LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Knee Pain

Neck Pain Chiropractor Mesa AZ

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Chronic Neck Pain and Car Crashes –

I DON’T WANT TO MILK THE SYSTEM AFTER SOMEONE REAR-ENDED ME… A not uncommon response after getting into an accident that is not your fault is to think that getting care is just “milking” the system.  Because of this, some people will actually forgo care for their injuries, be they major or minor. Never a good idea. It may require only a simple visit or two or a more lengthy course of care, but leaving an injury go without treatment is never a good idea. It is becoming clearer through current research that the time to begin treatment of an injury is NOW. This especially applies to soft tissue techniques like Graston.  Anything past immediate may be less than ideal (I’m not saying I’d come out to the crash site if you called our office, but…).  This goes for car accidents or any other type of injury. Sooner is better. Of particular note in this study is that, whether participants in this study had neck pain or not, they suffered a loss of quality of life!  This is serious and yet another reason to seek the care of a chiropractor sooner rather than later.  I think I know a good one… Read More…

Knee Pain Chiropractor Mesa AZ

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Don’t Wait, Pain Gains

SHOULD I WAIT TO SEE IF MY PAIN GETS BETTER FIRST?  It is very common for someone who has injured themselves, be it their back, shoulder, neck, knee or spleen (ok…maybe not really the spleen), to wait and see if the pain goes away.  Sometimes is does, but sometimes this is the beginning of what will ultimately develop into chronic pain.  I can tell you that, from my chiropractic perspective, that the sooner someone comes in to see me after pain begins, the sooner they recover.  If someone comes in within a week or so, many times we can knock out the problems in just one visit (for established patients that understand the way we treat soft tissues).  This particular study finds that, at least for low back pain, not getting relief within the first 3 months and being afraid to move too much for fear of worsening the injury were risk factors for chronicity.  I can tell you that these are factors we address heavily with every patient.  Many patients are still told to restrict activities for a period of time until they get better. This is usually very bad advice. Read More…

Knee Surgery for Torn Meniscus – Best to Leave it Alone?

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Natural Treatments for arthritis
Natural Treatments for arthritis

There are a few things that have managed to make it into “everyday thinking” despite the fact that it is more dogma than reality. Knee injuries are one of these things.

If you injure your knee and tear something, whether one of the supporting ligaments or one of the two meniscus (or is it menisci??), you’re going to have to have surgery.

I was personally one of these back in 1987 when I tore the medial meniscus of my right knee and had a portion of it removed surgically. If only I had known then what I know now…

The problem with evaluating whether or not surgery for a particular condition works is that we just don’t do placebo surgeries—it’s an ethical problem. Kind of like a placebo-controlled trial on whether parachutes are safer while skydiving. We just don’t do placebo surgeries.  Or at least we didn’t until 2002 when the Houston VA medical center decided to do a placebo-controlled surgical trial of patients with knee pain who went under the knife for “debridement,” or a clean-out to get rid of damaged tissue hanging around in the knee joint.

Turns out there was no difference between those who had the full surgery and those who had the placebo surgery.  Truly ground shaking outcomes considering that this type of procedure is done some 800,000 times per year in the US alone.

But I really don’t think that many surgeons truly changed based on the evidence of this study over a decade ago. From an insurance standpoint, it was pretty easy for the surgeon to just say he was going in to fix a meniscal tear.  And this sounded like a good idea because the back part of the medial meniscus (posterior horn) is commonly torn and it does not have a very good blood supply so healing just isn’t going to happen without surgical intervention to go in and remove the torn meniscus.

There are a couple of problems with this thinking.

The first problem is a biggie and has to do with how we determine whether or not there is any damage to the knee using MRI. Many people mistakenly believe that MRI is an exact science and that, if something is “found” on MRI, it’s the thing that is causing the problem.

Study and after has concluded that there is very little correlation to what is found on MRI and a patient’s symptoms. That’s not to say that that torn medial meniscus on your MRI is not causing you pain, it’s just that we can’t know for sure. And I can tell you, from treating hundreds of knees over the years, that a huge chunk of knee pain comes from the soft tissues surrounding the knees (muscles, ligaments, fascia) and not from what is going on inside the knee.

Fix these tissues and the knee pain goes away, regardless of whether or not the meniscus is affected by the treatment. But very few knee pain patients manage to find their way into physician’s offices that are truly competent with addressing these tissues. Part of this may be because they aren’t aware that these types of treatments even exist—It’s the surgeon’s office to MRI to physical therapy and back to the surgeon to schedule the procedure. Kind of circular.

