((((Catrin))))

Here's a little something from the practitioners perspective. It's always a very difficult discussion to have with a patient when you have to tell them something they love is not likely to be that good for them. Keep in mind that we are trained to always think about the worst case scenarios and to recommend the cautious course of action. It comes from having the fear of malpractice driven into us.

Here's my philosophy, I try to explicitly explain to my clients what the worst potential consequences for their actions could be and what I estimate the probability of those consequences are. Then we discuss what the more common results of their actions may be and what the outcome of those results would likely entail. Then I try to help them weigh the pros and cons with special consideration of quality of life.

For example, I had a pro kayaker that suffered a very bad low back disc buldge, he was told by his surgeon that he should never boat again. The reality was that the sitting position in the boat was considered a position of vulnerability and he could further injure his lumbar discs just through regular boating, but the probability of irreversible damage that would impact his function could be lowered dramatically by adjusting his position and by having him do regular exercise. There was however the possibility of very serious injury, for eg paralysis if he chose to run high waterfalls and landed the wrong way. The probability of that was low, but the consequences high. We talked things through extensively and he continues to be a river guide as his profession, but he no longer runs big waterfalls.

The moral of the story is that nothing is black and white and there is often some middle ground that is pretty safe even if it's pretty painful at times. Really it comes down to your own choices in what you can deal with and what isn't worth it in terms of quality of life. But you can only make that choice when you have all the information.

Meanwhile, have you thought about a recumbent?