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Chronic Pain

Can the Meniscus Heal without surgery?
Can the Meniscus Heal without surgery? 900 600 ResilientRx

When it comes to knee injuries, meniscus tears are a very common diagnosis and occur across multiple age groups. It’s estimated that the annual incidence of meniscus tears ranges from 60 to 70 cases per 100,000 people. The menisci are two C-shaped pieces of cartilage that play a vital role in cushioning and stabilizing the knee joint. Meniscus tears can occur generally in 2 ways: due to acute trauma or due to degeneration. Acute injuries involve twisting or impact while degenerative tears can occur due to factors such as lifestyle, general health (comorbidities), prior injuries, and genetics. Approximately 35% to 50% of individuals over the age of 65 have meniscus tears. In contrast, traumatic meniscus tears from sports or other physical activities are more frequently seen in adolescents and young adults. For both traumatic or degenerative tears, individuals can experience pain, swelling, limited mobility and impaired function.

It may seem that surgery is the only answer to fix these issues, however emerging research suggests that conservative management is a very viable alternative to surgery in MANY cases. In this blog, we will delve into the topic of meniscus tears and explore the growing body of evidence that supports conservative management over arthroscopic surgery. In fact, outcomes tend to be the same, if not better, when people rehab their knee instead of jumping right to the operating table.

Conservative Management: The Evidence

A robust body of research exists that shows the effectiveness of conservative management is just as good, if not better, than arthroscopic knee surgery, which includes physical therapy (exercise), activity modification, and pain management. Briefly summarized below are some key research findings in support of a conservative approach:

The FIDELITY Trial:
FIDELITY (Finnish Degenerative Meniscal Lesion Study) trial evaluated the outcomes of arthroscopic surgery versus sham surgery (placebo) for degenerative meniscal tears. The results revealed that there were no significant differences in pain or functional improvement between the two groups at 12-month follow-ups.

ESCAPE Trial:
The ESCAPE research group looked at nonobstructive degenerative meniscus tears in patients over the age of 45, and compared arthroscopic partial meniscectomies to physical therapy. They found no significant or clinically relevant difference in knee function at 5-year follow up between the two groups. The findings of this trial support the recommendation that exercise-based physical therapy should be the preferred treatment over surgery for degenerative meniscal tears.

The METEOR Trial:
The Meniscal Tear in Osteoarthritis Research (METEOR) trial focused on patients with meniscal tears and knee osteoarthritis. The study compared the outcomes of arthroscopic surgery with those of physical therapy alone. Surprisingly (or not surprisingly), the results showed that physical therapy alone was as effective as surgery in improving pain and function at 6-month and 12-month follow-ups.

The Benefits of Nonsurgical Treatment

Conservative management offers several advantages over surgery for meniscus tears, including:

Avoiding unnecessary risks: Arthroscopic surgery carries inherent risks such as infection, blood clots, and anesthesia complications. Opting for conservative management reduces exposure to these risks.

Cost-effectiveness: Surgery can be costly, especially when factoring in pre-operative assessments, post-operative care, and rehabilitation. Conservative management offers a more cost-effective alternative.

Preserving meniscal tissue: The menisci play a crucial role in knee function and joint stability. By avoiding surgery, there is a higher chance of preserving the meniscal tissue, reducing the risk of long-term complications such as osteoarthritis. In fact, patients who undergo meniscectomies increase their likelihood of needing total knee replacement down the road.

Faster recovery: Surgery typically requires a more extended recovery period, involving restricted movement and rehabilitation. Conservative management allows patients to engage in tailored physical therapy programs that can promote faster recovery and return to normal activities.

Summary

Surgeries (even simple, less invasive ones like knee arthroscopies) always come with potential risks and complications, and could lead to accelerated progression of knee osteoarthritis later in life. Individuals with significant, obstructive meniscus tears (i.e. knee locking) may still require surgical intervention. However the research is very convincing that most meniscus tears, especially degenerative, are better treated with a nonsurgical approach and that arthroscopic surgery is not superior to physical therapy intervention.

