Osteoarthritis (OA) is prevalent with aging. So is gray hair. And wrinkles. OA is a form of joint degeneration, just like gray hair and wrinkles represent types of degeneration. But we think of hair and skin changes kindlier, accepting them as normal, harmless parts of getting older.
OA, on the other hand, gets a bad rap – a painful rap – when in fact it can also be normal and harmless. An association between OA and pain is unfortunately widely believed. If someone’s knee hurts and a knee MRI shows osteoarthritis, we quickly blame the osteoarthritis for the pain and tell ourselves that it can’t be fixed (unless we have surgery). When our head or skin hurts, do we automatically blame our grays or our wrinkles?
It is clear OA doesn’t necessarily cause pain because we find plenty of OA in people without pain. In fact, a person over 60 undeniably has OA somewhere in her body. Pain in a joint may be from OA, but it may also be from an irritated nerve, a dysfunctional tendon, or a misalignment in the joint – which are all typically very fixable! Expert McKenzie clinicians identify (and then treat) the true cause of someone’s pain. -- Laura
The article Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial reveals no difference between the fake (or sham) surgery and the real surgery.
This type of shoulder surgery, know as subacromial decompression (SAD) is unfortunately still prevalent in the U.S. In this research study, both the sham surgery group and the real surgery group had something important in common: in both groups the shoulder joint was irrigated. Essentially the joint was power-washed. I believe this to be the key part of the intervention, the reason why both the fake and real surgeries provided the same results.
What I find in the clinic is that many joints have a piece of debris obstructing the joint's motion and causing pain. In the extremity joints this is thought to be a piece of fat, cartilage, bone, tendon, or similar. Of course, this can be effectively "power-washed" with repeated movement, too. My job is to find the movement that moves that piece of debris out of the way. My patient's job is then to perform that movement throughout the day and temporarily avoid movements in the opposite direction.
If you have been contemplating shoulder surgery, please read this study and/or contact me with any questions. Hopefully medical providers will no longer suggest this as an option. -- Laura
Check out how the US compares to other nations in terms of back surgery prevalence. Most are unnecessary! A McKenzie evaluation and treatment usually does the trick - and saves the patient from a lot of stress, risk, lost time, and cost. -- Laura
Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up
This study comes from the BMJ, formerly known as the British Medical Journal. I've included the conclusions here and a link to the entire study. This shows once again that surgery for orthopedic issues should be a last resort. -- Laura
BMJ 2016; 354 doi: http://dx.doi.org/10.1136/bmj.i3740 (Published 20 July 2016)Cite this as: BMJ 2016;354:i3740
Conclusions and policy implications
The observed difference in treatment effect was minute after two years’ follow-up, and the trial’s inferential uncertainty, as shown by the 95% confidence limits, was sufficiently small to exclude clinically relevant differences. Supervised exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Nineteen per cent of participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. No serious adverse events occurred in either group during the two year follow-up. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no radiographic evidence of osteoarthritis to consider supervised structured exercise therapy as a treatment option.
Find the entire article here: http://www.bmj.com/content/354/bmj.i3740?utm_content=buffer795ae&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer
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