The second problem has to do with this particular study. In it, researchers looked to answer the question about whether surgery to repair a degenerative meniscus tear (as opposed to one that happens from trauma) actually does squat. Specifically, they were interested in whether self-reported locking or catching would be improved by partial meniscectomy (since it is increasingly well-established that doing the surgery for pain alone is not beneficial).

Seventy patients underwent the real surgery to remove a portion of the medial meniscus and 76 had a sham surgery done. Here’s what they found:

  • Thirty-two patients (46%) in the true surgery group reported catching or locking before surgery; after surgery that number was 49%.
  • Of the fake surgery group, 37 (49%) reported catching or locking before surgery; after “surgery” the number was 43%.

In other words, some $50,000 later, risk of injection and time off and pain for rehab, there was pretty much no difference between the groups.

Studies like these and the other ones mentioned in this article are blowing open the doors of the dogma that surrounds knees injuries, findings on MRI and the value of arthroscopic surgery.  This is not to say that there is not value to the surgical options, but you better damn well be sure you see someone who truly understands how to assess and treat the soft tissues surrounding the knee before you go under the knife.

Is Surgery Necessary for ACL Tears? The Answer Will Surprise You

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I personally had my right knee scoped when I was 18 for a torn medial meniscus.  I now have arthritis on the inside part of my knee, which I keep solidly pain free with soft tissue work and exercise.

Knowing what I know now, I never would’ve had that surgery done.  While this particular article looks at 121 young active adults with ACL tears (a more complex injury than a meniscal tear), it again raises questions about the dogma that exists on the need for surgery for many knee conditions.  Basically, delaying surgery and trying non-surgical management first (which, in this office would include aggressive soft tissue techniques like Graston as well as whole body vibration to stabilize the joint) seems to be the better option.

Here’s the specifics:

  • 62 were put in rehab and had early ACL reconstruction, with 59 assigned to rehab plus optional delayed ACL reconstruction
  • Of the 59 who initially did not have surgery, 23 (39%) underwent delayed ACL reconstruction.
  • Based on the Knee Injury and Osteoarthritis Outcome Score (KOOS, which asks about pain, symptoms, function in sports and recreation, and knee-related quality of life), there was NO difference in any of the treatment approaches.

In other words, just because you have an ACL tear does NOT mean that you have to have surgery.  It makes complete sense to go into rehab after an injury like this with the expectation that you will not need surgery, but keeping an open mind about the topic if you do not respond to the rehab itself.

 

Common Knee Osteoarthritis Symptom Treatment Fails Again

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knee osteoarthritis symptoms
Knee arthritis and steroid injections

 

Knee osteoarthritis symptoms. For some, it seems like the diagnosis is pretty much the same as saying that surgery is inevitable.

There are times when I think that more information is a bad thing.  There have been countless times in my practice where someone gets hooked on imaging findings (whether they are MRI, CT scans or X-rays) and focuses on what damage is present rather then what is reality.

Whether it’s a shoulder, low back, neck or knee imaging study, there have been multiple studies pointing out two very important problems.  First, there is very little correlation between imaging findings and symptoms.  In other words, if someone has “stuff” wrong on a MRI, it does NOT mean this person is going to have pain.  You cannot look at a MRI and state that this patient will or will not have pain.

This misconception then leads to the second problem.  There is a large chunk of the surgical field that is devoted to doing procedures based on stuff we find on imaging.  Got a disc bulge?  Cut it out.  Have knee osteoarthritis?  Replace the knee.  Torn rotator cuff?  Surgical repair of the shoulder.

This particular study highlights just how wrong this approach is.  In yet another study on the relationship between arthroscopic surgery of the knee for arthritis found on imaging and beneficial outcomes of the surgery, researchers looked at the results across 9 different medical trials.  Specifically, these middle aged and older patients with knee pain and degenerative knee disease underwent knee arthroscopic surgery.  Here’s what they found after an average of 2 years had passed after the surgeries:

  • There was a very small benefit to surgery in patients’ pain levels (basically, a benefit of 2.4 mm on a 0-100 mm scale).
  • There was no significant benefit on physical function.
  • Harms included symptomatic deep venous thrombosis, pulmonary embolism, infection, and death.

The bottom line is that, going in for surgery just to “clean out” the knee has virtually no benefit but a list of risks.  This is a procedure that, frankly, should no longer be done except in rare cases (and I don’t know exactly what these cases might look like…).

So what can you do instead of surgery?

