Nonsurgical Options

Nonsurgical pain relief

The trend in orthopedics is for a specialist to exhaust all non-surgical treatment options in advance of surgery. That’s because the more invasive (surgical) the treatment option, the more tissue is disrupted and there is more potential for more complications than with physical therapy or a injection.

So if you are impatient, wanting a quick fix to your problem, keep in mind that the best specialists in orthopedics and sports medicine will first look at if there are non-surgical options for you to try first before surgery.

With sports medicine problems involving strain, sprain or overuse syndrome — non-surgical treatment options like anti-inflammatory medication, injections into a joint space or specialized therapy, can many times provide relief of symptoms without the need for surgery.

Types of diagnostics you may encounter:

  • X-rays show bones and the space between bones. Although X-rays are of limited value to muscle-related joint pain cases, your physician may conduct X-rays to detect possible fractured bones in or around the joint.

  • MRIs (Magnetic Resonance Imaging) provide images of soft tissues in a joint. This is valuable information to your physician in determining the cause of your pain. These tests provide a medical photograph of your body and are painless.

  • Pain-relieving injections can relieve joint pain and provide important information about your problem.

Click here for more information on diagnostics.

Pain relief

Doctors who focus mainly on pain symptoms often recommend the exact opposite course of action that is optimal for recovery from a joint problem. For example, years ago, doctors treated some joint pain with bed rest and heavy drugs in order to mask the patient’s discomfort. Patients became sedentary and increasingly dependent on drugs. It was later discovered that this treatment was actually damaging to the body, because it weakened muscles and caused more pain.

Pain is a signal from the body to the brain that something is wrong. Either a certain motion placed too much strain on the joint, or the joint is too weak or inflexible. Your specialist will help determine the origin of your pain and the best treatment for it.

Physical therapy

Physical therapy increases flexibility and strengthens muscles that support the joint. Greater strength and flexibility will help prevent future joint issues. A therapist may use ultrasound, electrical stimulation, heat or ice, dry-needling, mobilization and exercises to reduce pain and the likelihood of future injury. Click here for more information.

Exercise

Years ago, the prescription for pain was bed rest. However, we know today that more than a few days of bed rest after an injury can be counterproductive to rehabilitation.

Exercise and movement actually help tissues become stronger, more supportive of the joint and resistant to additional injury. Specific exercises can be used to target particular types of joint pain. Engaging in activity acts as a lubricant to the joints, and it is as necessary to recovery as oil is to the hinge in a squeaky door.

It is important to work with a therapist to make sure exercises are done properly. Click here to learn about specific exercises.

Medication

Medications can lessen swelling and reduce pain. The type of medication your physician recommends depends on your symptoms and your level of pain.

At home, pain can be relieved with Non-Steroidal Anti-Inflammatory Drugs (NSAID), such as ibuprofen products like Motrin or Advil. Tylenol or Aspirin may also be recommended to ease pain.

Injections

Your physician may prescribe oral medications for the relief of arthritis pain or joint pain. This can include pills with Aspirin, ibuprofen and naproxen which can relieve pain and reduce inflammation. If oral medications fail to provide relief, your specialist may recommend an injection of medication into the joint. An injection can offer quick, effective pain relief. Joint injections may include:

  • Cortisone — Used for short term pain relief and to reduce inflamation
  • Steroids — Used to reduce inflamation and swelling
  • Viscosupplements — Uses a gel-like medication (such as Synvisc and Euflexxa) to lubricate the joint
  • Other Medication — Your physician may use other medications depending on your diagnosis

Regenerative Medicine

Stem Cell Therapy

Mesenchymal Stem Cells (MSCs) are remarkable cells located in many tissues of your body. One of the most important characteristics of MSCs is that they are unspecialized cells with the ability to mature and differentiate into multiple types of tissue including bone, tendon, ligament, cartilage, muscle and meniscus. In addition, these stem cells can self-renew, producing more stem cells. They can even prevent other cells from dying due to lack of oxygen and they can produce anti-inflammatory proteins.

