What Works Better Than Knee Surgery?

New studies have been making big health news. These studies conclude that knee surgery is not needed to rehabilitate after several kinds of knee injuries, and that "question the benefits of the surgery." This information is not new. How do I know this? Because of years of previous studies concluding that surgery "worked." Here is what those previous studies often meant:

About 10 years ago, I attended a sports medicine conference. A new line of knee surgeries had come out, and the surgeons and manufacturers of the products used were anxious to have their surgery accepted and endorsed. One of the clinical presentations of the conference was the results of a study that compared patient outcome after knee surgery to the outcome of physical rehabilitation without surgery.

The patient group receiving physical therapy had improvement of function and reduced pain over time. The sample undergoing surgery went through the risks of anesthesia and surgery, lost work and wages, pain controlling narcotics during surgery and recovery, reduced activity for a minimum of 2 months following surgery, and pain from the surgical area. They then underwent months of physical therapy to regain function lost from the surgery. Many had permanent reduction of knee range of motion, considered "standard and acceptable" for that surgery. The loss of range can reduce function of the area, and reduce ability to stretch the hip, which can cascade years later into further restrictions. The physical therapy group had improvements that started soon after beginning treatment. The surgical group initially had decreases in all measures of strength and function, then months of painful recovery, and further months of reduced physical condition while they worked to "get back in shape."

Patient outcomes of muscle strength and pain levels were compared after two years and found roughly equal. The conclusions of the study were that surgery was effective, since two years afterwards, patents in the surgical group had made gains equal to the therapy group. I raised the question to the presenters about the initial painful recovery, then months of recovery, which the therapy group never had to experience. They were angry that I could not see that the outcome measures were equal, so "all's well that ends well." They pointed out that their surgical patients often thank them because they, "wake up and the pain is gone." They omitted that post-surgical patients are on pain relieving drugs, often narcotics.

I do not judge my own patients to be fine, or a method to be worthwhile, if they have to endure loss of mobility and physical levels at all, let alone over two years.

What works better than knee surgery?

1. Physical retraining of how you use your knees in daily life when walking, bending, running, and other activities.
2. Checking other causes of knee pain such as hard "supportive" shoes, and many prescription drugs with pain as side effects.
   
3. It is common to do exercises to strengthen the legs, then walk away from those same exercises allowing the knees to sag inward, slide, or twist in directions different from the line of the joint. The chronic unequal loading grinds, stretches, and wears at various bands of cartilage that connect upper and lower leg bone (ACL and PCL), meniscus cartilage, can grind the inside of the kneecap causing pattelo-femoral pain, and can even wear away at the shiny smooth cartilage covering bone ends (the articular surfaces), predisposing to arthritis.
4. This is why much supposed knee rehab isn't " working" - it is being undone the rest of the day by continuing the causes of the problem. Physical retraining is for all real life, not just a bunch of "sets and reps."
   

You don't have to have surgery to stop pain. Here are Fitness Fixer posts on fixing knee pain without surgery:

• Healthy Knees
• Daughter's Love Saves Parent's Knees
• Inspiring Update from Jill - Celiac, Knees, Fasciitis, and Restoring Happy Life
• You Can Fix Your Own Knees
• Prevent Knee Pain When Rowing
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Why So Many Aerobics Injuries?
• Walking Softly Benefits Olympic Wrestler
• Save Knees When Squatting
• Arch Support Is Not From Shoes
• Strengthen Legs Without Knee Pain - Standing Lunge
• Down the Stairs
• Better Exercise on the Stairs
• Knee Pain When Running - Check Your Yoga
• Common, Missed Cause of MusculoSkeletal Pain - Your Drugs
  
  

Coming next Monday - Surgery for anterior cruciate ligament (ACL) repair found to be not needed to restore function or prevent later injury - Anterior Cruciate Ligament (ACL) Surgery Unnecessary.

Labels: anterior cruciate ligament/ACL, fix pain, injury, knee, meniscus, practice of medicine, surgery

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