Since the end of last year, I’ve been walking around with a swollen knee. At the start, it wasn’t interfering with my range of motion or causing pain.
I consulted with a few different physical therapists, a specialist in functional movement and kinesiology, and an athletic trainer.
I tried to address the inflammation through rest, ice, heat, compression, and elevation. In the gym, I lightened my loads, did corrective exercises, more mobility, activation drills. I rolled it out. I used vibration.
I tried lymphatic drainage and massage.
Over the past few months I’ve consulted with two physical therapists, an athletic trainer, a functional movement specialist/kinesiologist, three different orthopedists, a primary care physician, an interventional radiologist, and a hematologist.
I’ve had the knee drained 3 times; each time it was pooled with blood, not inflammatory fluid. I’ve had X-rays, an MRI, and a full panel of blood work done.
My knee was immobilized for 3 weeks, which created a chain of compensation problems. It’s been two months since I ended immobilization. I still don’t have full range of motion and I’m no closer to a resolution — or even a coherent diagnosis.
The Lenses of Specialists
Every specialist I’ve seen is at the top of their field, highly rated, respected, and recommended.
One of the problems, however, is that (with the exception of the PCP) they are all specialists.
Each is looking at the problem through the lens of their specialty. And, for the most part, they are all looking only at my knee, because that’s the obvious source of the issue.
For the orthopedists, the lens is surgical. After two aspirations, the first doctor said that surgery was my only option.
Although I mentioned to each orthopedist that I had hip pain before the knee swelling, two of the orthopedists didn’t even evaluate my movements or test muscle function. The third at least did some passive tests, but wondered why I was seeing him if I didn’t want surgery.
None of the three orthopedists I went to actually watched me move on my own to evaluate my movement patterns. Their entire evaluations and recommendations were based on looking at my knee. None of them seemed concerned with determining what had caused the issue. If I didn’t want to be cut open, they had little time or patience for me.
The interventional radiologist was at least curious — probably a trait useful in a specialty that involves using a micro camera to explore the blood vessels. Although he looked at the issue through the lens of the specific procedure he does, he was open to the possibility that the hematologist could have a non-invasive solution.
The hematologist looked at the issue through the lens of my blood, and whether a previously-diagnosed bleeding disorder could be contributing to the issue. Like the other doctors, she was less concerned about identifying the cause.
The physical therapists, athletic trainer, and kinesiologist at least looked at my movement function, range of motion, and exercises that might strengthen the weak spots in the kinetic chain. They at least tried to identify movement patterns that might have contributed to the problem. For them, it is purely a biomechanical issue.
The Pitfalls of Specialization
There is no question that all of these perspectives are useful.
Each lens is a different window into the issue. None is “right” or “wrong.”
In fact, what’s going on with my knee probably requires a combination of these various perspectives — and others.
And therein lies the problem:
Each professional on my expanding “care team” is operating in their own silo.
Even within a system where most of the doctors can see the test results from tests other doctors performed and read other doctors’ notes, each specialist is looking at the issue through their distinct lens.
Each is looking at their part, but nobody is looking at the whole.
Each is looking at what they can see, but nobody is looking at what they cannot see.
What Nobody is Looking At
It’s well-established that stress can impact immune response and create chemical changes in the blood, such as levels of cortisol and clotting agents.
Yet none of the practitioners has asked me about other issues in my life that might be causing stress — and perhaps exacerbating the issue.
Nearly every practitioner has been quick to attribute the issue to some sort of physical movement thing “I must have done” in the course of my active lifestyle: kneeling during yoga or other workouts, lifting heavy loads, or moving with dysfunctional movement patterns.
To be sure, I probably spend more time than many people in focused physical activity. But, like most people, the vast majority of my time I spend using my body is spent outside those dedicated “workout” environments.
As I often point out to my clients and yoga students, you use your body beyond the hour you spend exercising or doing yoga.
Yet nobody has asked me about how I use my body outside the gym or yoga studio.
Nobody has considered whether the vast amounts of driving I do might have created a repetitive stress on my right knee—even though that’s the leg that controls the brake and gas pedals in a car.
Nobody has questioned the amount of time I spend sitting at a table or desk at a computer.
Nobody has asked about my sleep positions.
Nobody has asked about life stressors, support networks, relationship issues, or other social and emotional factors that can contribute to inflammation and biochemical changes.
And nobody has considered what impact perimenopause and its associated hormone changes might have on my movement patterns, ligaments, tendons, or the structure of my blood vessels.
The Inefficiency of Specialization
Over the past couple of decades, there’s been a push to specialization in every industry: lawyers, doctors, coaches, trainers, marketers, bankers, even production plants.
People who don’t specialize are generally dismissed as unfocused and less serious.
Specialization is viewed as the holy grail of efficiency.
In a team environment, the theory is that if you put a group of specialists together you’ll cover all your bases.
There’s no debate that specialization can be helpful to creating deep expertise. For example, if it turns out I do need surgery, I want the best knee surgeon—not a great general surgeon.
But the benefits of specialization are limited.
The best knee surgeon isn’t useful when I want to diagnose an issue or if I want to avoid surgery.
A Fragmented View
When specialists are confined to their silos, what they see is fragmented.
The body is a system of systems. The whole is more than just the sum of its parts. It includes the visible and the invisible.
What my care “team” is lacking is a “specialist” trained in the big picture.
As a result, after months of seeing doctors, I have lots of opinions, but I’m no closer to a resolution or even a coherent diagnosis.
That’s inefficient, ineffective, and frustrating.
When Specialization Can Be Effective
To reap the benefits of specialization, we need people who exist outside the silos. People who can
- look beyond one body part, organ, or system to see the entire network;
- convey and translate information across the specialization silos;
- integrate the biomechanical, biochemical, social, emotional, and psychological factors that might be at play.
Without a generalist who can view the situation holistically, specialization is inefficient and ineffective.
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