Not TMS, confirmed structural damage to knees and hips

Just an update to previous posts about my sports injuries. Have been on a roller coaster regarding confirming whether torn meniscus in both knees and hip labral tear are severe enough where TMS knowledge unfortunately is not going to fix the structural damage. Many ortho consults and my activity level diminution have pretty much told my brain that these things need to be fixed and am in quite a state of depression and anxiety because I have used TMS to resolve my IC, back stuff (minor), and foot stuff too. The tears in knees are severe enough to need arthroscopy and still on the fence regarding hip. (even though two experts in hip arthroscopy definitely recommend surgery with my high activity level. I have eliminated all activities that cause exacerbation of pain; its like telling a runner that you cant run at all until you have surgery or a yoga teacher no yoga with your torn labrum. So disappointed, angry, frustrated...arrrgghhhhhh.

 

I'm sorry you have had to stop activities that cause you pain, since you love exercise.
I urge you to read Steve Ozanich's book, THE GREAT PAIN DECEPTION,
and see how he kept active and even played golf while in pain. He discovered TMS
and it led him to realize his repressed emotions caused his pain.

Doctors love to prescribe surgery, but that often does not heal the pain.

Don't overdo exercise or yoga at this point, but I suggest you combine moderate activity
with journaling to discover your repressed emotions. If you haven't already, start the
Structural Education Program, free in that subforum.

As for hip surgery, I've seen friends get it for one or both hips and they walk like
they're not feeling any better than they were before.

 

For the knees check out this article....they studied numerous people who got real and sham surgery for their knees with the same one you mentioned and same results. I wonder if there are some situations where the surgery is necessary and most where it isnt; more research needs to be done but more and more when it comes to pain and a structural issue they are finding sham surgeries help no more than real ones that correct the structural problem; my guess is there is a structural issue in most cases but it is not causing the pain; similar to slipped discs.

http://www.nejm.org/doi/full/10.1056/NEJMoa1305189 (web site for what I pasted below)

Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear
Raine Sihvonen, M.D., Mika Paavola, M.D., Ph.D., Antti Malmivaara, M.D., Ph.D., Ari Itälä, M.D., Ph.D., Antti Joukainen, M.D., Ph.D., Heikki Nurmi, M.D., Juha Kalske, M.D., and Teppo L.N. Järvinen, M.D., Ph.D. for the Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group

N Engl J Med 2013; 369:2515-2524December 26, 2013DOI: 10.1056/NEJMoa1305189

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Abstract
Article
References
Citing Articles (46)
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Background
Arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking.

Full Text of Background...


Methods
We conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis. Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. The primary outcomes were changes in the Lysholm and Western Ontario Meniscal Evaluation Tool (WOMET) scores (each ranging from 0 to 100, with lower scores indicating more severe symptoms) and in knee pain after exercise (rated on a scale from 0 to 10, with 0 denoting no pain) at 12 months after the procedure.

Full Text of Methods...


Results
In the intention-to-treat analysis, there were no significant between-group differences in the change from baseline to 12 months in any primary outcome. The mean changes (improvements) in the primary outcome measures were as follows: Lysholm score, 21.7 points in the partial-meniscectomy group as compared with 23.3 points in the sham-surgery group (between-group difference, −1.6 points; 95% confidence interval [CI], −7.2 to 4.0); WOMET score, 24.6 and 27.1 points, respectively (between-group difference, −2.5 points; 95% CI, −9.2 to 4.1); and score for knee pain after exercise, 3.1 and 3.3 points, respectively (between-group difference, −0.1; 95% CI, −0.9 to 0.7). There were no significant differences between groups in the number of patients who required subsequent knee surgery (two in the partial-meniscectomy group and five in the sham-surgery group) or serious adverse events (one and zero, respectively).

Full Text of Results...


Conclusions
In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure. (Funded by the Sigrid Juselius Foundation and others; ClinicalTrials.gov number, NCT00549172.)

 

this goes into a bit more detail....again I think some are necessary but if it were me I would want the opinion of a TMS MD as to whether to proceed; or if that isnt available do diligint research before making a decision.

http://www.cnn.com/2013/12/26/health/knee-surgery-study/


Patients who underwent simulated knee surgery fared just as well as those who got the real deal, according to a new study that's raising eyebrows about the most common orthopedic procedure performed in the United States.

The findings, published Thursday in the New England Journal of Medicine, add to a string of papers suggesting that arthroscopic partial meniscectomy fails to help many patients. The operation typically is performed to relieve knee pain, whether from wear or from an injury.

But other doctors say it's still too soon to draw sweeping conclusions.

The study, which was conducted in Finland, followed 146 patients between the ages of 35 and 65 with symptoms of degenerative wear and tear of the meniscus, a disk-shaped piece of cartilage that acts as a shock absorber between the shinbone and thighbone. They had no detectable arthritis, suggesting that any pain was due to a problem with the meniscus.

About half the patients underwent an arthroscopic meniscectomy, in which a surgeon inserts a blade through a tiny incision in the knee, and essentially shaves down the rough, frayed edges of the meniscus.