Have you been diagnosed with a meniscus tear or have ongoing knee pain? Schedule an appointment with one of our Doctors of Physical Therapy to get you back to doing the things you love! CLICK HERE or call 512-777-0330.

References:

Hede, A., Jens|n, D. B., Blyme, P., & Sonne-Holm, S. (1990). Epidemiology of meniscal lesions in the knee: 1,215 open operations in Copenhagen 1982-84.Acta orthopaedica Scandinavica. 1990; 61(5): 435-437.

Goyal, D., Keyhani, S., & Lee, E. H. (2012). HHS public access. Annals of Internal Medicine, 156(12), 945–957. doi: 10.1059/0003-4819-156-12-201206190-00006

Paxton, E. S., Stock, M. V., Brophy, R. H., & Lubowitz, J. H. (2013). Meniscal repair versus partial meniscectomy: A systematic review comparing reoperation rates and clinical outcomes. Arthroscopy – Journal of Arthroscopic and Related Surgery, 29(3), 872–880. doi: 10.1016/j.arthro.2012.12.022

Englund, M., Guermazi, A., Roemer, F. W., Aliabadi, P., Yang, M., Lewis, C. E., … Nevitt, M. C. (2008). Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons: The Multicenter Osteoarthritis Study. Arthritis and Rheumatism, 58(3), 810–816. doi: 10.1002/art.23293

Sihvonen, R., Paavola, M., Malmivaara, A., Itälä, A., Joukainen, A., Nurmi, H., … & Järvinen, T. L. (2018). Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial. Annals of the rheumatic diseases, 77(2), 188-195.

Hwang, Y. G., & Kwoh, C. K. (2014). The METEOR trial: no rush to repair a torn meniscus. Cleveland Clinic Journal of Medicine, 81(4), 226-232.

Noorduyn, J. C., Van De Graaf, V. A., Willigenburg, N. W., Scholten-Peeters, G. G., Kret, E. J., Van Dijk, R. A., … & ESCAPE Research Group. (2022). Effect of physical therapy vs arthroscopic partial meniscectomy in people with degenerative meniscal tears: five-year follow-up of the ESCAPE randomized clinical trial. JAMA Network Open, 5(7), e2220394-e2220394.

3 Signs Your Shoulder Pain Is Actually Coming From Your Neck And What To Do About It
3 Signs Your Shoulder Pain Is Actually Coming From Your Neck And What To Do About It 1279 853 ResilientRx

Shoulder pain is a very common part of the human experience that many of us have or will experience. It’s estimated that anywhere between 18-26% of adults will have shoulder pain at some point in time (Linaker, et al, 2015). It can range from a mild, temporary issue, to a debilitating problem that impacts work, recreation, and daily life. Since pain in the region of the shoulder or shoulder blade (known as the scapula) is so common, it is very easy to assume the problem is located in that region, and thus remedies you may try will be directed at the shoulder.

Person touching shoulder in pain, It’s estimated that anywhere between 18-26% of adults will have shoulder pain at some point in time

However, there are instances where the shoulder may be the painful part, but the neck (also called your cervical spine) is actually the source of the issue. This can be due to irritation of the nerves that branch out from your spinal cord and travel through the arm as a result of a disc herniation, for example. These nerves control functions like sensation and movement, which can cause painful movement (more on this below).

Not only do nerves travel from the neck into the shoulder and arm, but the neck and the shoulder share muscle attachments which could also cause pain to be present at the level of the shoulder. 

If someone has been experiencing nagging shoulder pain and has tried lots of remedies such as heat, ice, massage, or exercises on the shoulder to no avail, they may want to investigate to see if the issue is actually coming from the cervical area. To help understand why this may be the case, let’s do a quick review of how we classify pain that can “travel.”

Radicular Pain vs Radiculopathy vs Referred Pain – Know The Difference!

