Recognizing Excellence

It's been another rough February.

Just like last year I'm looking at a nagging rehab of a herniated disc that has already seriously limited all the good winter fun and is beginning to threaten the shoulder season that allows me to train hard enough for full enjoyment of Spring. The days are getting longer, and warmer, and although my thoughts should be on the condition of the North Face of Gothics, instead I'm thinking about the importance of recognizing competence -- excellence even -- in the people from whom you take advice.

Case in point: my back.

The doctor: Due to similarity of my pain to previous episodes known (by MRI) to be related to a herniated L5-S1 disc, she recommended the standard conservative treatment along with physical therapy (PT). She spent a few minutes with me, most of it typing in a computer. She gave me painkillers to get me through the day and muscle relaxers to reduce the spasms which -- I was told -- was the actual source of pain.

The first Physical Therapist (PT): After a week or so of just being barely mobile, with debilitating pain that would occasionally cause near blackouts when getting out of the truck I got my first PT appointment. He had me stretch what I could (my calves!) and do what little bracing exercises I could do. I would spend an hour at PT. He would be in the room for about 1/3 of that, just long enough to put some ice under my back, or hook up the e-stim (which I LOVE, the best part of this hack was he gave me the controls to the e-stim and let me just crank it up as high as wanted... I'm a sucker for this shock therapy. I'd crank that up to just a little less than would cause a full back arch that would lift me off the table. I loved that!), or put on the ultrasound thing. I got progressively worse under his care. It got to the point that sometime 10-15 steps is all I could manage. He couldn't place his care in context except to say that actual spinal manipulation would be a very bad idea. After two sessions and a degrading condition, I dropped that facility (which I won't name here, I'm sure they're nice people and effective in other cases).

The second PT: During the first appointment at Penn States Sports Medicine, my PT spent over an hour with me. Watching me carefully. Talking with me. Making me move and describe the pain, it's intensity, it's quality, how it changes in different positions and how it had changed since we started the session. When she put me in what I recognized from my own reading to be a "Mckenzie" posture, she described what we were going to do, what the reasoning behind it was. When I asked about McGill's evidence that limited flexibility in the lumbar spine actually helped prevent lumbar injuries and my concern that the end range of motion required by Mckenzie's methods might not be helpful. She discussed it with me. She got down at my level (since I was facedown on the table) and we talked about it and was able to place different methods in context. When I left, she gave me her copy of Mckenzie's "Treat Your Own Back" for further study. A week later, when I had improved greatly but plateaued in my recovery, she admitted she could try only one other technique (lumbar flexion, after fastidiously avoiding any lumbar flexion for weeks priot) before reaching the limit of what she might have to offer me, but suggested others I might see if I wasn't improving when we next met. The lumbar flexion worked, despite being contraindicated by most of my symptons, and I'm on a generally positive slope of improvement again.

The important point is this: When you're dealing with anything important to you (health, life, family, even your job, maybe), you have to recognize what excellence is. What it looks like and sounds, how it behaves. How it fits into your broader understanding of life... And how it doesn't. Sorting the truth from the bullshit can make all the difference. Start by differentiating between students of truth and bullshitters.