rehabilitation on it, because the “absorption” doesn’t remove the energy of the impact. Only a change in movement modality will dissipate it away from the targeted areas.

Instead, these exercises may actually function as a moral hazard – perpetuating injurious behavior in the guise of being protective. It addresses the pain, rather than the cause of the pain. And coaches can be the cause of this peril.

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