You may have heard health and wellness providers use these terms interchangeably, but they are each distinct and can be the underlying reason for pain going into the shoulder or arm. Here’s a very simple breakdown of these terms:

  • Radicular pain is pain caused by a problem at the nerve root (the part of the nerve that exits the spinal cord between the vertebrae and then branches out down the entire arm)
  • Radiculopathy is weakness or numbness caused by a problem at the nerve root. Radiculopathy can also be painful, but not always
  • Referred pain is pain caused by a problem in a region such as a muscle or joint (not the nerve root) that is felt in a nearby area

So now that we’ve talked about how and why pain can exist away from the source of the problem, here are three (3) signs that your shoulder pain is actually coming from your neck (and what to do about it)!

Shoulder Pain Is Accompanied By Other Symptoms

This one seems like it may be noticeable right away, but you’d be surprised. Oftentimes these accompanying symptoms may be subtle or intermittent so they may slip under the radar, or you may feel that they are seemingly unrelated. Symptoms like numbness, tingling, and/or pain further down the arm can be indicative of a neck issue.

Another symptom to be on the lookout for is weakness in the shoulder, arm, or hand. While difficulty raising your arm could be a sign of something like a rotator cuff injury, it also can be due to irritation of the nerves. Another possible symptom could be if you notice changes in grip strength – like difficulty opening jars or dropping objects frequently.

Person touching shoulder

Head Or Neck Position Changes Symptoms

Sometimes change in your neck position can either aggravate or ease shoulder pain. For example, if turning the neck toward the same side as the painful shoulder is limited or increases pain in the shoulder, this could be a sign the neck is the culprit (Wainner, et al, 2003). There may also be circumstances where tucking the chin back (referred to as cervical retraction) actually reduces pain in the shoulder. The neck may be involved in this shoulder pain scenario as well if this is the case.

woman touching back, shoulder pain can move around sometimes.

Shoulder Pain Is Vague Or Tends To Move Around

Issues like a rotator cuff tear or bicep tendinitis tend to have very specific points of pain and activities or movements that cause an increase in pain. If pain in the shoulder region seems to be more diffuse or changes locations on any given day, the cervical spine should be considered as a possible contributor.

If any of this resonates with you or a loved one, here’s what you can do right now:

  1. First and foremost, don’t panic! The chances of it being something really serious are very low and can most often be treated with conservative measures such as physical therapy. It’s very similar to when we have low back pain in this sense – see our other blog article on LBP and MRIs.
  2. Temporarily avoid or modify things that aggravate your pain or symptoms. No need to drastically change your life, but if things are painful or flared, it may help to take a pause on some things.
  3. Contact your physical therapist or physician. If your shoulder pain is coming from your neck, it doesn’t mean you’ll need imaging or surgery, nor does it automatically mean you have a disc issue. Your physical therapist or physician can assess your situation and make recommendations on the course of action to take.

*Not medical advice – everyone’s situation is different, so consult with your healthcare provider*

References:

Linaker, C. H., & Walker-Bone, K. (2015). Shoulder disorders and occupation. Best practice & research Clinical rheumatology, 29(3), 405-423.

Wainner, R. S., Fritz, J. M., Irrgang, J. J., Boninger, M. L., Delitto, A., & Allison, S. (2003). Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine, 28(1), 52-62.

Blanpied, P. R., Gross, A. R., Elliott, J. M., Devaney, L. L., Clewley, D., Walton, D. M., … & Torburn, L. (2017). Neck pain: revision 2017: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 47(7), A1-A83.

The Benefits of Dry Needling
The Benefits of Dry Needling 2560 1707 ResilientRx

Have you ever had a deep tissue knot in your shoulder or back? Or perhaps you’ve had a muscle strain or even a herniated disc that was causing you significant pain. Others may even experience nerve pain in parts of their body that physical therapy and exercise don’t seem to relieve. Rather than using different exercises or manual therapy to treat these problems alone, many PTs are turning to dry needling to help their patients recover faster and restore mobility to the body.

