Joint Surgery For Pain - Read This First!

Did you know that orthopaedic surgeries can be performed on patients without any clinical proof that they actually work?!

In fact there's a growing body of evidence that many of the most commonly performed joint surgeries have no more success in relieving pain and restoring function than a placebo treatment.

A 2021 meta-analysis study (1) published in the BMJ (British Medical Journal) states that musculoskeletal conditions accounted for over 25% of all surgeries performed by the NHS.

This same study found that the 10 most popularly performed orthopaedic surgeries did not have high quality, randomised clinical trials to back up whether they worked or were more effective than conservative treatments or a placebo procedure (sham operation).

And yet the public is still being told that invasive surgeries are the best and, in some cases, only way to relieve musculoskeletal pain by medical practitioners.

The most commonly performed orthopaedic surgeries are:

• Knee - arthroscopy 
• Spine - lumbar fusion
• Shoulder - rotator cuff repair

1) Knee Arthroscopy

The 2021 BMJ analysis (1) found that arthroscopic repairs for traumatic meniscal tears was slightly more effective than non-surgical treatments, but arthroscopy for degenerative wear and tear did not work any better than conservative methods, such as a supervised exercise programme.

In 2017 (2) the BMJ published this clinical guideline for treating degenerative knee pain with the following recommendations:

• We make a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease, based on linked systematic reviews; further research is unlikely to alter this recommendation

• This recommendation applies to patients with or without imaging evidence of osteoarthritis, mechanical symptoms, or sudden symptom onset

• Healthcare administrators and funders may use the number of arthroscopies performed in patients with degenerative knee disease as an indicator of quality care.

And yet knee arthroscopies are still being pushed as the first line of treatment for chronic knee pain.

2) Lumbar spine fusion

Lumbar spine fusion used to performed routinely for degenerative disc disease. Fortunately it's on the decline and isn't usually offered as the first choice treatment option.

In my experience of training clients who've had spinal fusion surgery they've all had varying results from their op, but also complications and movement compensations that can be directly attributed to the surgery.

A 2005 RCT (randomised clinical trial) looked at 349 patients aged 18 to 55 years with chronic low back pain of at least 1 years duration and who were considered suitable candidates for surgery (3).

Half were assigned to spinal fusion surgery and half enrolled on a rehab programme based on CBT principles. Both groups were followed up after 2 years.

The trial found that both groups reported a reduction in disability, possibly unrelated to either intervention. There was no significant difference between the 2 groups.

3) Shoulder Rotator Cuff Repair

The story is similar with the shoulder. 

An interesting 2015 research article (4) published in the American Journal of Sports Medicine found that 26.6% of repaired rotator cuffs showed a tear on MRI scans taken 23 months post surgery. 

Even more interesting was that patients felt they had recovered even if their rotator cuff showed a post-op re-tear on MRI.

In other words, the patients in this American study believed that their shoulder was better even if the rotator cuff looked exactly the same before and after surgery!

Another point to consider is that some surgeries to relieve chronic shoulder pain involve removing some of the structure responsible for stabilising the shoulder complex.....hmmm!

Why Aren't Orthopaedic Surgeries As Effective As They're Made Out To Be?

When you get a diagnosis or a scan image showing damage to a body part, such as knee osteoarthritis, spinal disc degeneration or a shoulder tear or impingement, you tend to attribute all your pain to that finding.

A story begins to form - "If I can fix my osteoarthritis / dodgy disc / torn shoulder I'll get out of pain".

So you look for anything that will treat the problem body part, and surgeries are often promoted as the best / only way to repair the damaged joint.

This viewpoint is reinforced by doctors, surgeons, physiotherapists, chiropractors and soft tissue therapists who are trained to treat musculoskeletal injuries and chronic pain according to a simple structural, biomechanical model.

This totally ignores the neurophysiological aspects of pain, movement compensations and long-term injuries, such as sensory motor amnesia, central sensitisation, hypervigilance and cell oxidative stress.

Caveat:

This blog is not meant to make a blanket statement that all orthopaedic surgeries are useless, or that people never get any relief from these operations.