  1. Move.  Not exercising is one of the worst possible things you can do for knee arthritis.  Hiking, swimming, weights, stationary bike, whole body vibration–there are lots of things you can do to strengthen your knees.
  2. Find a chiropractic who can competently treat the soft tissues of the knees–look for those that do Graston, ART, NMR, fascial manipulation.
  3. Consider a TENS unit to control the pain in the short run.
  4. Consider a joint support formula with glucosamine in it.
  5. Add vitamin D to your supplement list.
  6. Get down to your ideal body weight.

By using these tools to help manage your knee osteoarthritis symptoms, you won’t ever need to worry about whether or not the risks of surgery outweigh the miniscule benefits.

 

Having Orthopedic Surgery? You NEED to Know this Scary Risk

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orthopredic surgery and troponin
lenetsnikolai / Dollar Photo Club

Everyone knows that there are risks associated with any surgery. But the risks that you know about are the obvious ones.

Problems with the anesthesia such as aspiration pneumonitis or respiratory failure.  Problems with the surgery itself such as excessive blood loss, damaging the spinal cord or spinal nerves, infection or blood clots.

But what if there was something more insidious that can occur?  Something that won’t kill you today or tomorrow, but waits in the shadows until years later?

Before I tell you what this scary thing is, I do need to point out that there is a time and a place for orthopedic surgery.  But this should only be considered as an absolute last option.  All too often we THINK something is a last option.

But time and time again research proves that this is just not true.  Some examples:

This list is much longer, but you get the idea.  There are an uncountable number of orthopedic surgeries done every year that were unnecessary.  Which would be fine if there weren’t dangerous risks associated with orthopedic surgery and the chance that you will be no better after the surgery, or worse, in more pain after the surgery.

Side note–these comments do not apply to trauma-induced orthopedic surgeries–in these cases there are usually no options for avoiding an emergency surgery after trauma.

All of this brings me to this particular study.  In it, researchers looked at a scary side effect of orthopedic surgery called myocardial necrosis.  As you may be able to tell from the name, this is a condition were the heart muscle dies as a result of the stress on the heart from the surgery.  This bad effect from surgery is well known and characterized for short term mortality after orthopedic surgery.

What is not as well-known is what happens in the long term.  To get a better idea of how often this happens, researchers looked at levels of troponin (a protein found in the heart; elevated troponin levels are a sign that damage to the heart has occurred) immediately after orthopedic surgery and whether this related to long term death in hip, knee, and spine surgery 3 years later.  Here’s the details:

  • There were 3,050 surgeries with an average age of 60.8 years.
  • Myocardial necrosis occurred in 179 cases (5.9%) and heart attacks in 20 (0.7%).
  • In those patient who experienced myocardial necrosis, 16.8% of them did not survive in the long term (3 years).
  • In those who had normal troponin levels around the time of surgery only 5.8% did not survive.
  • To put it clearer, those orthopedic surgery patients who had higher levels of troponin were 233% more likely to die in the long term evaluation, while those who had a heart attack after the surgerys were 351% more likely to die.

Now certainly, if you had a heart attack just after your orthopedic surgery you’d know about it.  But myocardial necrosis may not have been fully explained to you if it had been identified.  Either way, if you DO end up having orthopedic surgery, it may makes sense to push your surgeon to run troponin levels along with everything else to get an idea about whether or not you’re going to be around in the next 3 years.

Seems simple enough.

 

Tylenol for Your Pain; Surprising Finding on How Well it Works

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Tylenol for back pain
Radosław Brzozo / Dollar Photo Club

Society would never consider going without over the counter pain meds. Doesn’t matter what’s it’s for; headaches, knee pain, shoulder pain, back pain.   We don’t seem to care where the pain is; that magical little pill hones in with radar precision to zap the pain and give you relief.

Or at least this is what the advertising messages would have you believe.

For starters, there is no magical honing; all drugs reach all areas of the body.  This is one of the reasons why so many side effects occur in organ systems that have nothing to do with the reason for taking a drug in the first place.

Personally, I haven’t taken any over the counter or prescriptive medications for at least 20 years (it may have been longer—I just can’t actually remember…) despite my share of martial arts injuries over the years.  But I certainly have my share of patients who take them on a regular basis.  We’ve become somewhat immune to the idea that every drug has a risk / benefit ratio.  There is not a drug out there that does not have side effects; since every single drug interferes with the way your body functions to some degree or another this is inevitable.

Paracetamol, the active ingredient found in Tylenol and generic acetaminophen, has a long list of side effects.  Just some of these include:

But, as mentioned, sometimes the side effects are worth the risk (although anyone on the liver or kidney transplant waiting lists may disagree…) so long as there are benefits.