The other half underwent an elaborately staged "sham" surgery, in which the doctor made an incision and poked around without any actual manipulation, shaving or cutting.

A year later, there was no significant difference in the knee pain reported by patients in each group. Nearly two-thirds on each side said they were happy with the results, and most said they would do it all again.

Video: Knee pain common in women 50 and up

In patients without arthritis, the authors conclude, the procedure "provides no significant benefit over sham surgery."

As many as 700,000 arthroscopic partial meniscectomies are performed in the United States every year, at a direct cost of $4 billion, according to the study authors.

But the procedure has come under scrutiny with the publication of papers -- 2002, 2008 and earlier this year -- that found it provides little or no benefit in older patients, whose meniscus is frayed through simple wear and tear as opposed to a specific injury.

"It's pretty obvious to anyone who really has an interest in this that what we've called a meniscal tear isn't really a tear," says Dr. Teppo Jarvinen, who led the research team. "It has nothing to do with the tears we talk about in a 20-year-old athlete who twists or sprains their knee."

According to some, the new study draws a stronger conclusion because it includes patients with mechanical symptoms like popping, clicking or a sense of the knee locking up.

"When we hear a knee is locking, a bell goes off: 'this needs arthroscopy,'" says Dr. Dennis Cardone, an associate professor of orthopedic surgery at NYU Langone Medical Center in New York.

"If anything, this (study) swings it a little bit more. Even when a patient complains of locking, arthroscopy might not be necessary."

But Dr. Frederick Azar, vice-president of the American Academy of Orthopaedic Surgeons, says patients in the study are not typical.

"To have a degenerative medical meniscus tear and no evidence or arthritis is extremely unusual," says Azar. "It's well less than 1% of the patients we see."

Dr. Scott Rodeo, co-chief of the Sports Medicine and Shoulder Service at the Hospital for Special Surgery in New York, says it's likely that many of the patients in the study are in the early stages of developing arthritis, even if it's not detectable through X-rays.

He said the Finnish study reaffirms the sense that surgery is not likely to help these patients whose pain is due to arthritis.

Azar, a professor of medicine at the University of Tennessee and team physician for the Memphis Grizzlies basketball team, says he's worried about scaring away patients who might be helped.

"This is a very useful low-cost intervention, with a short recovery time and good results in most patients," he says.

Surgeon: How to give your knees some TLC

A worn meniscus can be a simple result of aging, but it's more common in people whose knees take a lot of pounding, including long-distance runners and people whose jobs have them standing for long periods on a hard floor. Obesity is an additional risk factor.

The Finnish study looks at meniscectomy, as opposed to meniscus repair, in which a surgeon actually sews together torn cartilage. According to Cardone, patients under 40 do especially well with meniscus repair, especially those whose injury stems from a single incident.

But orthopedists say many people with knee pain can be helped with physical therapy to strengthen muscles that support the knee.

Before recommending surgery, Azar also counsels patients to consider switching to low-impact activities -- for example, to mix biking or swimming into a workout routine, instead of just long-distance running. He says other patients may be helped by anti-inflammatories or injections of hyaluronic acid.

In advanced cases, when the meniscus is totally worn away, more drastic steps are an option.

"If it's bone-on-bone," says Azar, "their pain is coming from osteoarthritis and the only surgery to help is a knee replacement. But we try to exhaust all measures before doing that."

However, Jarvinen says the abundance of caution needs to start much earlier.

"All your fellow orthopedic surgeons will tell you, 'I already knew this.' But the facts are, this is still the most common orthopedic procedure," he says, and the vast majority of operations are unnecessary.

 

I notice Gatormom that you don't mention whether your various tears were due to "real" injuries from impact, contusion, puncture etc. etc. etc. That's my litmus test for the necessity of surgery. Just because an MRI detects osteoarthritic degeneration doesn't necessarily mean that those changes are the real cause of your pain. My general rule of thumb is: Wait before you operate. If most tissue injuries heal up in 6 to 8 weeks, it's a good idea to wait at least that long before you pull the operation trigger and go into surgery. I had terrible pain in my left shoulder, waited two months and it just went away completely.

 

Thank you all for your replies to my last thread! This morning I am still in a little bit of shock. Had a terrifying incident of being bitten and attacked by a neighbor's dog while trying to protect my dog This dog chomped down on the back of my legs pretty good so ER visit last night; a bunch of deep puncture wounds that hurt like a son of a gun, but no stitches needed. Just pretty shook up. I am an animal lover and have never had an incident like this happen. Boy, talk about a fight or flight response! I did the flight route but this dog would not let go. However out of all of this, and thinking about it all last night and this morning, it is truly amazing how those neural pathways work! My hips and knees were particularly hurting all day yesterday (the dog incident happened around 5 pm). Did not get much sleep last night but was lying there and was noticing that because I was so focused on the dog bites, my hips and knees were way less painful! I remember reading in Steve's book about where he would focus on a body part that did not hurt while either running or other activity and the pain would lessen.

