orthopedic surgery

Three Science-backed Reasons not to Rely on Imaging for Orthopedic Surgery

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Approximately 7 million people undergo an orthopedic surgery each year in the United States. Topping this list are elective procedures (meaning they are not life threatening or urgent) such as ACL reconstruction, total hip and knee replacements, arthroscopic surgery (meniscus repairs, shoulder decompression, etc), and spinal fusions.

Now, what if I told you that of the top 10 elective orthopedic surgeries performed, only one (carpal tunnel syndrome) has real evidence to support that surgery will have a better outcome than conservative care. A recent study published by scientists in the UK hospital system and National Health service reviewed thousands of published studies in an effort to find out if orthopedic surgery was truly better than conservative care or placebo procedures. They found that sadly, thousands of patients are undergoing invasive procedures every year with known associated risks and complications. All while there was an equal or better alternative.

One of the biggest reasons this happens is because people rely on imaging (X-rays, MRI’s, CT scans) to determine whether or not they need surgery. Don’t get me wrong, this incredible technology has revolutionized the field of medicine and orthopedics. The problems occur when we fail to look at the full picture (no pun intended) and rely on images alone to make important decisions about our musculoskeletal health.

Here are three science-backed reasons not to rely on imaging alone when considering orthopedic surgery:

 

1. Imaging does not always correlate with symptoms

One of the most fundamental reasons why imaging alone should not dictate your decision to get orthopedic surgery is the well-documented lack of correlation between image findings and actual symptoms. 

Studies have shown that 20-25% of all people will show a bulging disc in their spine on MRI. This happens even when they don’t have any back pain. At least 50% of adults over the age of 50 will show torn meniscus or cartilage in their knees and feel completely fine. In 2013, The New England Journal of Medicine published a study that found one-third of participants with no knee pain had “abnormal” results in their imaging. This was while one-half of the participants who actually experienced knee pain had completely clear scans. 

We have to start normalizing what aging actually looks like on a scan. Just because you’ve got a bulging disc, torn cartilage, or even “bone on bone” arthritis – it doesn’t mean you need to rush into the operating room.

2. Risk of Over-diagnosis and Overtreatment

Overdiagnosis refers to the identification of conditions that aren’t actually causing symptoms or harming a patient. The biggest culprits here include spinal stenosis, joint arthritis, and degenerative joint conditions. One notable study from 2017 published in PLUS ONE, a peer-reviewed mega journal, found that at least 20% of arthroscopic knee surgeries were overdiagnosed and subsequently overtreated. How did they now? Because even though their scans showed things like “wear and tear” and torn cartilage, they had no relevant dysfunction or clinical findings. The only thing indicating they needed surgery was the overdiagnosis of normal aging in their knee.

A particularly sad story comes to mind as I write about this. I recall treating a man with spinal stenosis who was told by his doctor he needed steroid injections to calm the inflammation in his back. He had 6 weeks until his injections, and during that time, we were able to decrease his pain by about 80%. Since it’s impossible to reverse or stop spinal stenosis without surgery (because it’s related to wear and tear as you age), I knew that his pain was being caused by other unrelated factors. But following doctor’s orders, he still went through with the injections. Unfortunately, he had a bad reaction to the injections that left him worse off than when he started with me. His over-diagnosis of spinal stenosis led to a cascade of over-treatment and worse pain than when he started. 

3. Non-surgical treatments can be equally effective (if not better)

Orthopedic surgery should really only be considered as a last resort. No matter how routine or “non-invasive” the surgery is, there are still risks of infection and complication, and you want to avoid those at all costs. The problem with conservative treatment is that it takes longer to get to the same (or better) result. And let’s face it, we live in a quick fix world and rarely have patience for this, especially when you’ve got a scan that seems to say otherwise.

Study after study shows that arthroscopic knee surgery (in particular) has the same or better results when treated conservatively (physical therapy and exercise). In fact, when you get arthroscopic surgery on your knee, it increases the likelihood you’ll need a total knee replacement. With back surgery, we know that in the first year or two, your pain will be better or gone. But by year 2-3, if your symptoms haven’t crept back in yet, you’ll feel just as good as your peers who forewent surgery. But after year three, your back pain symptoms tend to return, and you’ll often feel worse than your friends who decided to take the conservative approach from the get-go.

The research continues to support that 70-80% of all musculoskeletal pain is mechanical in nature. Mechanical problems have to do with movement dysfunction and lifestyle/postural habits. They don’t show up in a scan, and they are best treated conservatively. When you see something on an image, it’s better to assume it’s irrelevant and that you fall into the 70-80%. This will protect you from being overdiagnosed and help you avoid potentially unnecessary procedures and surgery. Pay attention to your pain, symptoms, and overall function – they tell a much better story than your images.