But what if what you’ve been taking your Tylenol for really doesn’t work?  I can tell you that it certainly seems like many of my patients who are in pain and take many of the OTC pain medications aren’t jumping up and down for joy over how well they work (because, after all, they are in a chiropractor’s office looking for additional pain relief.

At the most, they seem to help “take the edge off” or help for a few hours at the most.  This particular study seems to agree with what I’ve experienced in my office.  In it, researchers looked across 13 different clinical trials looking at the use of paracetamol for back pain, knee or hip arthritis pain.  In the review, the researchers looked for the quality of the studies to see what the outcomes were.  Here’s what they found:

  • High quality results from the studies found that paracetamol is ineffective for reducing pain intensity and disability or improving quality of life in the short term in people with low back pain.
  • High quality results from the studies found that paracetamol used for hip or knee osteoarthritis for that any short-term improvement on pain and disability was not clinically important.
  • High quality results showed that those taking paracetamol were nearly four times more likely to have abnormal liver function tests.

When it comes to research, there are no absolutes and no single study can determine whether something works or not. To make it a little more complicated, there are good quality and bad quality studies.  But when you have multiple high quality studies pointing to the same outcome, you can be far more confident that the results from that study may apply to you.

That’s what we have here.  Could you be one of the few for whom Tylenol is going to work for back, knee or hip pain?  Possibly.  But it should not be your first choice given that there is a long list of side effects associated with the use of Tylenol and this review strongly suggests that it is not going to work.

Of course, being somewhat biased towards chiropractic care for these conditions, I would strongly suggest that chiropractic care should be your first choice for treatment of these conditions.

Knee Osteoarthritis Symptoms: To Use Steroid Injections or Not?

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knee osteoarthritis symptoms
Knee arthritis and steroid injections

Somewhere along the line steroid injections became the knee-jerk (pun intended) reaction for pain anywhere.

Shoulder pain?  Shoot it with some steroids.  Elbow pain?  Wrist pain?  Knee pain?  Scoot right on up and we’ll stick some corticosteroids directly into the joint.  Low back pain?  Despite the fact that there is very little evidence to support it, let’s go ahead and inject steroids into the sanctity of the spinal canal and see what happens.

When given orally, most would shudder at the random use of steroids given the risks of bone damage, obesity, diabetes and brain damage.  But given that it’s just a local injection it doesn’t affect the rest of the body.

At least, that’s what most people (doctor’s included) think.  Then why, in a prior blog article I did several years ago, did researchers find that it didn’t matter whether the injection was given directly into the shoulder or whether it was given in the buttock?  Because it does not matter.  Steroids, whether given orally, inhaled or injected anywhere, have an effect everywhere else in the body.

Because of this, we need to be darned sure that every use of steroids is going to have a positive effect on whatever condition it is being used for.  This definitely includes steroids being used for pain.  Which is why I bring you this particular article.

In it, researchers looked at whether the use of a cortisone injection for knee pain 2 weeks prior to a 12 week supervised exercise program helped in the long run or not.  All participants had arthritis of the knee on X-ray, clinical signs of localized inflammation in the knee as well as knee pain during walking (score >4 on a scale of 0 to 10).

The participants were evaluated using the Pain subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire (range, 0-100, where higher scores indicate greater improvement).  Half of 100 knee pain patients ended up in the steroid injection group and the other half in the placebo-injection group.  Here’s what they found:

  • After 14 weeks, those in the steroid group had a change of 13.6 on the KOOS score and those in the placebo group changed by 14.8 points.

Basically, the use of steroids led to a difference of 1.2 points (out of 100).  In addition, there were no differences in physical function, markers of inflammation or additional KOOS pain scores.

In other words, there were increased costs and increased risk of systemic damage from the steroids but no actual benefit.  Just to thrown a further wrench into the use of steroid injections for knee pain, it is entirely possible that the injection itself may have some benefits by disrupting blood vessels and bringing new nutrients and blood flow to the joint.  In other words, the benefits of the steroids may be even less (or worse-creating WORSE outcomes) because the injection portion of both treatments may have therapeutic benefits.

In case this STILL isn’t enough for you, it is very clear that any anti-inflammatory treatment damages the joint surface itself, preventing the cells from healing from future damage.  This means that, not only does the use of steroid injections for knee osteoarthritis symptoms not actually help, but you are damaging your knees for the future.

If you are wondering what else you can do to help your knee pain, feel free to check out my Knee Pain eBook on Amazon by clicking here.