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Should you always believe your doctor?

By Jennifer Sage On December 6, 2011 Under Form and Technique, Medical

I’ve been confronted with this dilemma on several occasions in the past, and I’m curious if anyone else has as well. A woman was in my SpinningĀ® class quite a few years ago and her saddle was way too low, to the point of being dangerous to the knees. I’d never seen her before, and I never saw her after, but this was a club that had hotel guests in classes (in a ski resort).

I asked her if I could raise her saddle for her, explaining that it would improve her comfort and her experience, as well as protect her knees. She said, “Oh no, my doctor wants me riding here. I have really bad knees.”

After I picked up my jaw, I explained that I had had knee surgery myself, and that as a personal trainer with clients with bad knees, I worked closely with some physical therapists, and riding with the saddle too low was actually much worse for the knees because it increased the pressure in the knee joint. She refused, assuring me this was where her doctor wanted her to be. Since it was at least 8 years ago, I don’t remember if I said anything more (I probably wanted to say something like, “well, you obviously don’t have one of the world-renowned orthopedic doctors we have here in Vail as your doctor, because none of them would be stupid enough to give you that kind of advice”). I might have asked her how he would know this bike.

Whatever happened, this was one of those situations where you just leave them to their (silly) decisions.

Whenever anyone I know who is a cyclist or skier or other kind of endurance athlete has to make a decision about an injury or surgery, the advice I give them (if they ask, of course!) is to make sure they talk to more than one doctor, and also to make sure their doctor is an athlete or works a lot with athletes. Athletes have specific needs, even just the recreational ones – this advice isn’t limited to “elite” athletes – and very few doctors that I’ve come across really understand the needs of people who NEED to move and WANT to be healthy.

I’m actually more likely to believe the physical therapists I know than the doctors who would rather do surgery on everyone.

I am lucky to live in such an athletic town, where virtually all of the medical personnel here, doctors, nurses, physical therapists, etc, are active and/or they deal with very active people on a daily basis. But I know that isn’t the case everywhere.

I came across this blog post by Alfonso the Angry Trainer, which asks this very same question. I follow Alfonso’s blog quite closely – he’s another “Fitness Myth Buster” (like James Fell). He HATES the bad advice people are given in the fitness industry. He received a letter from a woman who wanted to train with him but her doctor told her to do different things than Alfonso recommends. His response was correct, and obviously he was biting his tongue a bit, but the advice this woman received from her doctor was so dated and inappropriate compared to what we now know to be true in the world of fitness.

Alfonso and I both agree that most doctors are specialists in “disease”. Their focus is more on taking you from a diseased or injured state to a normal state, rather than from a normal existence to a healthy, vibrant and fit existence. For the latter, I would trust a well educated and experienced personal trainer, especially one who has worked closely with the medical community, more than I would the average doctor who hasn’t been educated on fitness and training. Of course, if someone has a medical condition that needs supervision, then without a doubt the doctor’s advice must be followed (see, like Alfonso I must add this statement in to cover my you-know-what so no one can claim I’m giving medical advice!) But make sure it’s appropriate, not like the woman sitting with her knees to her chest in my Spinning class sticking dangerously to her dumb doctor’s advice. (Which to be honest, I bet she had no idea how high he told her to put the saddle.)

The perfect world is to find an athletic, fit doctor who follows and understands current training methods!

Has anyone else encountered a situation like this?

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7 Comments Add yours

  1. Darlene
    December 8, 2011
    3:35 am #comment-1

    Jennifer,

    Yes I’ve encountered a situation very similar to yours – and this person was also an ‘older’
    woman – a very vivacious and humorous one!! – and insisted that her seat position was in the correct one for her:
    Her Fore/Aft was SO far forward that her knees were in her chin! No, seriously, I also had
    to pickup my jaw when I saw how she was seated but when I approached her and asked her about her it she told me it was FINE for her and that she has ‘bad knees’. She also said that
    this position on the bike prevented her from the pain she might feel afterwards (arthritis, she
    said).

    I can’ t remember if her doctor advised this for her but I, too, agree with your thoughts about
    MDs and Physical Therapists. It is far better to seek multiple opinions rather than rely on
    just one when it comes to our health. However, if someone insists that a peculiar position
    prevents pain then it would be logical to assume that over time, the weird position might
    return? I guess if both of our ladies are STILL riding like that…and it prevents pain for them…
    then go figure. ?

    Jennifer there is a website I’d love for you to look at: you’ll get a kick! (I promise):
    Bike2theBeat, Orange County, California. Check out the website “tour”.

    Happy Holidays!
    – d

  2. Andrea
    December 8, 2011
    4:41 am #comment-2

    I recently had a similar problem during my pregnancy. I could not get a satisfactory answer from my primary care doctor or OB/GYN group as to how to approach my training intensity while pregnant. I had to do lots of research and go with my gut instinct. I taught classes up until 36 weeks, and excercised up until my due date. I probably would have been able to teach up until 40 weeks but was fearful of having an embarrassing situation while in class. In case you are wondering my baby was very healthy and turned out to be 9lbs 13oz! I think your article hit the nail on the head when it stated doctors are most accustomed to treating disease, it is difficult to get performance advice from them. The only thing, I can say is if your doctor is out of shape or not into fitness themselves, you may want a second opinion. šŸ˜‰

  3. Lorie Bickford
    December 8, 2011
    6:31 am #comment-3

    This is why I am sooooooo happy to have a young, healthy, female doctor who also cycles!! She really listens and “gets” that my physical fitness and vitality is paramount to my lifestyle and my livelihood!! It helps that our HMO focuses on preventative care and their motto is that the want their patients not to just survive, but to thrive! I know that I am fortunate because not all health plans have that kind of focus.

