More than 1 million patients undergo total knee or hip replacement surgeries each year in the US and numbers continue to climb. The trend might be easily explained by an increasing number of elderly people, but reports are showing that there is a growing trend for younger patients to opt for surgery.
No matter how old you are when you go for surgery, one thing is certain: you will feel pain.
For most patients this is not a new sensation. The majority of patients seek joint replacement surgery because they have been living with pain for extended periods of time. It is easy to think that surgery is a quick fix and in some ways it is. The new joint is ready to function immediately and many patients are beginning their physical therapy rehabilitation on the same day as their surgery. But what most people do not expect is how much recovery it will take to overcome the damage caused by the surgery.
The nature of joint replacement surgery involves deep penetration into the body that requires tissue cutting, splinting, stretching, stapling, nerve severing, and bone scraping/removal to name a few. Having a clear understanding of what you are getting into, and how much pain to expect following the surgery, will help you recover quicker and help you manage post-operative pain more effectively.
My aches and pains have been steadily diminishing since seeing Shmuel Tatz, PT, PhD for the first time but they hadn’t vanished completely – yet. Only because it’s been a long and winding road of minor injuries over the decades. This being my tenth visit, I didn’t know what to expect since there are a variety of problem areas in my small frame. Tatz, usually a man of little words, surprised me when he sat down and spoke at length before my treatment began. He was insistent that I understand, “People don’t always want to hear what their real problem is.” I was a little worried he had something unpleasant to tell me about my own health, but I listened.
First he told me that sometimes people have psychological problems and not physical problems. “I always tells my patients the truth but sometimes they get upset with me.” Very recently, he told one of his patients that she might want to consider talking to a professional about her emotional problems; she left in tears. He explained in cases of the mind, doctors such as bestselling author Dr. John Sarno are very good at helping people understand that they can heal themselves by addressing underlying emotional issues. He also noted that can only happen if there is not an underlying physical problem. He was very concerned about this patient of his.
I felt bad the second time I saw Shmuel Tatz, PT, PhD because while I had initially gone to see him about my knee, what was plaguing me the most was the pounding headache I’d been having for four days solid. Well, I hadn’t even told him on his initial consultation that I’d had unsolvable undiagnosable daily headaches for over two years, not to mention intermittent migraines ten years preceding that. Sure I’d seen several medical doctors including a neurologist and many other practitioners. My greatest most painful attempt to end the headaches was the hugely scary six-injections-at-once of nerve block treatments, in which my head was painfully sore for a month. The second most alarming treatment was a blood pressure medicine ‘sometimes used for migraines.’ This put me into the Emergency Room after three doses. That said, most of the specialists were talented and kind, but no one, no treatment, thus far had solved the problems inside my head. Least of all me.
In any case, I confessed my headache sorrows to Tatz who immediately began to work on my head. Always gently. First, with his hands assessing and probing where my stress was being held: Primarily in the back of my skull where I once had a childhood cyst removed. Then he placed his left hand over my heart, while gently pulsing with his right hand across the sensitive parts of my head – which was just about everywhere that particular day. He then asked me to try opening and closing my mouth, mild cranial exercises while he continued the rest of the treatment: He put hands-on pressure on my legs – and later explained the pain in my legs was connected to my head and that a person’s entire physical body is all inter-connected. There are no separate parts! All this being his ‘body-tuning’ technique that he developed over the last fifty years. He told me to keep moving my jaw up and down gently while teaching me mild facial stretches, including scrunching up my nose. After he spent more time and intensive work on my head, neck and skull, I was already feeling better.
Before heading to see Shmuel Tatz, PT, PhD about my knee, I’d heard from more than one doctor the WHAT NOT TO DO LIST: No stairs, no kneeling, no crossing legs, no sitting on floor, no squatting, no dancing. Plus I had a hard time wrapping my head around my previous physical therapist experiences: lots of clipboards and sessions with different PT’s each time and no results other than frustration. Still left with an imperfect knee that had suffered a few life-injuries. First there was the fall resulting in the tibial plateau fracture, then the torn meniscus, then the basic wear and tear, and loss of cartilage. The messages I was receiving from the medical community was to accept my ‘trick knee’.
That said, I wasn’t willing to give up and started asking friends and searching online for a specialist in physical therapy. One that might take insurance was another issue as I was on a pretty tight budget. After calling at least twenty PT offices, I reached Dr. Tatz’ office whose lovely assistant ushered me in immediately.
Tatz, the NYC acclaimed gray-haired PT, wasn’t much for words. He was more interested in what my entire body was saying to him and his reactions to my body versus vocabulary. His navigations seemed to be intuitive rather than straight out of a medical journal. He ‘tuned’ my body from the jaw down, gentle manipulations that made me feel thankful for the solid hour away from the pressures of NYC. Sometimes when seeing practitioners, I worry about what’s going on outside of the room rather than relaxing and healing inside.
Pain in any part of the body is a sign that the body of out of “tune.” For instance one can complain of pain in the knee, but the x-ray, MRI and even manual testing show that there is nothing wrong with the knee. So the question becomes why is this person complaining of knee pain? In this case we need to look at the body parts that are directly related to the knee such as the back, hip and ankle. One must analyze the hip and ankle to understand what is occurring in the knee.
A person with a limited range of motion and flexibility in the back, hip and/or ankle requires the knee joint to work twice as hard, eventually causing discomfort, then tension and finally pain in the knee. If the issue is not addressed simultaneously in the back, hip, knee and ankle it can lead to inflammation of the tendons, sprained ligaments and inevitably major problems in the knee.
In order to resolve the problem in the knee, one should have a number of body tuning treatments on the back, hip and ankle as well as perform movement exercises at home.
Reasons to think twice before going under the knife
With this procedure a surgeon places a tiny camera in the knee, then inserts small instruments through other incisions to repair torn or aging cartilage. Studies show the operation works well when patients have in fact torn their meniscal tissue, but it is no more successful than noninvasive remedies in treating osteoarthritis of the knee. In a 2008 study, 178 patients with osteoarthritis received either physical and medical therapy without surgery, or therapy plus surgery. After two years the two groups had nearly identical outcomes, reporting less pain and stiffness and more mobility.
Alternatives to surgery
If you have knee pain, “start with the least harmful and invasive treatment and work your way up the ladder,” says Colin Nelson, a senior research associate at FIMDM. This includes lifestyle changes such as exercise, as well as medication and cortisone injections.
by Karen Cheney, AARP The Magazine, July/August 2011