Archives for October 2013

Premature Celebration

To err is human…

When I look back at my own education and experience I often learned the most from my failures, mistakes, and complete embarrassments.  These struggles drive future success.  In the interest of admitting my mistake and hopefully someone else learning from it… here is my latest folly.

Premature Celebration

Bolt celebrates before the line in the 100m finals in Bejing.

Sometimes you get away with celebrating before the finish line (as Usain Bolt did in the Olympic 100m finals), but on occasion it shows you to be a classic fool.

As an avid sports fan I’ve witnessed others suffer from premature celebration with both excitement and ridicule.  Yesterday it was my turn.

I vividly remember Steve Tasker, (perhaps the greatest special teams player of his era, and perhaps the most impactful non-kicker or returner special teams player ever) chase down Leon Lett at the goal line in Super Bowl XXVII.  As a Buffalo Bills fan, I recall the devastation of the fumble, followed by the elation and finger-pointing  as Leon Lett carelessly celebrated from the 10 yard line to the 1 yard line where he was caught from behind and stripped by Tasker.  Premature Celebration = Failure(There was also the Thanksgiving Day slide for Mr. Lett, but that’s another story)

Again 2008 premature celebration struck. The promising young Philadelphia Eagles star DeSean Jackson catches a deep ball, runs ahead of the defense towards the goal line, and releases the ball in celebration at the 1 yard line, failing to score.  A spectacular 61 yard touch down reception and 6 points, erased by hubris.  I remember shaking my head, chalking this up to a rookie mistake, and hoping for a better future for #10.

In both cases, the excitement of the moment, the palpable sense of accomplishment, and certainty of success clouded judgement and action… resulting in heartbreaking and public failure.  Premature celebration is hazardous to your outcomes.

Yesterday I found out that I was Leon & DeSean, only the camera wasn’t on.  Admitting our own failures is humbling, but it is also where the best learning comes from.

I had a patient/recreational athlete who initial reported with a right shoulder injury, post swimming that had persisted for 10 weeks.  This was a chronic, recurrent problem in a very active adult.  We set out to resolve this and modified but didn’t limit activity level and were successful.  As the shoulder resolved, the patient explained she’d had 8-10 years worth of daily back pain and wondered if that too could improve.  While taking a deeper look we uncovered layer upon layer of dysfunction, compensation, and guarding that had protected her and allowed her to continue life and training for years.  With some guidance, her diligence and determination chipped away at these layers (and her shoulder remained functional and pain free).  We rebuilt her ability to breathe from the ground up, we rebalanced her orchestra of core muscles, we improved freedom at the ball & socket joints, and we challenged these things in progressively higher positions, with endurance, load, and speed.  In the end we had a human who was pain and injury free,  who could feel movements, muscles, and body positions that were previously unknown to her.  She was to attempt self-care and had a discharge exam scheduled  month later where we would see how she was doing.  At that follow up it was clear we had someone who had been training for 4 weeks with no issues doing things that were previously painful and some that were unimaginable.  In short, we started with little, had come a long way, and felt like we were in the end zone; but we weren’t.  At her discharge exam we assessed her progress and then spoke about what came next.  Her movements looked coordinated and strong, functional assessment was relatively clean, and her endurance was beyond good.  There was excitement in the room, there was optimism in our tone and words, and there was a sense that the world could now be conquered.  We spoke about the future, new goals, and further achievements.  We were both proud of her journey.

It took me a day or two to reflect and realize that perhaps the emotion of accomplishment was driving us a bit too far.  I remember a feeling of concern as I reflected, “too much too soon” was my fear.  In my detailed assessment of physical measures (movement, muscle activation/tone, joint ROM, functional abilities, etc) I had failed to realize that this biomechanical model was insufficient.  I was dealing with a human; emotion, psychology, and other psychosocial factors play a role — and in this case an important role.  There are two types of patients; those who need prodding and motivation, and those who need restraint and guidelines.  My patient fell into the later category.  I knew this about her, but failed to address it at her discharge.  My excitement for her and pride in how far we’d come caused me to overlook discussion of graded exposure, pacing, and appropriate advances in training loads.  I sat thinking about this possibility but I didn’t act.

Then it hit me like a ton of bricks.  A week after discharge I was getting an urgent visit call from this patient.  We took the ball to the one yard line, but failed at the last moment.  Our beautiful play had turned into a tragic recurrence.  We will pick up the pieces and try to win the game (as they Eagles did after DeSean’s performance), but this bitter pill will serve as a reminder.  Knowing your patients, understanding their mindset, and preparing them for the future is just as important as assessing their function.