The book Explain Pain is wonderfully rendered, with pictures that are fancifully distorted with illustrations that remain identifiable throughout, but with a purposeful abstraction to the “people” portrayed in the book. I understood why this conscious choice was made by the authors, but I had an opportunity to see a real-life example myself last week…
I was working with a patient, encouraging her to move her knee as far as she could comfortably after a total knee replacement, actively in supine. I was later explaining to her the concept of active insufficiency and showed her how much active knee flexion range of motion I had in standing.
I grabbed my foot. With my foot in my hand, I pulled my heel toward my buttock and she gasped. I quickly looked in her direction (I had been looking at my own leg) to see her baring her teeth with a tortured expression.
Later that evening she experienced the most agonizing pain (6 weeks post op) that she had experienced since the day after her surgery.
Coincidence? Perhaps, but next time I will demonstrate the concept with an uninvolved finger. You know, just in case.