When stem cells are injected into an arthritic joint or injured tendon, they attach to the areas of damaged tissue. The MSCs are able to sense the microenvironment of the injury and determine what kind of cells to grow and what molecules are needed to enhance tissue healing. The stimulated MSCs begin to grow new cells and also act as your body’s own natural drug store producing and releasing the right combination of growth factors and proteins to stimulate healing and new growth of cartilage, tendon and other injured tissues.

Platelet Rich Plasma (PRP) Therapy

Plasma is the clear portion of the blood in which all the other blood components such as platelets, red blood cells and white blood cells travel. Platelets are part of the blood that circulate around the body ready to help stop the bleeding should you have a cut, broken bone or injury that bleeds internally. Besides containing clotting factors, the platelets release growth factors and proteins that help start the healing process. PRP contains a concentrated amount of platelets that release potent quantities of these growth factors and proteins to stimulate a robust healing response.

Many famous athletes — PGA’s Tiger Woods, NBA’s Kobe Bryant and Steph Curry, MLB’s Alex Rodriguez, tennis star Rafael Nadal, and several others — have received PRP for various problems such as sprained knees and chronic tendon injuries. This treatment technique is relatively new in the field of sports medicine, but has been gaining popularity quickly.

Massage

Massages release toxins in muscles, increasing circulation, releasing endorphins, reducing inflammation, alleviating muscle cramps, breaking down scar tissue and calming the nervous system.

Aside from the physical health benefits, massage has a psychological impact by teaching the patient to feel relaxed.

Biofeedback

For thousands of years, Eastern medicine has emphasized the importance of the mind in controlling physical health. In the West, these ideas were touted as mystical and scientifically unfounded. Recently, however, as more scientific connections are being made between mind-body healing, Western science is starting to appreciate and incorporate this type of therapy into pain rehabilitation.

Due to its objective means in tracking progress, biofeedback is one of the more popular mind-body therapies in pain rehabilitation. During biofeedback sessions, electrodes are attached to the body to monitor body temperature, heart rate, muscle tension, skin resistance and perspiration.

Through biofeedback, the patient is taught to recognize how stress and relaxation chemically alters the body's functions. The patient can learn to lower heart rate and muscle tension. The biofeedback equipment records statistics and gauges progress as the patient learns to control the body, thus controlling pain.

After recognizing the body’s signals during biofeedback sessions, the patient is able to recognize them in daily life and arrest the onset of muscle spasms or high blood pressure. This can reduce pain and even eliminate it.

Acupuncture

While acupuncture has limited value for many orthopedic injuries, occasionally your orthopedic surgeon may recommend you try acupuncture as a way of avoiding a surgery. Traditional acupuncture is based on the ancient Chinese theory that there are energy pathways that run throughout the body. These pathways, called meridians, carry the body's vital energy, or chi (pronounced "chee"). The principle behind acupuncture is that disease and pain are a result of an imbalance in the body's energy flow (chi). Through the insertion of thin needles at specific points along meridians, the flow of energy is controlled and rebalanced in the body.

Acupuncture dates back to the first century B.C. in China, during the era of the Han dynasty (206 B.C. - 220 A.D.). Because Western physicians in the United States have difficulty understanding the correlation between acupuncture philosophies and traditional physiology, acupuncture has not been readily accepted in the United States.

Modern scientists have attempted to explain how acupuncture can relieve pain. Some observe that the traditional Chinese "meridians" overlap with pathways of the central nervous system. By using needles, an acupuncturist can stimulate the nervous system to release endorphins (morphine-like chemicals) in the muscles, spinal cord and brain. These chemicals either relieve pain symptoms or trigger other chain reactions that relieve them.

Acupuncture is nonsurgical, does not involve drugs, and has no extremely negative side effects or permanent complications. It may be worth exploring as a nonsurgical option, particularly if you have exhausted the traditional remedies of Western medicine.