The Knee Was Never the Story
“Begin with the person, and end with the problem”
-Scott Livingston
I’ve spoken recently about beginning a new chapter as Head of Reconditioning at Cirque du Soleil. It has been an incredible first month. Every day has stretched my thinking, reinforced things I’ve come to believe through a lifetime of discovery, and at the same time pushed me to question, revise, and rethink ideas I thought I understood reasonably well.
One of the things I have always loved about this profession is that, if you remain curious, it never stops teaching you. Experience doesn’t provide certainty. If anything, it teaches you to become more comfortable with uncertainty. The longer I do this work, the more I realize that every answer simply opens the door to a better question.
This new chapter has also taken me back for a moment.
I found myself thinking about my early years with B2Ten and one Olympic athlete in particular. Even now, nearly twenty years later, I still think about that project whenever someone presents with what appears to be an obvious problem.
He was an elite alpine skier, almost ten years into an extraordinary career, contemplating retirement because of debilitating back pain. Everyone’s attention was understandably fixed on the lumbar spine. The MRI showed a disc herniation. His hip constantly needed to be released. Every intervention seemed to revolve around where the pain lived.
But the back was the distraction.
The real story had begun years earlier with an ACL injury. Quietly, almost imperceptibly, his nervous system had learned to unload a knee that no longer felt completely trustworthy. Over time it became remarkably efficient at shifting load elsewhere, and eventually the spine became the place that paid the price.
Once we clarified the map and helped his nervous system rebuild confidence in the knee, the back pain slowly began to settle. What followed wasn’t simply the resolution of symptoms, but the much longer process of restoring everything that years of protection had quietly taken away. Only then could we truly begin rebuilding the athlete.
I didn’t fully appreciate it then, but looking back now, that project became one of the first lessons that would eventually shape what Jaime and I came to call Reconditioning.
Here I am, nearly two decades later, surrounded once again by remarkable performers whose bodies have spent years solving extraordinarily difficult movement problems.
Almost immediately, I inherited four complex cases. Three artists with significant patellar tendinopathy and another with a substantial articular cartilage deficit in the knee. On the surface they appeared remarkably similar. Four injured knees. Four artists unable to perform at the level they expected of themselves.
It didn’t take long to realize they had almost nothing in common.
Each artist carried a completely different history of trauma, surgery, previous interventions, movement strategies, compensation, success, disappointment, and recovery. For every one of them, the knee wasn’t the beginning of the story. It was simply the latest chapter in one that had been unfolding for years.
As I inherited these projects, I found myself doing what experience has taught me to do.
Slow down.
Become curious before becoming clever.
Resist the temptation to solve the obvious problem before understanding it.
Every previous injury had left its mark. Every surgery had altered more than tissue. Every previous attempt to solve the problem had influenced the way each artist now moved, loaded, and interpreted their own body.
The deeper I looked, the more one idea continued to present itself.
The knee was always the subject matter.
The knee was never the story.
That simple observation probably sits at the very centre of what Reconditioning has become.
Thirty-eight years ago, I believed reconditioning was about treating injured tissue.
Twenty years ago, I believed it was about correcting the mechanics.
Today, I believe it’s about understanding why a beautifully intelligent nervous system concluded that protection was the best available solution.
That isn’t to say tissue doesn’t matter. It absolutely does. Mechanics matter. Strength matters. Capacity matters. Biology matters. They all matter.
What has changed over the years is not what I value.
It’s the size of the lens through which I view the problem.
One of the unexpected consequences of that larger lens has been humility. Earlier in my career, I found myself searching for certainty. Today, I’m much more comfortable with questions. I’ve become less interested in proving myself right and far more interested in understanding why this particular human being has adapted the way they have. That shift has probably made me a better practitioner than any certification or technique I have ever learned.
A recent conversation on the Leave Your Mark Podcast with my good friend and applied neurology practitioner Matt Bush reinforced something I have slowly come to appreciate over the better part of my career.
The nervous system isn’t passively receiving information from the world around us.
It is continuously interpreting it.
Every movement we make. Every visual cue. Every sensation from our joints and muscles. Every previous injury. Every success. Every disappointment. Every night’s sleep. Every stressful day. Every conversation with a practitioner. Every explanation we receive about our condition becomes information that the nervous system must somehow organize into a coherent understanding of the world.
Beneath all of that complexity, I have come to believe there is one remarkably simple question it continues to ask.