Getting back to the replies, you are right about certain surgeries not being successful and Joey, I had actually read that study (have been doing a ton of research as my injuries are now going on about four years for one and one year for others). Walt, I have read Steve O's book twice and these inspirational stories have so resonated with me. Responding to Bruce, my injuries have been going on for quite a while and I have not one bit of OA change. Believe me, I would LOVE for all these ortho issues to be TMS based but with sports injuries, there seems to be a fine line but I have decided to hold off on any surgery. I know for me my pain is generated by FEAR and fear breeds anxiety and I am still determined to buck the traditional orthopedic medical intervention. The community where I live in Florida is kind of close knit as far as the running, cycling, etc group so everyone relates their experiences with injuries. Regarding meniscal tears, it truly depends on the tear..medial tears (as shown in the studies and that is what I started out with four years ago and these tend to heal with no surgery and I have not one bit of OA or any type of arthritis in hips or knees). However my medial tears have advanced to more serious tears due to pounding away I am told (horizontal cleavage) so there is a fine line there; again, the big question-structural or TMS. I know several long distance runners, had knees scoped and are running with no pain but as a definite TMS person like myself (have resolved a bad case of IC, disc herniation which took me no time at all when I first learned about Sarno), don't know if that applies to me. Regarding hips, don't need hip replacements; have tears in labrum (think Lady Gaga, A-Rod, Tara Lipinski). So again, nothing to do with arthritis. And even those with arthritis and needing hip replacements, a friend of mine was in debilatating pain with hips and after surgery is back playing tennis and golf five days a week. And again, another example of that fine line. Been desperately trying to wrap my head around thinking psychologically through the last year but I think personally I have that crappy combination of structural and TMS. I think my biggest obstacle is FEAR..fear of medical establishment, hospitals, surgery, am I making things worse by continuing to hold out. Also the pressure of family, friends, a few docs that I actually do trust (they had said hold off on surgery initially), is huge...hard to explain to them the TMS concept and they have the best intentions though of wanting to see me back to my old self and out of pain and ensuing depression and more anxiety. So definitely could use the support of this wonderful group of people! (And I think my initial story of the pain lessening with distraction is another example of how we can "unlearn our pain" so I will KEEP AT IT!)

 

A combination of TMS and structural issues or prior injury can be extremely tricky, I think. You really might want to consult a TMS doc if you can find one. Certainly we can't diagnose or advise you on medical courses of action, and you seem to be very aware of the downsides or deceptions of surgery. Are your docs aware of that as well - not just conservative, but really understanding that surgery may be fixing something that isn't actually broken?

For myself, I had a prior injury (ankle sprain) which "took forever" to heal, was re-injured later, then "took forever" again and seems clearly to be TMS at this point, but the seed of doubt is always there because there is a history of prior tissue trauma, and to ligaments, which are commonly slow to heal and prone to re-injury. So I understand some of your doubt, even if the issue I have is different.

I'm sorry to hear about your dog bite experience! That sounds terrifying. It's interesting that it affected your level of pain elsewhere. It seems like even if you have some structural issues, the situation is unclear because you have a lot of fear around those supposed issues and this could make real pain worse, as well as generate pain out of thin air. Now that you know the level of pain might be separate from the injury to a degree, are you able to unhook that cycle at all so that you can try to get a picture of what the base level of pain is? Easier said than done I'm sure.

Good luck healing!

 

Hello armchair!

You are so spot on about the seed of doubt but it was nice to hear that even though your injury is chronic and slow healing, it sounds that you truly embrace that this is TMS. Would love to see a TMS doc as most of us to get that confirmation and hear those words, YES, it is TMS but unfortunately in Florida, Dr. Scott Brady is no longer accepting patients. I am seriously considering traveling out of state to consult with someone (wish there was a skilled orthopedic doc who was TMS based). I think that most surgeons tend to just think traditionally but I actually have one that was not in favor of hip labral tear surgery (one out of three consults). He is one of the few docs that do not just go by MRI findings so I think he kind of gets it. I really also prefer docs who are very sports minded and get the impact how activity diminishes anxiety and depression.

Forest had posted that VOMIT poster about the validity of radiographic findings and that really caught my attention. But, due to lingering chronic pain that worsens so much with my activity level, when the poster stated statistics such as 48% had some kind of tear that did not need treatment, my mind went right to the thought of, well I am most probably in the 52% that does..i guess its my conditioned response.

 

UFGatormom, since Dr. Brady is no longer accepting patients, but you would like to meet with a TMS doctor who is very sports minded, I suggest you read Steve Ozanich's book, The Great Pain Deception. He isn't a doctor but writes about his many pains that did did not heal from multiple traditional treatments including surgery. He learned about Dr. Sarno and TMS and it led him to discover the repressed anger that caused his pain. Learning that, and continuing sports activities including golf, even when in pain, he became pain free. It's a fantastic book that could help you a lot.

 

Just a quick note to say- I had that surgery. Can confirm the results from the above-study. I have had infinitely better results from TMS treatment than I did from the surgery (medial meniscal tear with locking).

I know how tough of a decision it is to choose to have surgery (or not). At the time I was so desperate that it made sense to me (I didn;t know about TMS then, but I sure wish I had!)
Good luck.