Are you local to Portsmouth, NH?

Consider seeing one of my Specialists – they’re experts in mechanical pain. In a free Discovery Visit you can tell us everything that’s been going on with you, and determine for yourself if we’re the best people to help you. It’s a no-obligation appointment that will give you all the information you need to make the BEST decision for YOUR health. Whether that’s working with us or not!

CLICK HERE to request a Free Discovery Visit.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, email her at [email protected].

Pickleball

Six Reasons to Try Pickleball this Father’s Day

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If you’re looking for something fun and active to do this Father’s Day – why not try a game of Pickleball?

If you haven’t yet heard of pickleball – it’s quickly become one of the most popular racket sports in the country. It’s a paddle sport that combines elements of tennis, badminton, and ping-pong. Since the rules are fairly straightforward, it tends to attract people of all ages and skill levels – but it’s been a huge hit in the over-50 crowd. You can find both outdoor and indoor courts just about anywhere – and it provides a fantastic opportunity for the whole family to engage in a fun-filled day of friendly competition – while also honoring your favorite active dad.

Pickle ball also comes with a ton of health benefits. 

Here are 6 of my favorite reasons why pickleball is good for your health – and why I think you should give it a try this Father’s Day:

1. Get’s the Heart Pumping:

Since Pickleball is a dynamic sport – it keeps you on the move – making it an excellent cardiovascular workout. When you play pickleball regularly – it can improve heart health, increase endurance, and strengthen your cardiovascular system. Pickleball consists of both aerobic exercises as well as bursts of anaerobic activity – such as quick sprints and lunging on the court. This helps to elevate your heart rate in a way that is great for promoting overall hearth health and cardiovascular fitness.

2. Weight Management:

Everyone knows you need both diet and exercise to effectively manage your weight. When it comes to exercise – why not pick something fun that you know you’re more likely to do because it’s enjoyable. The continuous movement involved in the sport of pickleball helps to burn calories and increase your metabolic rate. But it’s not just cardio that pickleball is known for – there is a strength component too. This combination of both strength and cardio only adds to your calorie-burning – making it not only fun – but an efficient way to manage your weight.

3. Improved Balance and Coordination:

Pickleball requires you to move quickly, change direction, and react to the ball’s trajectory. These dynamic movements help to improve balance and coordination because they force the engagement of multiple muscle groups at once. When you have to anticipate shots from any angle, pivot at a moment’s notice, and reach for the ball – this helps to enhance something called proprioception – your body’s ability to sense position in space. Since pickleball is super popular with the over 50 crowd, anything that works on balance and coordination is something I support – since these two areas only tend to decline as you age.

4. Increased Strength and Endurance:

When you play pickleball – you have to do everything from swing the paddle, lunge at the ball, and reach for shots. These varied physical movements help to engage just about all the muscles in your body – particularly your arms, shoulders, legs, and core. When you play pickleball regularly – it’s going to lead to improved muscular strength and endurance. Plus, pickleball is generally low-impact – so you get to improve your strength and endurance while not having a huge negative impact on your joints.

5. Cognitive and Mental Benefits:

The strategic aspects of pickleball – such as shot placement, anticipating your opponent’s moves, and the adaptation to different playing styles – challenges your brain and enhances mental agility in a fun and active way. For example, just the hand-eye coordination required to track the ball and make split-second decisions sharpens your cognitive skills and improves your reaction time to things. When you play pickleball regularly – you’ll find that your focus, concentration, and overall mental well-being will simply improve.

6. Social Interaction and Emotional Well-being:

This is probably my most favorite health benefit of pickleball. For the younger crowd (30’s and 40’s) – it’s quickly becoming one of the hottest business and networking events out there. And for everyone else, it’s a fabulous social sport that encourages interaction and camaraderie. Regardless of who you play with – whether it be friends, family, or in a community league – pickleball fosters a sense of belonging and enhances social connections. Plus, the positive connections you find on the court can easily extend off the court – so it becomes a fun and active way to quickly expand your social circles and overall well-being. Your new pickleball buddy could suddenly double as your gym and walking buddy too.

So there you have it – six healthy reasons to try Pickleball if haven’t already.

And why not use Father’s Day as the perfect excuse to to make it a family affair. With any new activity, there’s always a risk of injury, so make sure you warm-up properly and go into  it with ease – especially if it’s your first time. And if you’re currently suffering from an injury that is keeping you from wanting to even try this super fun and accessible sport – consider talking to a movement or mechanical pain expert who can help you sort out what’s going on.

