Feeble to Fit Part 1: my experience with a world-class physical therapist

Man clutches at knee in pain
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Editor’s note: This is Part 1 of a series about my experience with physical therapy to fix chronic knee pain and problematic shoulders

Introduction

I love to run, but for years I’ve struggled with chronic knee pain. In the fall of 2021 it got so bad that I could barely jog around the block.

Six months later, however, I was running over 40 miles a week – pain free. What happened?

Physical therapy happened. One session a week plus at-home exercises brought me from grimacing at the mere thought of lacing up my shoes to smiling as I completed yet another eight mile run.

Along the way I grew stronger, improved my running efficiency, and stabilized my vulnerable, injury-prone shoulders. I began skiing and resumed other activities I loved but had long avoided.

Today, I am faster, stronger and healthier than I’ve ever been. I want to share what I did to fix my knee pain, how doing that caused me to become fitter overall, and what I learned about physical therapy.

I hope my story helps others who want to train harder but are hampered by chronic pain.

Why was this time different?

Saying that my success is thanks to physical therapy is a little misleading.

I had tried physical therapy before – multiple times in fact – but never saw anything beyond mediocre, temporary improvements. This time, however, it was transformative.

What made the difference was who I worked with, a remarkable physical therapist named Lev Borukhov. It was his skill and dedication that helped me return to running after years of pain.

Compared to other physical therapists I had worked with before, Lev is unique.

Lev Borukhov standing in his office

His martial arts training

Besides having studied physical therapy, Lev has also trained as a Muay Thai fighter. Years of martial arts practice teaches you to move with power and finesse. This corporeal understanding of movement complements physical therapy book smarts. Lev’s got both.

Movement as a foundation to everything else

The degree to which Lev prioritizes movement was also new to me (his practice is even named Movement Minded).

I would liken Lev’s approach to that of a good violin teacher who understands that without the right posture and breathing students will always remain beginners no matter how nimble their fingers are.

It’s not about my knee (most of the time). It’s about how my hamstring fires when my foot lands while I run. It’s about whether my TFL is tight. It’s about whether my quad is as much work as it should be. It’s about a dozen different things all operating in synchrony.

Working with Lev, time and time again the source of my discomfort, and its relief, has been not the point of the pain, but instead something else, something that only a deep understanding of anatomy and a holistic view of movement could identify.

One-on-one attention

Unlike other physical therapists, including ones that elite orthopedic surgery departments refer their patients to, Lev never treats more than one patient at a time.

Before Lev, my experience had always been that my physical therapist would do a one-on-one intake session, but all subsequent sessions would have them spending ten minutes with me, then ten minutes with another patient while I did exercises, and then maybe another ten minutes with a different patient while I waited. This is the standard way physical therapy offices run.

How, specifically, does a one-on-one session produce a better outcome for the patient?

In my experience it’s meant that Lev has been able to pay close attention to how I do certain movements and provide immediate feedback. Usually this feedback takes the form of a different exercise that, for example, activates a muscle I should have been relying on but wasn’t. As a result, I’m able to learn how to move pain-free much faster.

Our one-on-one sessions are also extremely flexible. Though Lev knows more or less what he wants to do going into the appointment, most of each session unfolds based on how I feel and how quickly we make progress. If I feel great, we speed up. If I feel pain, we halt and focus on resolving that discomfort.

Speed is the final major benefit of focused one-on-one physical therapy. A single hour of Lev’s full attention is more useful than many hours of his divided attention, and that means faster healing.

Habitually seeking the cause and verifying the diagnosis

Lev’s most distinct trait is how he diagnoses what’s causing pain and how he verifies that diagnosis is correct. It’s a lot like developing a hypothesis and then testing it.

For example, if I come to Lev and say that my knee was feeling better last week but now irritation has returned to the area next to my kneecap on the outside, he’ll usually respond by asking me to get into a certain pose or try a specific movement. He’ll ask, “What muscles are activated when you’re doing that? Is there any discomfort?”

My answers to what muscles are doing work and if there’s any pain let Lev triangulate what’s probably going on.

The next step is usually a lightbulb moment for him and I’ll find myself doing a couple sets of some exercise that, for example, works my left hamstring.

But Lev isn’t done. He then checks if the discomfort has decreased if it hasn’t, he interprets that as evidence that his initial diagnosis was wrong. Back to the drawing board.

If the issue is really uncommon or tricky to figure out this might happen two or three times, but Lev seems to figure it out in the end.

This is very different from my previous experiences with multiple physical therapist offices. There, I would come in with some injury or complaint, they would evaluate me, and then I would be told to do certain exercises.

If those didn’t work initially, I had to keep doing them for a while longer. If there was still no improvement, the physical therapist would try different exercises.

Crucially, there was no formulation of any hypothesis about what was causing my pain. There was only the pattern matching of X injury to Y rehabilitative exercises. This isn’t much better than just buying a book about your injury and following its exercises. It’s a general, one-size-fits-all approach to treating pain and injury.

Lev is driven

Finally, Lev is extremely impatient – in a good way. He’s eager for success and wants his patients to get better fast.

Like a runner who races their previous times, Lev tries to help people return to doing the things they love sooner than he was able to before.

Previous physical therapists I’ve worked with cared about me and they were enjoyable to work with, but I never sensed a fire driving them to improve themselves and measuring their success by how quickly their patients felt better.

Next in Part 2

If you get the impression that I’ve been very pleased with what Lev’s been able to do for me, you’d be wrong.

I’m way happier than that. I’m thrilled. I’m over-the-moon happy with the results. In a little over six months I went from not being able to run to seeing some of the fastest medium-distance times of my life with only occasional mild discomfort.

In Part 2, I’ll get into the really impressive part – the fact that we did this almost entirely over video chat.

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