Dry needling can mitigate pain caused by a number of issues – arthritis, nerve pain, trigger points, ligament strains, headaches, muscle spasms, and more. Before we dive into the benefits of dry needling, though, let’s start with the basics of what dry needling actually is.

What is Dry Needling?

Dry needling can be used as a part of a comprehensive plan to help restore movement and function in the body. It’s a skilled practice that uses filiform needles to penetrate the skin and stimulate trigger points. A trigger point is a place of muscular dysfunction, causing pain and impacting mobility. They can be tender to the touch and difficult to eliminate as these tight bands of skeletal muscle can cause pain to permeate into other parts of the body. 

How do trigger points form? Inflammation builds up in muscles that are injured or overused, causing tension and depriving the muscles of oxygen which occurs from the impaired blood flow. This causes the muscle to be taut, limiting normal movement of the muscle.

How Dry Needling Works

To perform dry needling, a PT will insert super-thin needles into the skin. The needles stimulate the myofascial trigger points, creating twitches and muscle reflexes. These reflexes decrease muscle tension, reducing irritation and pain while improving flexibility. This increases blood flow to the area to promote healing.

By using dry needling, a Doctor of Physical Therapy can target these areas and stimulate them in a way they can’t do with regular physical therapy techniques. It can be painless but most people say the cramping is more of the sensation which can be slightly painful for some. Some patients also report some soreness around the needle sites for around 24-48 hours, while others don’t feel any soreness.

Benefits of Dry Needling

By inserting needles into trigger points on the body, the muscles relax, boosting blood flow, diminishing inflammation, and triggering an immune system response. There are four specific benefits to dry needling:

Relief of pain

Looking for immediate pain relief? Pain improves as blood flow is restored, moving acidic wastes away from the muscle and providing those areas with oxygen and nutrient-rich blood. Many people report immediate relief after one session, but some do require additional sessions.

Improving mobility

When you have tight knotted muscles, the tendency is to stop moving and limit your mobility and movement to avoid pain. By combining dry needling with physical therapy, strength and mobility are restored and future trigger points can be avoided.

Quicker Recovery 

Regardless of the injury or pain, restoring movement is the best way to heal and recover. While physical therapy can be the main component of treatment, adding dry needling to the treatment plan can help speed up your recovery time. 

Assists with Chronic pain

Dry needling specifically helps with chronic conditions such as back or neck pain. This can result in trigger points and tenderness. Patients with chronic pain who have had dry needling report significant pain improvement. It helps to increase blood flow to these areas that are impaired and help improve mobility

Dry Needling vs. Acupuncture 

While both dry needling and acupuncture use the same filiform needles, they are vastly different practices. Acupuncture is based on eastern medicine principles, and it’s focused on different points and meridians throughout the body. Needles are used superficially to assist with the flow of energy. Based on western medicine, dry needling inserts needles into a specific part of the muscle that is causing dysfunction and pain. 

Is Pain Holding You Back?

Are you limited in mobility and function because of pain impacting daily activities? We can evaluate your movement, strength, and function to form a plan of care, whether that’s dry needling, PT, or home exercises, that can get you back to doing the things you love. If you are struggling with pain or an injury, our physical therapists can help! Start moving again with help from ResilientRx. Book a consultation online today!

How Stress and Anxiety Affect Pain
How Stress and Anxiety Affect Pain 2560 1707 ResilientRx

Anxiety disorders, commonly associated with chronic stress, are the most common mental illnesses in the United States. In fact, anxiety disorders affect nearly 40 million adults each year. People suffering from anxiety are three to five times more likely to visit the doctor than those without anxiety disorders.

The reason?

Stress and anxiety do not just have an impact on the mind. Together, they cause or enhance chronic pain. Many of us forget that anxiety or worry can cause several painful physical symptoms — chronic fatigue, heart palpitations, muscle aches and weaknesses, headaches, and more. 