    I agree wholeheartedly with Jennifer that as fitness professionals we should work closely with physical therapists and trainers who have medical backgrounds to be sure that what we recommend (not giving medical advice of course since we don’t have MDs after our names) but answering practical questions from our students, is safe, sound and up to date!! I just sigh when students come to my classes with their first heartrate monitor and tell me their doctor or their personal trainer told them to figure their heart rate zones using 220 minus their age.

    And I agree with Andrea that you must often do some homework on your own and definitely seek out other opinions if you aren’t getting answers to your questions regarding your health and performance.

    Once again Jennifer you bring up very important considerations. Thanks for the blog suggestions I’ll be checking those out!!

  4. Paul Whittingham
    December 8, 2011
    2:07 pm #comment-4

    Not directly linked to the subject but maybe a useful motivator for someone.
    When I was 18 I had an operation for a knee injury – probably caused from playing to much soccer in my mid teens – whereby a small piece of bone/cartilage becomes damaged and can come adrift from the knee joint – I believe the condition is called Osteochondritis Dissecans. I understand that… although rare, it is an important cause of joint pain in physically active adolescents.
    Anyway after the successful operation the surgeon informed my parents that I must ensure that I keep my quads strong particularly in that leg – which I have tried to do ever since. He also added that I would have a severe limp and have to use a walking stick by the time I was 40.
    I have been fairly active all my life since, rugby, running and now just some circuits, cycling and Spinning. This year I became a part-time Spinning Instructor.
    No limp – so no walking stick required (yet) and apart from the odd twinge if I twist suddenly, all is still working fine. I’m now 60 and intend to keep cycling until the grim reaper comes to get me.

  5. Carole
    December 9, 2011
    4:14 am #comment-5

    I had a similar situation with a female rider. She had so much resistance on her bike that her RPM was around 40. Her legs were barely moving. I cued all the standards of about good form and technique but she didn’t respond. I got off my bike and worked my way to her and urged her to release the tension and work on a smooth pedal stroke. She snapped that she had sciatica and her Dr. told her to ride with lots of resistance. WHAT? I told her I couldn’t imagine any one advising to ride that way. Needless to say, she continued to do her on thing throughout the class that day but has not been back. Some of the time, I think what the Dr. says and what the patient hears are two different things.

  6. Jennifer Sage
    December 16, 2011
    9:46 pm #comment-6

    Great responses. Carole, you hit the nail on the head. I think that what the Dr says and what they hear ARE two different things. In your example, maybe her doctor actually did know what he was talking about in terms of indoor cycling and was probably thinking of the all-too-often scenario where people ride with little to no resistance at up to 140rpm and are therefore bouncing around in the saddle – not good at all for sciatica (or anything). Resistance in her case IS a good thing. BUT, you and I both know that resistance is relative. She should add enough to keep her cadence at 60-90-ish rpm, maybe not go above 80-85rpm if he really meant “heavier” resistance on average. She went off the deep end and will therefore pay the price with her other soft tissue and joints.

    I am seeing a doctor right now for low back issues. Actually, he’s a DO – an osteopath who shuns surgery unless absolutely necessary. He referred me to a fantastic physical therapist who specializes in movement therapy (I must increase my hip mobility to take stress off my low back – a result of sitting and writing too much these days!!). He said, “she is an expert at this, I know you will love what she is doing. She really knows her stuff and is great at working with athletes of all kinds.” Oh how I love humble doctors like this who respect the knowledge and experience of others!

    I think I need to write a blog post about the other end of the spectrum – cases when an instructor should admit something is beyond his/her scope and refer the student to a doctor or PT.

  7. Barry Edwards
    March 3, 2014
    5:51 am #comment-7

    I agree wholeheartedly with this. I am a Physiotherapist who keeps very fit through cycling, core and weights and is actually a part time fitness instructor who teache indorr cycling, Boxercise and Step. I look at patients from a movement impairment view, in that whatever the pain they present with I look to see what is causing it and change the way the body moves for example some presenting with knee pain may just have weaknees in the outer hip and tightness of the ITB which is causing abnormal loading of the joint. I would then release the tightness and give exercises to strengthen the weakness. I would also look at exercises technique whether spin or weights and give advice on changing position or lifting technique. I have developed a good relationship with local Orthopaedic Specialists who now refer to me for corrective work rather than go straight for Surgery. I feel it is useful for Instructors to seek out a good Physio, Osteo etc and refer injred clients to them and as a result they are more likely to trust you with more of their patients in the future. I have treated many people with disc problems and got them back into exercise pain free both at recreational and elite level just by showing them how to load the body correctly.

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