Availability Error

The Danger of Assumptions

By Douglas Nelson
[Table Lessons]

“You’re kidding! Seven?” I remarked with astonishment. 

“Yep, seven softball games in one day,” Mr. H. replied with pride. 

“How the heck does that happen?” I asked. “Is this the softball version of a marathon? Court-ordered punishment?” 

“No,” Mr. H. laughed. “Just a big tournament with a bunch of old guys. Most of us come from great distances, so we have to play all the games in one weekend.”

“Was there a specific incident at a game that initiated your left-thigh pain?”

“I was running the bases, trying to stretch a single into a double, when I tweaked my right ankle pretty seriously. I was able to run on it, or perhaps I should say limp on it, for the rest of that game. Unfortunately, that was game five and we had two more to play. By the end of game seven, I felt this pain in my thigh. It disappeared after a few days, but resurfaced with a vengeance later.” 

I just stared at Mr. H., trying to process these details without getting distracted by the fact that this guy is 67 and can kick my butt from here to Maine and back again.

“What happens if you lift your leg? Any pain when you do that?” I queried. 

As Mr. H. lifted his leg (hip flexion with no knee extension), I happened to put my hand over the rectus femoris muscle belly. What I felt was a remarkable protrusion of muscle tissue right at the muscle belly. I have seldom felt such a pronounced muscle projection as this. My first thought was of several clients who have torn the long head of their bicep: the torn muscle retracts it, leaving the person with what looks like a massive Popeye-style bicep. Outlining the muscle projection with my fingers, I knew I was on to something big. 

“Is this painful?” I asked, knowing that it would be.

“Nope,” Mr. H. replied with indifference. 

Pressing harder, right into the epicenter of the muscle bulge, I asked Mr. H. again if my pressure created discomfort. (How’s that for trying to make myself right?)

“Nope, not at all,” he responded. 

I looked at him with confusion. “It is thigh pain we are addressing?” 

“Yes, it really hurts sometimes. My sleep is quite often interrupted.”

“Does your thigh hurt during activity?” I asked. 

“No, I do wind sprints and distance runs without any pain at all. If I do leg extensions on a machine, there is no pain during that exercise either. The only time my leg hurts is at rest.”

Why in the world could he run with no pain if the problem is a tear in his rectus femoris muscle? That is exactly when I had my “aha” moment, realizing I was incorrectly looking at this entire problem. There is a principle in logic called availability error; the tendency to choose the most obvious answer using the information that is most available to us. The explanations readily available to us can be recent examples of other people with similar symptoms, or something attention-getting—in this case, the big muscle bulge that preoccupied me. The moment I felt the bulge, I assumed, whatever his pain, that a tear had to be part of the problem. In essence, I wanted the problem to fit my answer, instead of the other way around. I decided to start over, taking the tear totally out of the equation. 

“Is your leg in pain now, just resting on the table?” 

“No. As long as I am on my back, my leg is fine. What really sets it off is if I turn to lie on that side. Lying on it can create pain that lasts for hours.”

“How about this muscle? Is this sensitive?” I asked, pressing into his vastus lateralis. Mr. H. just about levitated off the table. “I’ll take that as a yes,” I quipped. 

“Holy cow! I can’t believe how painful that is,” Mr. H. exclaimed with a strangely satisfied tone of voice. Interestingly, I could see that he was happy to have someone validate his pain. My pressure recreated his mysterious pain, something that no one else, even he, had done previously. Even Mr. H. had assumed the bulge was the source of his problem. 

For the next 20 minutes I treated his vastus lateralis, gluteus medius and minimus, and tensor fasciae latae slowly and methodically. The tenderness abated substantially, and he volunteered to be diligent about stretching his thigh over the next few days.

I called Mr. H. about a week later to check his progress. His leg had seldom hurt, and he even awakened to find himself lying on his left side. “What about the lump,” he asked. “Will it go away?”

“Perhaps a better question is: should you care?” I responded. 

“If the pain is gone, I guess not,” he admitted. 

Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars and president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois. His clinic, seminars, and research endeavors explore the science behind this work. Visit www.nmtmidwest.com or email him at doug@nmtmidwest.com.

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