Are you local Portsmouth, NH?

Consider speaking to one of my specialists. Tell us everything that’s been going on with you, and determine for yourself if we’re the best people to help you. It’s a completely free, no-obligation appointment that will give you all the information you need to make the BEST decision for YOUR health – whether that’s working with us or not!

CLICK HERE to request a Free Discovery Session with one of my specialists.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media group. To get in touch, or request a free copy of one of her guides to back, knee, neck or shoulder pain, visit her website www.cjphysicaltherapy.com or call 603-605-0402

morning neck pain

Three Causes of Morning Neck Pain and What to Do

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Waking up with morning neck pain puts a huge damper on your day right from the start. While neck pain may not be at the top of the list when it comes to debilitating musculoskeletal problems (aka people tend to just “live” with it) – it still impacts between 10-20% of the population at any given time – so it’s worth discussing. 

One of the most common problems I see with those suffering from neck issues is that seemingly out of nowhere they can go to bed feeling great – but wake up with a stiff and painful neck that can last up to a day or two. When this pattern starts to repeat itself and goes on for too long – you can end up with a chronic neck problem that doesn’t just show up in the morning – but will start to impact your day-to-day life and get in the way of things you love to do.

Here are Three Common Causes of Morning Neck Pain and What you can Do:

1. Sleeping position

Any joint – including those that make up your neck – will feel strained after being in a prolonged position for too long. In a healthy, uncompromised neck – this is fine if it happens on occasion. But if it’s happening once per month or more – it’s time to address your sleeping position.

Those that like to sleep on their stomachs, or with multiple pillows under their head, are going to have the biggest problems. When you sleep, you want to get your neck as close to what I call a “neutral spine” as possible. That means your neck feels relaxed, maintains its natural curves, and your ears, neck, and shoulder will be aligned on top of one another.  I find the best way to achieve this is by sleeping on your side – or on your back with just one pillow. If you’re a multi-pillow type of person – make sure you’re using the second pillow to hug and support your arm – or in between your legs – not underneath your head.

2. Clenching Your Teeth

While many people tend to associate clenching your teeth with TMJ – or jaw dysfunction, it can cause neck problems as well. When you clench your teeth, you’re also tensing the muscles around your neck. If you do this every night, and for prolonged periods, your neck is going to become very unhappy and start to have problems of its own.

Many folks are unaware they are clenching their teeth at night. But some signs this could be happening to you  include tense or fatigued jaw muscles in the morning, walking up with headaches, or a stiff and painful neck and shoulder when you first wake up. Clenching teeth is often a reaction to stress – so having a good end of day routine could really help with this problem. Be sure to shut off TV and electronics at least one hour before bedtime. Practicing some meditation and/or relaxation breathing just before bed could help too. If all else feels, a night guard could help as well. It won’t stop you from clenching completely, but it will protect your teeth and could minimize your neck pain.

3. A Bulging Disc

This isn’t spoken about too often, but if you’ve got a bulging or problematic disc in your neck – this could be the reason you’re waking up with a stiff and painful neck in the morning. When you lie down and “unload” your spine for a period of time – such as at night while sleeping – our intervertebral discs hydrate and actually get larger. If you wake up with a sudden movement – this could be all it takes to “pinch” that disc and cause your neck to feel “locked up” and with sudden pain.

Now, don’t feel like you need to go running to the doctor for an MRI to figure this out. It’s not necessary. Most people have bulging dics occurring normally as they age throughout their entire spine. They only become a problem when you don’t take care of your spine. When it comes to your neck, the biggest risk factors for turning a normal bulging disc into a painful and problematic one include behaviors such as looking down at your phone, tablet, or computer for too long and not being respectful of the fact that a healthy neck needs to move in all directions – not just forward and down. Doing some simple chin tucks frequently throughout the day and making sure your upper back stays flexible can go a long way in preventing (normal) bulging discs from becoming a problem.

I hope these tips help shed some light on why you might be waking up with morning neck pain and most importantly – what you can do about it. If you try some of these remedies and still find yourself unsuccessful – then it’s time to talk to a mechanical pain expert. There’s no need to rely on pain pills or expensive tests and procedures to resolve morning neck pain. Most of the time, problems like I’ve just described can 100% be resolved naturally and with the right “movement therapy”.

Are you local to Portsmouth, NH?

Consider speaking to one of my specialists. Tell us everything that’s been going on with you, and determine for yourself if we’re the best people to help you.

It’s a completely free, no-obligation appointment that will give you all the information you need to make the BEST decision for YOUR health – whether that’s working with us or not!

