Supporting Research
When treating my patients it is important to me to demonstrate why their pain is most likely NOT related to a structural defect.
I have provided links below to a number of studies for each body part that demonstrate that things like rotator cuff tears, bulging/herniated discs, meniscus tears, & arthritis DO NOT solely cause pain.
I have also provided several studies that demonstrate that placebo surgery is just as effective as real surgery, further demonstrating that structure is not the cause of pain.
There is much more to pain than structure and the more my patients recognize that, the faster they heal!
The Spine:
Conclusions: ‘Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient's clinical condition.’
Conclusions: ‘The correlation between degeneration severity found in imaging study and symptom severity of Low Back Pain remain unclear. This consequently results in an insignificant correlation between the degenerative changes found on MRI or other imaging studies and the presence and severity of Low Back Pain.’
Conclusions: ‘On MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions but not extrusions. Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.’
Conclusions: ‘The findings on magnetic resonance scans were not predictive of the development or duration of low-back pain. Individuals with the longest duration of low-back pain did not have the greatest degree of anatomical abnormality on the original, 1989 scans. Clinical correlation is essential to determine the importance of abnormalities on magnetic resonance images.’
Conclusion: ‘In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms.’
The Shoulders:
Conclusions: ‘An astonishingly high rate of rotator cuff tears in patients with asymptomatic shoulders was thus demonstrated with increasing patient age. At this stage it remains unclear, however, which parameters convert an asymptomatic rotator cuff tear into a symptomatic tear. As a result, rotator cuff tears must to a certain extent be regarded as “normal” degenerative attrition, not necessarily causing pain and functional impairment.’
Conclusions: ‘The profile of age-related degenerative rotator cuff disorders fails to correlate systematically with self-reported nontraumatic shoulder pain, particularly in older age; thus, it appears that degeneration should not be considered the primary source of the pain. Physical activity may play an important role in the production of the pain, a theory that warrants further study.’
Conclusions: ‘Shoulder pathology is apparent in both symptomatic and asymptomatic shoulders and clinical symptoms may not match radiological findings. The cost burden of ordering MRI scans is significant and the relevance of the findings are questionable when investigating shoulder pain.’
The Hips:
Conclusions: ‘MRIs of asymptomatic participants revealed abnormalities in 73% of hips, with labral tears being identified in 69% of the joints. A strong correlation was seen between participant age and early markers of cartilage degeneration such as cartilage defects and subchondral cysts.’
Conclusions: ‘Overall, 30 of 39 (77%) asymptomatic hockey players demonstrated MRI findings of hip or groin pathologic abnormalities.’
The Knees:
Conclusions: ‘The results of our study show an equal to or higher prevalence of meniscal lesions in male professional basketball players than previously reported in the literature. We found a large number of patella-femoral articular cartilage lesions in our study population of male professional basketball players. These athletes perform at the highest demand level, which indicates that the presence of these lesions did not cause any symptoms.’
Conclusions: ‘Nearly all knees of asymptomatic adults showed abnormalities in at least one knee structure on MRI. Meniscal tears, cartilage and bone marrow lesions of the patellofemoral joint were the most common pathological findings. Bucket handle and complex meniscal tears were reported for the first time in asymptomatic knees.’
Conclusions: ‘In asymptomatic subjects, MRI shows an increasing prevalence of meniscal alterations which correlates with age. Especially in subjects older than 50 years, a significant number of meniscal tears must be expected. This shows the potential danger of the use of MRI alone as a basis for the determination of surgical intervention.’
Surgery is not the only answer to your pain!
Placebo surgical intervention is just as effective (sometimes more effective) as real surgical intervention as demonstrated by the studies linked below:
Conclusions: ‘This review suggests that sham surgery has shown to be just as effective as actual surgery in reducing pain and disability.’
Conclusions: ‘Arthroscopic Shoulder Decompression provided no benefit over placebo (diagnostic arthroscopy or exercise therapy) at 5 years for patients with shoulder impingement syndrome.’
Conclusions: ‘In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure.’
Conclusions: ‘Surgery had similar effects to sham surgery on pain, function and range of motion in the midterm. Physiotherapy was as effective as surgery both in the midterm and long term for pain, function, ROM and tendon force, and pain, treatment success and quality of life, respectively.’
Conclusions: ‘With the number of available participants, this study failed to show additional benefit of the surgical excision of the degenerative portion of the ECRB over placebo surgery for the management of chronic tennis elbow.’
