Rehabilitation Medicine

Let me start with the most common misconception: Rotator cuff tears are very common, they aren’t always what’s causing the pain, and they don’t always require surgery. I wrote this for anyone whose shoulder hurts, who can’t lift their arm, or who’s been told after an exam that “your rotator cuff is torn” or “you have calcification in your shoulder.” What exactly is the rotator cuff? The bones in your shoulder are shaped a lot like a golf ball sitting on a tee: the ball is large, and the tee is shallow. ...

Let’s start with the most frequently asked, and most counter-intuitive, statement: As long as someone teaches the movements and an adult is supervising, elementary schoolers can do weight training, and it won’t stunt their growth. What really gets kids hurt isn’t lifting heavy things, but having no instruction, no supervision, starting too heavy, and progressing too fast. If even one of these four things slips, injuries happen; if you do all four, the injury rate is lower than many ball sports. ...

Let me start with the most common misunderstanding: De Quervain’s is not “weak wrists,” nor is it “sore muscles from holding a baby too long." Instead, it’s about two tendons at the base of your thumb. The tunnel they share gets narrow and thick, and the tendons can’t glide through. So resting makes it hurt less, but as soon as you go back to the original movement, the pain comes right back. It won’t resolve itself just because you sleep a few more days. ...

Let me start with something a lot of people don’t know: if you get an X-ray for heel pain and see a bone spur, that spur usually has nothing to do with your pain. One study looked at a thousand random foot X-rays. Thirteen percent had bone spurs, and of those, only 40 percent had ever experienced heel pain. Conversely, many people in agonizing pain have completely normal X-rays. So the spur isn’t the culprit. What’s actually hurting is the fascia attached to your heel bone, which has been repeatedly pulled until it developed micro-tears and degeneration. ...

Let me start with the one thing you need to remember most: osteoporosis has almost no symptoms before a fracture. It doesn’t ache, it doesn’t hurt, and it isn’t uncomfortable. The bones hollow out bit by bit. By the time you have symptoms, you’ve usually already crushed a vertebra just bending over to lift something, or fractured your hip slipping in the bathroom. So the phrase “I’m perfectly healthy, I don’t feel anything wrong” is completely useless when it comes to osteoporosis. ...

Let me open with a sentence that makes a lot of people relax: knee osteoarthritis is not a one-way street where the cartilage grinds away and that is the end of it. It is closer to an imbalance — the body’s rate of repairing the joint has fallen behind the rate of wear. That gap can be narrowed, and the things that narrow it happen to be the cheapest things on the list. ...

Let’s start with the most common misunderstanding: the place that hurts is usually not the place that’s broken. Almost everyone with a trigger finger points to their middle knuckle and says, “It gets stuck here.” But the real problem is at the base of the palm, that ring where the finger meets the palm. This is why the doctor presses your palm, not the spot you’re pointing at. This is written for those whose fingers get stuck in the morning, who feel pain when gripping things, or who have already been told they need an injection. ...

Let me say the most important thing first: when older folks walk slower, complain of being tired, and lose their strength, it’s not “just getting older." It has a name—frailty—it has clear diagnostic criteria, and the earlier you deal with it, the better you can stop it. I’m writing this for anyone with older relatives at home. What is frailty, exactly? Frailty isn’t a disease; it’s more like your body’s savings account running low. ...

At the sidelines of track meets, road races, and ball games, the most common accident isn’t a fracture. It’s someone collapsing. And the first question to ask on the scene isn’t “Are they dehydrated?” but “When did they collapse?" The answer to this question splits the situation into two different worlds: collapsing during the race, and collapsing after crossing the finish line. Collapsing during the race: Treat as the worst-case scenario first If a person suddenly falls to the ground while running, playing, or competing, and wasn’t hit by anything, the correct response is to first treat it as cardiac arrest: call for help, call an ambulance, grab an AED, and start CPR. ...

Let’s start with the most counterintuitive thing: when a kid collapses during hot weather exercise and their mental status is off, the right order is to cool them down on site first, then send them to the hospital. Not call an ambulance and figure it out on the way. The international consensus is blunt—cool first, transport second. Because what determines whether they suffer permanent damage isn’t how fast they get to the ER, but how long their body temperature stays above 40°C. ...