Doing it is not the same as affording it

Plenty of people with altered mechanics do everything asked of them and pay for it privately, in recovery time, in evenings written off, in things quietly dropped. That is success by any external measure and it may not be sustainable. Six questions to find out which version you are running.

Written by Heath, who has lived it: casts from birth, a fusion at sixteen, the US Army, and distance running.

What does your function actually cost?

Six questions about the bill instead of the performance. Answer for an ordinary month.

Recovery after a demanding day

A long day on your feet, a big walk, a hard session. How long until you are back to baseline?

How long?

Things you have stopped doing

Not because you lost interest. Because of what they cost afterwards.

How many?

Pain in an ordinary week

Not your worst week. A normal one, doing what you usually do.

How often?

Planning around it

Do you arrange your week to protect the affected side, spacing hard days, avoiding certain ground?

How much?

The direction of travel

Compared with two years ago, and not compared with last week.

Which way?

What other people see

Do the people around you know what any of this costs?

Honestly?

Reading Six questions, about three minutes

This measures the cost of what you do, not whether you can do it. Answer for a normal month instead of a good week, and be honest about the parts nobody sees.

A better definition

Clinical outcome measures ask what you can do: walk this far, climb these stairs, score this on a questionnaire. Those are useful and they systematically miss the cost, because a determined person answers yes to all of them right up until the point they cannot.

A more honest definition has three parts. You do what you want to do. You recover from it in reasonable time. And the amount you can do is stable or improving, not quietly shrinking. Fail any one of those and the picture looks like success from outside while feeling like something else from inside.

CapabilityCan you do it? The part everybody measures, and the least informative on its own.

RecoverabilityDo you get back to baseline in reasonable time? The part that predicts next year.

TrajectoryIs the amount you can do stable, or has it been shrinking so gradually you stopped noticing?

Anyone can do it once. The question is what Thursday looks like, and whether the list of things you do is getting shorter.

Why high-functioning people get missed

The people with the most to lose from this framing are the ones who cope well. If you turn up to appointments, walk in unaided, work full-time and describe yourself as fine, the system has no way of detecting that you spend every Sunday recovering and have not been on a hill in four years. Clinical measures pick up limitation, not cost.

So it falls to you to report it, and specifically. “I can do a full day but I need the next one quiet” is a piece of clinical information. “I’m managing” is not, and it is what most of us say.

When gains are not worth their price → Raising it properly →

Functional success

What counts as functional success with altered mechanics?

Doing what you want to do, recovering from it in reasonable time, and finding that the amount you can do is stable instead of shrinking. Capability alone is the part everybody measures and the least informative on its own.

Why is recovery time so important?

Because it moves first. Capability holds steady while recovery quietly lengthens, so it is the earliest signal that load is outrunning capacity. Years before anything appears that would prompt an appointment.

Is planning my week around it a bad sign?

Sensible load management is not a problem. Constantly arranging life to protect one side is a signal about how thin the margin has become, particularly alongside lengthening recovery and dropped activities.

Why do clinicians miss this?

Because standard outcome measures ask what you can do, and determined people answer yes right up until they cannot. Cost is invisible unless you report it specifically instead of saying you are managing.

How should I describe it at an appointment?

In costs and not in adjectives. “I can do a full day but the next one has to be quiet” is clinical information; “I’m fine” is not, and it is what most people say.

What actually improves sustainability?

Strength above the affected part, footwear that reduces the demand, and deliberately building recovery capacity instead of assuming it. Those move the cost of doing things, which is the variable that matters.

Sources

Where this comes from

1 World Health Organization: ICF FrameworkWorld Health Organization 2 American Physical Therapy AssociationAPTA 3 AAOS OrthoInfoAAOS OrthoInfo

Keep going

Adaptation →Why looking normal is the wrong target. Compensation fatigue →What runs out, and when. Daily life →Where the cost accumulates.