Referred Pain - But it's my KNEE!! - the perception tells lies!

Damned69

I am a retired Hypnotherapist, so I know a thing or two about the mind - one of the most interesting facts being that your perception can lie to you - remember the phenomenon of "is the dress white and gold or black and blue?"? I was one of those who would have sworn in blood that it was white and gold, until it was proved to me that it was in fact black and blue - yet my perception continued to lie to me!! I still only see white and gold to this day. Many an optical illusion, including all those pitchside adverts on sports fields that look 3D, exploit these limitations in our perception.

Yet despite knowing all this full well, I was completely unprepared for my perception lying to me so spectacularly when my hip cartilage started to crumble. It was around February that I thought I had sprained two cartilages - one in my thigh and the other in my knee - or was it sciatica? Or all of them?

For the next month or two I struggled on thinking a knee and thigh brace would help - but they didn't! More curious was which part of my leg hurt - it shifted continuously. And it was getting worse!

Finally once Covid restrictions were eased to allow indoor non-essential consultations, I immediately sought out a Physio - I didn't want to wait around for months on the GP just to be seen. I knew exactly what I wanted - to have the problem diagnosed and a treatment plan to fix it.

Physio 1 said the problem was a weak hip, which was affecting my knee, and prescribed the exercises to strengthen it. In the coming days, I decided that I just didn't buy it. My knee was in AGONY and to me that was the prime issue. I fired off a somewhat terse e-mail accusing him of being fixated on one thing and ignoring the other. Physio 1 referred me to Physio 2. Physio 2 gave me the most astonishing demo. He pummeled and wiggled that knee for all it was worth and got no pain response at all! A few tugs of the thigh revealed a hip in trouble. He showed me a diagram of all the areas a hip can refer pain to, and guess what, that's where I hurt!

I had been clearly shown, beyond reasonable doubt, that my perception was being blatantly lied to because of the way nerves are wired. Interestingly enough, I found a similar article making the same point somewhat tucked away on this fair site - all rather after the event. Of course then Physio 2 dropped his bombshell life-changing diagnosis - that the root cause was osteoarthritis of the hip. ****. And Double ****.

My experience makes me wonder how many poor s*ds have gone to the GP complaining of knee and miscellaneous leg pain, months of investigation revealing nothing, when all along their hip was gradually disintegrating. Someone needs to shout from the rooftops that KNEE PAIN MIGHT BE ACTUALLY COMING FROM THE HIP!! Every GP, chiropractor, osteopath and orthopaedic consultant needs this fact burned into their brain.

Oh btw the dress - on average 57% will see this dress as its true colours of blue and black; 30% as white and gold; 11% as blue and brown; and 10% will see between any of the colour combinations. Less than 1% will see it as blue and gold. Women and older people disproportionately see the dress as white and gold.

Lilymary

I’ve always gone to my physio for joint/muscle/nerve pain , and only go to the GP, with a letter from my physio, if drugs are needed or further investigation such as X-ray. This doesn’t always work. One time, many years ago I took a note from my physio saying I needed prescription anti-inflammatories and omeprazole to stop my stomach eating itself. I was seen by a young random GP in the practice who offered a prescription for cocodamol. I said “that’s not an anti-inflammatory is it”. She agreed. I patiently explained an anti-inflammatory had been recommended by said physio because of inflammation of the soft tissues. And then had to explain why I would also need the omeprazole as I am prone to acid stomach. She very grudgingly gave me what was required. I can only assume she'd slept through that particular lecture on analgesics vs anti-inflammatories, or she had a total lack of faith in physios.

Even with my lovely GP, my favourite of all time (to the point that when she left the practice to join another, I seriously thought about moving house, but then also realised that couldn’t be seen as stalking)... anyway, even my lovely GP rejected the first recommendation from my physio for an X-ray to see what was going on in my hip, on the basis that “there is no treatment for wear and tear”. It was only when I turned up in surgery with mobility in my hip reduced to around 40% (even less laterally) that she agreed it was time to X-ray, by which time the damage was so bad I was put straight on the list for a new hip.

So my point is, some physios do “get“ referred pain, but some GPs don’t “get” pain at all, referred or otherwise

(And the dress is white, bordering on very pale blue, and gold, don't let anyone tell you otherwise ! 😅)

Damned69

I agree absolutely about GPs - at critical care, the NHS is the best in in the world, but at CHRONIC care, it is in my experience a pile of ****. You have by necessity become far more knowledgeable about your condition than your GP ever will be, for they are also by necessity jack of all trades and master of none, and far more attuned to killer conditions than debilitating ones. I have however generally found that if you're the pushy type who clearly won't take no for an answer, and are prepared to stir up all manner of **** if you don't get the answer you want, they'll give you that drug/referral whatever you need just to get you out of their consulting room. Example: after being bitten by a mouse, missus went to the GP for a tetanus jab. "We don't normally give out tetanus jabs for such things" said the nurse. "I WANT IT PLEASE!" said Missus. She got the jab.

Lilymary

Self advocacy. It makes an enormous difference. The medical profession are acutely aware of this, that those who can state their case most effectively get the best treatment, and those who quietly sit and wait or don’t know what to ask for can get overlooked. But if people don’t put themselves forward, and clearly state their problem (and for many just going to the doc at all is an intimidating process), how are they going to know?

Add to the mix that each body they are presented with is so individual, there are so many variables imposed throughout our lives on bodies that probably weren’t equal even from the date of birth, that it’s both a matter of luck as much as professional judgement and experience that they hit on the right diagnosis. In my consultations I probably overload them, albeit succinctly, with case history, as the bit you inadvertently leave out may be the vital clue. I know this from my own work. (I’m not a medic, but my work involves a lot of forensic fact gathering and analysis, and asking of seemingly daft questions). So our health care workers are really up against it from the moment we walk in, and I try to make it a team effort. Sometimes this may involve being politely persistent, particularly for referrals to the right specialist to take your case further, which I've found usually works. Sometimes I think the GPs are happy to do this as it gets you off their desk, so to speak, but then they have Regional Health Care Trust budgets to consider, so it’s not always in their control.

I try to avoid being demanding with a health care worker, as it can backfire badly. The only time I’ve ever had to go on the offensive was when the tactlessness of a clearly bored specialist (not an orthopod) left me in tears after a bizarre consultation, and I’m not the weepy type. I got an apology from the hospital, and I hope he cleaned up his patient-handling skills thereafter.

( Ps, I go for tetanus top-up jabs routinely, usually associated with travel to third world countries, and also because of my job. I wonder whether the policy for doling them out varies between practices/health care trusts?)

Damned69

Your conciliatory tone is commendable and I wouldn't diss it for a moment. I fear that personally I am aggressively cynical and believe that professional relationships are about different agendas that aren't always on the same page. If I get official resistance, rudeness or incompetence, I'm going to wave my metaphorical club in the air and make it quite clear I've no scruples about wielding it. Give me my way or expect grief - that's how things get done. However there's a Yin to my Yang - I'm reasonable in my demands and gushingly appreciative when I'm helped.