Am I safe?
Not, Can I move?
Not, Can I become stronger?
Not even, Is my knee damaged?
Simply…
Am I safe enough to do what is being asked of me?
I often say that the body will not access what it doesn’t know, or perceives as unsafe.
Over the years, that simple statement has become less of a teaching point and more of a clinical observation.
I see it every single day.
Shortly before arriving at Cirque, I spent time with one of the world’s best Brazilian Jiu-Jitsu athletes who had been struggling with persistent back pain. We spent our first session talking very little about her back. Instead, we explored her history, her schedule, her stress, her recovery habits, the demands of competition, and the realities of trying to perform at the highest level while navigating everything else life was asking of her.
Only then did we begin talking about the pain.
That session reminded me of something I have come to believe very deeply.
Begin with the person, and end with the problem.
Not the other way around.
I don’t think we spend nearly enough time understanding the life that surrounds the injury. Sleep. Relationships. Work. Fear. Expectations. Previous experiences. Confidence. None of those things appear on an MRI, yet every one of them changes the way a nervous system interprets the world around it.
Our physiological and psychological state changes everything.
A tired nervous system doesn’t interpret movement the same way as a rested one.
A fearful nervous system doesn’t explore options the same way as a confident one.
A stressed nervous system doesn’t perceive opportunity the same way as a calm one.
State drives interpretation.
Interpretation constrains options.
Recognizing the controllable elements in someone’s life may be one of the most important interventions we make before we prescribe a single exercise.
The body doesn’t become protective because it is flawed.
It becomes protective because protection is one of the most intelligent things the nervous system can do.
Long before we consciously appreciate a potential problem, the nervous system is already predicting what might happen next based upon everything it has learned throughout our lives.
Those predictions influence how we move, how much force we produce, how confidently we load a limb, how much pain we experience, and ultimately what options the body believes are available.
Once we begin to appreciate that, something important changes.
We stop asking only, “What’s wrong with the knee?”
Instead, we begin asking, “Why did this nervous system conclude this was the safest solution available?”
Those are profoundly different questions.
One of the artists I’m currently working with ruptured her ACL years ago, which was repaired with a patellar tendon graft. She later sustained an Achilles tear. Now she presents with patellar tendinopathy. All on the same side of the body. Coincidence?
Another has patellar tendinopathy on one side, but strangely enough, a previous opposite ankle fracture repaired surgically, followed by a patellar tendinopathy and a chondral deficit in the same-side knee. What’s the real problem?
If all I see is today’s diagnosis, I miss the story entirely.
Their bodies have spent years adapting.
Some of those adaptations served them brilliantly. Others gradually became less useful as new demands were placed upon them. None of them were mistakes. They were intelligent solutions to the problems each nervous system believed it needed to solve at the time.
That realization has probably changed my practice more than any technique I have ever learned.
It has made me slower to judge movement, less interested in labelling compensations as “bad,” and far more interested in understanding why they emerged in the first place.
Every compensation tells a story.
Every protective strategy has a history.
Every movement pattern reflects an ongoing conversation between a human being and the world they have experienced.
It has also changed the way I think about every intervention we provide.
Every intervention is information.
Manual therapy is information. Exercise is information. Balance training is information. Vision training is information. The conversations we have are information. The explanations we provide are information. Even the confidence we communicate as practitioners becomes information.
Whether we appreciate it or not, the nervous system is listening to all of it.
Our responsibility isn’t simply to prescribe the right exercise or apply the right technique. It is to provide information that helps the nervous system become more confident in the choices it makes.
When that happens, movement often changes.
Pain often changes.
Performance often changes.
Not because we overpowered the body, but because we helped it arrive at a different conclusion.
The longer I do this work, the less interested I become in chasing injuries.
I’m far more fascinated by the extraordinary intelligence of human adaptation.
Every compensation tells a story.
Every protective strategy once served a purpose.
Every movement pattern reflects a nervous system doing its very best with the information available to it.
Our responsibility isn’t to fight that intelligence.
It’s to understand it.
Then, patiently and respectfully, provide better information.
Because when the nervous system begins to perceive the world differently, it often begins to move differently.
And when movement changes, everything else has the opportunity to change with it.
Perhaps that has been the lesson quietly waiting for me all along.
The artists arrived with injured knees.
But the knees were never the story.
The story has always been about the remarkable human beings adapting beneath them.
And perhaps that is what Reconditioning has really been about all along.
