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I apologize if this gets double posted. I originally sent it to the physio-request address. I'd like to applaud Dr. Siff for his scientific approach to exercise, training, and treatment. After working as the coordinator of a chronic pain program and along side physical therapists for almost 3 years I'm shocked at how evaluation and treatment worked. I called it medicine by statistics. Dr. Siff hits it (addressing the issue) right on the head when he says, "For a start, we have to remember the basic principle that it is not necessarily an activity that may be dangerous, but the manner in which it is executed." I like to call this 'the assumption of risk', that being the assumption that a body performing a, so-called, function activity is performing it functionally. Professionals making this assumption work their profession by statistics and not science. Having lived in Asia for 3 years I walked up and down hundreds of stairs everyday and I'm happy to report not once did encounter knee pain. To support my perspecitive, the other 15 million people walking around Tokyo seemed to be moving quite rapidly as well. 15 million pain-free people versus a hundred thousand (or however many have pain knees from stepping) should lead to a logical conclusion that the real issue is in HOW the exercisers are stepping as apposed to stepping itself. It might be more productive to, as Dr. Siff said, develop a more scientific understanding of how bodies are functioning during the particular activity of stepping off an aerobic step during class. It could be entirely possible that the body's center of gravity is forward of the landing foot (meaning that those exercisers with pain might be leaning forward, while the exercisers not reporting pain are erect) producing a situation similar to that of leaning forward during a lunge. Stated another way evalution of only the knee or the leg will unfortunately only lead to more dogmatic statistical rules. However, consideration of the entire body's position and interaction can lead to greater scientific understanding. Exercise Sceince and Medicine are "Sciences" even though some say they aren't, and actually those that say they aren't may be right in the sense that to be a science, one would be able to predict the outcome (after all that's one of the goals of science - understanding something so well that you can begin to predict outcomes). However, uncertainty is normally the rule. I must give a real life example. I encountered a young man in his twenties training for his first marathon. A month before the race, he had to stop running because of knee pain. When I met him he was running 2 miles twice a week. He had had the following treatment; an office eval, an x-ray, an MRI, and 6 PT sessions. I spent 10 minutes with him and performed 2 quick evaluations of certain functional components and gave instructions. I saw him again 7 days later, and he said that had run 6 miles everyday since I'd seen him. He asked how I knew he'd feel better, to which I said, "That's science". Robert Heppe, M.A. http://www.biosolutions.net As a side note, Dr. Siff's Puzzles and Paradox can also be discussed in bulletin board format at: http://www.biosolutions.net %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%