Click here to book a free Discovery Visit.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of one of her guide to neck and shoulder pain CLICK HERE or to get in touch, email her at [email protected].

Shoulder Impingement Syndrome

Shoulder Impingement Syndrome – Treat the cause not symptoms

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Have you ever had pain in your shoulders when you try to raise your arms overhead, pull off a sweatshirt, grab a gallon of milk from the fridge?  Or place grocery bags on the counter?  You were likely dealing with shoulder impingement syndrome – also known as rotator cuff impingement.

They call it impingement syndrome because your rotator cuff tendons literally get “impinged” between the round head of your shoulder joint and a hook-shaped bone in the front of your shoulder joint (called the acromion) that is part of your shoulder blade.

This can occur for a number of reasons…

You could have a deformity that causes this, an injury could lead to this, arthritis could contribute to this, or poor posture can cause it.

Any of these scenarios can cause crowding in the space where your rotator cuff tendon passes in front of your shoulder. If this happens often enough – it’s going to get irritated every time you raise your arm past 90 degrees.

When this first begins to happen, it will typically cause acute inflammation. You may be diagnosed with rotator cuff tendonitis. But eventually, the more constant pain and irritation of tendonitis subsides and you only feel pain when you go to raise your arm or reach in certain directions.

This is more commonly known as shoulder impingement.

With the exception of a deformity, almost all cases of shoulder impingement can (and should) be resolved naturally.

The tempting and easy fix is to get a cortisone shot to calm the inflammation.

But what you need to understand is that impingement syndrome – in most cases – is actually the symptom of a more overarching problem. And injecting the tendon with cortisone will often cause more harm than good.

The cortisone will temporarily mask your problem. It will eventually cause damage to your tendon if you keep getting injections. Remember, impingement is caused by crowding of the space where your tendon passes through. You can temporarily take the inflammation away and it will feel better. But, unless you address the reason for the crowded space, your problem will keep coming back.

So how do you naturally get rid of shoulder impingement for the long term?

First, you must address the reason for the crowded space in your shoulder joint where your tendon passes through. Most often – it’s due to poor postural habits and immobility around your shoulder joint – specifically your neck and upper back.

For example, if your upper back is stiff, curved, and lacks adequate mobility – it’s going to impact how your shoulder blades move and are positioned.

With a stiff and curved upper back, your shoulder blades will respond by moving out and up. This scenario makes that hook-like bone (the acromion) sit more forward and down than it should. When this happens, there isn’t enough room for your tendon when you lift your arm above shoulder height. The bony surfaces above and below your tendon create friction and this eventually turns into pain and inflammation. This can happen slowly over time. Or, more quickly if you’ve got something like arthritis where that space might have naturally already narrowed.

Another common scenario is after a shoulder injury. Your neck and upper back may have learned to compensate for a time while you were healing from your injury. The result is some unwanted postural deformities that can lead to impingement of your rotator cuff tendon.

When it comes to shoulder pain, always make sure to examine your neck and upper back FIRST.

If there are poor postural habits there, your shoulder will undoubtedly be impacted.

If you really want to get rid of your shoulder impingement – and back to lifting, reaching, and carrying things without any worry – it’s essential that you identify and address the root cause, not just the symptoms (inflammation of the tendon).

Next time you go to the doctor complaining of shoulder pain – and you hear the words “impingement syndrome” or “rotator cuff tendonitis” – don’t assume you need rest, ice, a cortisone shot, or surgery to resolve it.

None of these solutions will give you the long-term solution you’re looking for.

The very last thing you want to do is choose passive treatment interventions or procedures. These either mask the pain or prolong the problem because they only address symptoms.

You want to do everything possible to preserve the integrity of your tendon. The best way to do that is by optimizing the mobility and strength around your shoulder joint first. Do this before resorting to more aggressive measures like cortisone or surgery.

Are you currently suffering from shoulder pain (or anything else) that is keeping you from doing things you love?

Are you contemplating surgery or a cortisone shot because you have been told it’s your best and only option?

Let me know and let us help!

We’re happy to provide a second opinion for you.

We will examine your shoulder and see how it responds to certain movement tests. Then we’ll be able to tell you – and show you – if your problem can be resolved naturally with movement instead of a procedure like a cortisone shot or surgery.

Our patients find that if they end up needing a procedure (which is rare) – they do so with peace of mind. This is because they’ve exhausted a natural, movement-based solution with us FIRST.

If you want to talk to us and see if what we do is right for you – CLICK HERE to request a Discovery Call with my client success team.

They’ll let you know if we can help and get you on our schedule as quickly as possible!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of one of her guide to neck and shoulder pain CLICK HERE or to get in touch, email her at [email protected].