Rejuv Medical

Alternatives to Surgery – The Conservative Approach

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by Michael Meighen, MD Board Certified Physiatrist & Regenerative Medicine Specialist

02/12/20 

Get Your Life Back with Out Drugs or Surgery – The Rejuv Advantage

Any doctor will agree, treatments should start with conservative care before progressing to invasive, riskier surgeries.  But what that progression looks like depends on whose clinic you walk into.  If you feel like you’re being pushed to surgery as your “only option”, we’ve created a sample flow chart for step-wise treatment of joint pain to make you a more informed consumer.

                1. Rest!  Listen to your body.  Many injuries in the active population are overuse and will improve with rest.  Even better– Cross train!  Cross training for running should focus on glutes and hip flexor muscles.  This could involve elliptical at high cadence, stationary bike at a high resistance standing on the pedals, or aqua jogging.  If doing a lot of weight lifting, scale back to more aerobic circuit training or body weight exercises focusing on core strength. 
                2. Muscle tightness is commonly the root of back aches or headaches.  Many doctors recommend muscle relaxers for this, but they often cause sedation.  Most Americans are low in Magnesium, as it is found in leafy greens and is poorly absorbed.  Low magnesium causes muscle cramps and spasms, so try starting a magnesium supplement.  Also focus on hydration, keeping a bottle of water on hand throughout the day.  Getting checked for other deficiencies like Vitamin D, B12, or thyroid hormone can identify other causes of chronic achiness and fatigue.
                3. If you do need to reach for an over-the-counter pain medication, go with Tylenol rather than NSAIDs.  Tylenol works on the brain and doesn’t influence your healing response.  NSAID medications- like Aleve, Naproxen, and Ibuprofen- block the healing response and lead to decrease muscle rebuilding after exercise.  Many doctors, looking for another conservative step, recommend prescription strength NSAIDs like Meloxicam.  We do not recommend these due to increased risk of stroke, heart attack, kidney disease, and stomach ulcers, in addition to blocking your healing as above.  Opioids are not effective for chronic musculoskeletal pains, as the brain becomes desensitized to their pain-blocking effects and addiction set in. 
                4. Physical Therapy. Extremely valuable when delivered by a certified Physical Therapist evaluating the full kinetic chain.  In addition to strengthening the muscles around a painful joint, they should also be evaluating how you move, such as lifting or running technique, postural control, and neuromuscular activation of underused stabilizing muscles.  They also have modalities such as active release therapy, taping, and ultrasound that can help speed recovery. 
                5. This step is often missed.  There are many effective braces to help stabilize joints and allow them to move in ways that don’t cause pain.  These may be used in combination with other treatments to prevent the need for surgery and allow you to remain active. Unfortunately, the soft neoprene knee sleeve is not giving much support, and copper’s effect is overstated. 
                6. Cortisone shots. This is often the only step offered between NSAIDs and Surgery.   But steroids have actually been shown to be toxic to cartilage cells, leading to faster degeneration of the joint and increased need for knee replacement, sooner.  They also decrease your healing, just like the NSAIDs do.  We do not recommend this as a treatment for a chronically degenerated joint or for an acute injury, but they are commonly done because insurance covers it and they can provide partial relief for 2-3 months. 
                7. At this point, patients are often told there is no choice besides narcotic pain meds or surgery. Sometimes a “clean out” surgery is offered as a more conservative option.  Such procedures remove degenerated-looking tissues whose job it is to stabilize the joint and buffer the cartilage (usually labrum or meniscus).  However, many people have such degeneration but no pain, and removing these tissues leads to rapidly progressing arthritis and the need for joint replacement.  Do not fall into the trap of thinking that a “clean-out” arthroscopic surgery is a normal housekeeping type procedure to make the joint healthier.  They may be conservative relative to a joint replacement, but they do have downsides.

6.5.  Regenerative Treatments.   The forgotten step of conservative care, treatments like Stem Cells and Platelet Rich Plasma (PRP) use your body’s own healing cells to repair degenerated tissues.  They are often not even mentioned by doctors because they themselves do not have the training or lab abilities to process or inject your cells.  Much of the research on these effective treatments has been done in the past 10 years- perhaps your doctor hasn’t read the literature lately.  Or perhaps they make assumptions about the effectiveness or value of the treatments based on insurance coverage.  But insurance companies are in the business of making money, and many covered procedures are ineffective or even harmful in the long term.  Compared to paying for a cheap procedure (like steroid shots) or a rare procedure (like replacement), insurance won’t profit by providing preventative regenerative treatments earlier in the course of disease for a larger number of patients.   But if it’s my knee being pushed towards the operating table, I would reevaluate my options and take the road that’s in my best interest, not in the interest of my insurer or my hospital system.  Follow the link below for more information on regenerative treatments for orthopedic conditions: www.rejuvmedical.com/orthopedics-sports-medicine/

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