Of course there are times when surgical repair is necessary or the best option based on an individual case by case basis.

But orthopaedic surgeries are expensive, there are often long waiting times on the NHS, invasive and not without risk of infection developing in the joint. 

They also require a structured, supervised post-op rehab programme. This is rarely included with the NHS, and paying for months of private physiotherapy and training is costly.

What Can You Do?

• Do your due diligence about your injury - educate yourself as much as possible
• Read up about chronic pain - check out my other blog articles HERE
• If you're offered surgery, take time to sit down with your surgeon to discuss in detail what the procedure involves, the benefits vs risks and the recovery time. Don't be afraid to ask for clinical proof that the proposed operation is actually as effective as promised.
• Investigate conservative alternatives to surgery.

Introducing The Befriend Your Body (BYB) Method.....

The BYB Method is a unique and effective system for finding lasting relief from pain. It addresses the different components that feed persistent and recurring pain.

The 4x pillars of The BYB Method are:

• Body - simple explorations of movement patterns that your body is designed to do naturally but may have changed with lifestyle, work or injury
• Breath - an easy breathing technique to reset the nervous system back to a state of safety and upregulate the parasympathetic nervous system for healing
• Be - addressing your habitual beliefs, thought patterns, emotional patterns and response to pain, your body and movement
• Bond - using connection to bring the nervous system back to a balanced, safe state

The BYB Method provides a framework to help you find your pain-free body by addressing unconsciously held patterns of muscle tension that leads to persistent pain. This is a phenomenon known as sensory motor amnesia (SMA).

The BYB Method involves simple exercises and explorations that can be done in the comfort of your home, without the need for additional expensive equipment or supplements. 

These movement practices to relieve muscle tension and pain can take as little as 10 minutes a day.

NEXT STEPS

• Book into a Stretch, Yoga or Pilates class with me - these are a good introduction to The BYB Method: A Roadmap to Finding Your Pain-Free Body.
• ** COMING SOON ** Free guide "How To Relieve Back Pain & Muscle Tension in Just 10 minutes a Day"
• Attend a mind-body retreat - these are deeply relaxing, fun, social small group experiences typically held in various locations within easy reach of Worthing, West Sussex. The next retreats are "Rest & Reflect" half-day winter retreat on Sunday 3rd December (FULL) and "Sun & Moon" mini retreat on Sunday 17th December (5x spaces). Click HERE to read more about them,
• Look out for new resources and workshops, coming soon to help you find your pain-free body
• Subscribe HERE to receive "The Movement Chronicle", a weekly e-newsletter delivering mobility and pain reduction tips directly into your inbox every Monday morning,

To find out more about my classes and retreats, or to join my email list you can contact me via any of these channels:

• Email at norma.pearson1@ntlworld.com
• DM me on Facebook Messenger 
• WhatsApp message to 07801 867361.

Study Links

1. Blom A W, Donovan R L, Beswick A D, Whitehouse M R, Kunutsor S K. Common elective orthopaedic procedures and their clinical effectiveness: umbrella review of level 1 evidence BMJ 2021; 374 :n1511 doi:10.1136/bmj.n1511 https://www.bmj.com/content/374/bmj.n1511
2. Siemieniuk R A C, Harris I A, Agoritsas T, Poolman R W, Brignardello-Petersen R, Van de Velde S et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline BMJ 2017; 357 :j1982 doi:10.1136/bmj.j1982 https://www.bmj.com/content/357/bmj.j1982
3. Fairbank J, Frost H, Wilson-MacDonald J, Yu L, Barker K, Collins R et al. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial BMJ 2005; 330 :1233 doi:10.1136/bmj.38441.620417.8F https://www.bmj.com/content/330/7502/1233
4. McElvany MD, McGoldrick E, Gee AO, Neradilek MB, Matsen FA. Rotator Cuff Repair: Published Evidence on Factors Associated With Repair Integrity and Clinical Outcome. The American Journal of Sports Medicine. 2015;43(2):491-500. doi:10.1177/0363546514529644 https://journals.sagepub.com/doi/abs/10.1177/0363546514529644