Last week I read a provocative online article online The New York Times. Entitled "Why Useless Surgery Is Still Popular", author Gina Kolata investigated the lack of scientific evidence to back the success or efficacy of surgery to repair torn meniscus in the knee and offset pain. Perhaps shocking to many, she then also discussed similar lack of research findings backing the success of the use of spinal fusion and vertebroplasty surgery to offset back pain.
As a Corrective Exercise Specialist, I was not at all surprised.
As Kolata explained, surgical procedures are not regulated in the same way drugs are before going to market. When surgical procedures fail to produce measurable success in clinical trials, the procedure is not always taken off the market and is offered as a treatment option to patients.
Because this is the current standard, and nothing regulating surgical efficacy, it falls on the patient to investigate and do the research on alternative options to having surgery if they are faced with the situation.
"Surgery was no better than alternative nonsurgical treatments, like supervised exercise and therapy to help patients deal with their fear of back pain. In both groups, the pain usually diminished or went away."
and offers a conclusion from Dr. Gordon H. Guyatt, professor of medicine and epidemiology at McMaster University in Hamilton, Ontario. Dr. Guyatt states:
“We have randomized clinical trials that produce the highest quality of evidence. They strongly suggest that the procedure is next to useless. If there is any benefit, it is very small and there are downsides, expense and potential complications.”
However, there will be many who are polarized in their opinion on this piece simply because each case is unique, and most assuredly, some will heal completely from said surgeries. My intent here is not to cause controversy, or make an individual who has had success feel badly, but simply to discuss.
Torn cartilage in the knee is extremely common as an individual ages, and many believe it so common it is an expected part of the aging process. With the rise of arthroscopic surgery offered as primary treatment option for a torn meniscus, this may be just one of many reasons an individual may question the value of actively treating knee pain associated with a torn meniscus with a therapeutic corrective exercise program.
Danish scientists decided to test it for themselves. Researchers compared the efficacy of a 12 week exercise program to arthroscopy surgery in clinical trial to evaluate common treatment options for knee pain due to a torn meniscus. And the results back up Kolata's findings as well.
The 12 week therapeutic exercise program was designed to strengthen and re-balance the muscles around the knee joint and incorporated more balance and functional movement patterns for the body to move within to meniscal repair surgery.
There was NO DIFFERENCE between the two treatment options. The rate of knee pain relief in the surgical patients was not any better than those who participated in a corrective exercise program. However, the subjects in the exercise program did report an increase in muscle strength and not susceptible to complications subject to surgery.
Most interesting to me, was that researchers gave the exercise test subjects the option to go ahead and have arthroscopic meniscal repair surgery after their 12 weeks of exercise therapy if they were not happy with their results.
Approximately one out of every 5 in the exercise group went ahead and had the surgery. And the results were (in my opinion) astonishing!
The individuals from the original therapeutic exercise group who later had surgery after the trial ended reported NO IMPROVEMENT at all! The surgery was in effect, "useless".
If you're interested, you listen to Dr. Norman Swan's Health Report podcast interview with the doctor responsible for the research. Dr. Swan discusses the findings with Dr. Nina Kise on ABC Radio Nation  and the full transcript is available as well.
From my professional experience, none of this is news to me. I've worked with many clients over the years who have had failed or unproductive surgery to repair the knee meniscus, and other areas like the lumbar spine, hip and shoulder.
Unfortunately, and often very frequently these clients experience a return of the pain, and the meniscus is subject to tearing again, or pain moves to another area of the body.
Repairing the meniscus without correcting the underlying imbalances in the joints, muscles and connective tissues that act on and cross the knee joint leave it as vulnerable as ever to the natural wear and tear patterns caused by said imbalances.
As illustrated in the picture above, this is the ideal positioning of a healthy, functional knee joint. Rarely will a knee look or function like this once pain and a potential meniscal tear occur.
When you look at the failure to prove success in the majority of these surgeries, I'm in agreement that most times a surgical option for repair is not necessary.
Why? In my opinion the underlying cause of the damage is not addressed. If you do not correct the imbalances within the body causing the bones and muscles to work out of their designed function, the body will break down and experience pain.
Pain is a Signal
Think of pain as the body’s built in early warning signal system.
Any kind of damage or stress to the body’s bones, muscles, cartilage, tendons, ligaments, joints or connective tissues and left unattended to results in a the nervous system signaling pain.
Pain the only way our body can tell us that something is wrong, out of balance and that care and correction is required. Yet the culture we live in teaches us to simply avoid pain. We're not taught to understand and respect common muscle and joint pain as the body’s early warning system calling for attention in protecting the musculoskeletal system.
It is common practice to alleviate such pain using painkillers, however, would you want to shut off the car alarm system just because it is loud & annoying? Alleviating pain with pills or surgery is like silencing the body alarm that highlights a dysfunction without catching the vandal. While pain is a physical discomfort, musculoskeletal damage is the cause and requires the needed attention.
Make corrections to the imbalances, pain diminishes as function is restored. In my experience, when you change the position of joint alignment towards it's design and function the muscle-length tension relationship returns to proper balance in the three planes of movement. Function improves, faulty movement patterns are corrected and ultimately, pain goes away.
Sounds simple. It is, BUT ..... it does requires the individual to make 3 Important Changes to Overcome Chronic Muscle & Joint Pain.
- Look at the pain from a larger whole body perspective. If you are unaware of how your body alignment should be organized and function in daily life and athletics, you can't fix it.
- Want to change. It takes a willingness to change your movement habits from a phycho-social-emotional perspective.
- Do the work required. The clients have to get the corrective exercise done.
There are many corrective exercise solution options available to individuals. In addition to corrective exercise, other modalities like Foundation Training, yoga and Pilates can also be beneficial. Interestingly, Shirley Archer reported in the July-August 2016 edition of IDEA Fitness Journal, that The American Academy of Orthopaedic Surgeons recommends stretching programs like yoga and Pilates. Researched-based findings report that those modalities provide:
- less back and joint pain
- better circulation
- improved joint motion
- better athletic performance
- improved muscle health
Ultimately, it comes down to the individual and her/his choice of what program is right for them. Partnering with a certified professional who is well versed in posture assessment, muscle and joint alignment, and how to teach and train a client towards a restorative process can be as successful (or more) than surgical intervention.
What choice a person makes if they are faced with knee pain due to a torn meniscus should be made on good information. Clearly weighing the cost-benefits of that choice is definitely worth doing before considering a surgical intervention.
Why 'Useless' surgery is Still Popular retrieved from http://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-operation-is-next-to-useless.html
- Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients retrieved from http://www.bmj.com/content/354/bmj.i3740
- What's best for busted knees? on Health Report with Norman Swan retrieved from https://radio.abc.net.au/programitem/pgoMGry5B7?play=true
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Stock Photo Credit: Shutterstock.com
Head Photo Credit: Melissa Thome Photography
Author: Deb Preachuk is a Certified Foundation Training & STOTT Pilates Instructor, Corrective Exercise & Posture Alignment Specialist, and the founder/owner of Pain Free Posture MN.
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