Normal Is Not the Goal: Why I Hate "Within Normal Limits"
In this monologue, Christopher Ellis reflects on his time in the insurance industry and early physical therapy training to critique the clinical shorthand "WNL" (within normal limits). He explains that PT education often emphasizes achieving only about 75% of a patient’s pre-injury function—enough for them to perform basic daily tasks—rather than restoring full or improved capability. Using a rotator cuff repair case, he illustrates how therapists settle for a limited range of motion (e.g., 135° of flexion) that merely lets patients reach a cabinet, labeling this outcome as "within normal limits." Ellis expands the argument to the broader healthcare system, describing it as reactive: designed to detect disease rather than proactively restore optimal function. The overall message is that accepting "WNL" as a satisfactory endpoint perpetuates a minimalist, disease‑catching model instead of striving for true functional recovery.
