Old Knees and Backs, Surgery or Exercise and Chiropractic?
Many of you remember our prior discussions about repeated studies throughout the 1990s and in the current decade that showed back surgeries for herniated disc were no more effective than doing exercises and staying active. A pair of new studies in the September 2008 issue of the New England Journal of Medicine suggests that the same may be true of knee surgeries for cartilage and meniscus tears of the knee.
In one study patients received anti-inflammatory medications, Tylenol, glucosamine or chondroitin, weekly therapy for three months, and information on twice-daily exercises to strengthen their knees at home. Half the patients were randomized to also receive arthroscopic surgery. After two years, of 178 patients that completed the research, there was no significant difference in arthritis scores or quality of life measures between patients who went to surgery as compared with patients receiving only therapy, exercise and medications.
In a second study of 991 subjects aged 50 to 90, magnetic resonance images (MRI) of the knees revealed that meniscal tears were found in 63% of those with knee pain, aching, or stiffness on most days. However, fully 60% of seniors without these symptoms had MRI confirmed tears of the meniscus. Moreover, 61% of subjects who had meniscal tears in their knees denied any pain, aching, or stiffness during the prior month.
Scientists concluded—as they have with back surgery for herniated lumbar discs—that apparently meniscal tears are merely a normal sign of aging, and may not correlate with the presence of acute pain. Whether these lesions leave us susceptible to pain remains to be seen, but clearly surgical approaches for back and knee pain associated with aging have not been proven to work. Instead of surgery, gentle activity such as use of an exercise bike, gentle knee exercise, glucosamine/chondroitin supplements, and therapy including gentle chiropractic procedures may be equally effective.