Here’s a deeper look into the impact chronic stress and anxiety have on the body.

Man really feeling how stress and anxiety affect pain

How can stress and anxiety impact pain response? 

Have you ever noticed that your muscles hurt more when you’re worried about work or family? Do you get headaches more as you think about something too much? These are all small signs of how anxiety and stress can impact our body’s pain levels.

Research has also proven that stress and anxiety can influence pain perception (how we perceive pain). Some people, when their cortisol levels spike, experience stress-induced analgesia — which suppresses our sensation of pain. 

Stress-induced hyperalgesia, on the other hand, occurs when stress, anxiety, or even fear, are already present, elevating pain and increasing intensity and duration. 

The fight or flight response affects pain

We all know the “flight or fight” response our bodies experience when we undergo stress. When our bodies activate this response, it dumps higher levels of cortisol into the bloodstream which spikes our blood sugar. Your body also experiences an increased heart rate and adrenaline output. Over a period of time, this influx of cortisol can harm your body and cause you to be more susceptible to injury and pain. 

In the fallout of this response, people tend to feel exhausted, which can heighten mental and physical ailments and decrease their immune system response. 

The nervous system and stress

Stress is very closely aligned to the nervous system. Your body’s reaction to stress can tip off pain perception in the body and, because the nervous system extends into the brain, can impact the way your body responds to pain. Over time, your body may develop a more sensitive nervous system reaction to stress and anxiety, which could be the cause of chronic pain. 

Woman sits at computer looking very stressed out and anxious because of how stress and anxiety affect pain

Common physical symptoms of stress and anxiety

The longer a person experiences chronic stress and anxiety the more intense the symptoms may be. You could equate it to heart health — the longer you eat fatty, high-sugar, and highly processed foods, the greater your chances are for heart disease. So, the more often you’re stressed, the more vulnerable your body becomes because of the wear and tear that results. 

Symptoms of stress and anxiety often go unnoticed or are mistaken for something minor. However, consistently experiencing the following systems can wear out your body. 

Fatigue

This is the most common symptom associated with stress and anxiety. Because the mind is in a constant state of alertness, it tires out much faster than the mind of someone who may not often experience stress and anxiety. Even after healthy sleep, people can still feel exhausted because of mental fatigue or the physical symptoms that come along with prolonged high-cortisol levels in the body. 

Heart palpitations

Having heart palpitations can be distressing, which may cause a continued increase in cortisol levels and can increase heart rate. Heart palpitations feel as though your heart is pounding too fast and skipping beats. 

Muscle aches and weakness

Tension is usually to blame for muscle and joint pain caused by stress and anxiety. Prolonged periods of these emotions cause muscles to tense up and leave you feeling stiff. A high level of stress consistently can impact immune system functions, making it more difficult for your body to fight off inflammation. 

Muscles also tend to become weak, especially in the legs and arms. During a fight or flight response, blood flow is increased to the limbs to make it easier to take action against a perceived threat. After the adrenaline response has ended, muscles can become sore and painful. 

Woman laying down clutching her head and stomach feeling sore from stress and anxiety

Headaches

Headaches and migraines are other common results of chronic pain and anxiety. Because other systems, such as teeth grinding, tension in the face, and poor posture often accompany stress and anxiety, prevalent headaches and migraines that are extremely painful are likely. Sharp pain or dull aches accompanied by pressure in the head and eyes are usually the headaches caused by stress and anxiety. 

Find relief for your pain

Stress and anxiety are common ailments in the U.S., but if you’re experiencing pain that you believe is associated with stress, it’s time to get help — for both your brain and your body. The key is to manage daily habits to ensure this type of pain does not get out of hand. 

If you are experiencing pain that is impacting your daily life, our team can help. With extensive training in treating patients with chronic stress and anxiety disorders, we can get you back on track to feeling calm, relaxed, and healthy in no time. 

To find relief from your chronic pain, book a free consultation today!

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