Most of us probably know someone who has had arthroscopic surgery for a meniscus tear of the knee. The reason the surgery is done is was believed that the tear in the meniscus would interfere with the function of the joint. When arthroscopic surgery was developed years ago, it revolutionized this procedure and improved the outcomes for those who had it done.
As with most medical procedures, patients are rarely if ever followed up months or years after the procedure and rehab was done. This will be changing this year with the Centers for Medicare and Medicaid (CMS) patient centered care formula’s that will be requiring follow up on procedures such as these because procedures are assumed to be effective, rather than proven to be effective. We as a society are moving toward evidence based practice; is your doctor?
Recently studies on arthroscopy which is a common procedure both in the USA and Britain are showing that the results of surgically treating these tears may not be very effective at all, and that the placebo effect may be one of the main reasons for perceived benefit, after the swelling and discomfort from the procedure goes away. In other cases, patients may have had this procedure done a few times over the years as they develop more tears.
It has also been found recently that exercise can dramatically improve the symptoms of knee pain as well or better than arthroscopy itself.
To understand why this is so, we must understand that the knee is just a conduit of force, or a pulley which uses the kneecap for leverage. Forces are transmitted from the foot through the knee into the hip and through your core muscles as we move forward while walking. If this mechanism is compromised, and often knee pain sufferers have biomechanical inefficiencies that are inherited, as explained in the book Cheating Mother Nature, what you need to know to beat chronic pain, it will affect motion in the foot, hip and pelvis, as well as the important fascia which guides movement. These forces will impart additional strains to the knee, increasing the probability of a knee problem or meniscus tear developing with normal activities or during athletic participation.
Most people who have had knee problems know that the orthopedic doctor will look at the knee, probably order and MRI and even may suggest arthroscopy as a necessary return to normal pain free function. Does this make sense when the problem involves the other parts of our body and how can we diagnose a knee problem without looking at the feet, gait, hip function and core stability? Perhaps this is why this current study is suggesting that exercises can get the same or better outcomes for knee pain at a lower cost.
While simply adding exercises sounds logical, is it really enough or are there other things that should be considered to improve the likelihood of success?
Four things you should consider doing now if you experience knee pain and have been told you have a meniscus tear.
- Wear a good off the shelf orthotic such as power step or superfeet. Do they reduce your pain?
- Do core stability exercises such as planks, lateral leg raises and hip extensions. These will help strengthen the supporting muscles that can affect your knees. Do you feel better after doing these?
- Perform foot drills. These strengthen the intrinsic muscles in the calf that affect your feet, knees and core.
- See your sports certified chiropractor. They will be more holistic in their approach to the way your walk and how you move, which is important to determining which exercises will work best and if a joint or joints in the feet, hips and pelvis are not functioning properly, they will use manipulation to restore normal movement patterns.
Does exercise work on everyone; no, however, it does work on most. For most people with a meniscus tear, the tear itself and the forces that caused it are often just the symptom, while the mechanism that created it which includes how we are built, how we stand and how we move should be considered to properly evaluate and recommend any intervention for back pain. By looking at just the knee, we are simply missing the point of why the tear exists. Treating the tear surgically may help in some cases, however, it is logical that removing the mechanical strain from the knee with exercise, manipulation and proper management is most likely to offer the best result both now and years into the future.
Cheating Mother Nature is available through Amazon.com and other booksellers.