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[RC] Knee Injury - Bruce Weary DCFolks, I'd like to make a few comments about our human injuries, how to handle them, and what to expect long-term if we try to "economize" too much, or make treatment decisions based on symptoms alone.Let's take knee injuries for example, since that is a frequent topic on RC. There is a principle in medicine that there is often no reliable correlation between the severity of symptoms, and the severity of a medical condition or injury and the need for treatment. One can have cancer and not know it, and a paper cut can be excrutiating. The same is true of knee injuries. There may be either a lot or a little pain, and a lot or a little swelling. The pain may last or not. These are not in and of themselves clear indicators to the patient as to appropriate medical decision making. Add in some financial concerns or lack of insurance, and you may find yourself avoiding important diagnosis and treament because of seemingly rational, but flawed reasoning. Here's how I look at it as a doctor and endurance rider: Premise: I can afford horses. Corollary: I can't/won't afford medical insurance or appropriate medical care for my injuries. Conclusion: I can't afford horses. Allow me to explain why I take this position. Healthy joints don't wear out or become pathological with use. They tend to become stronger, more stable, and less prone to injury. Injured joints (ruptured ACL's, torn cartilage, thinning cartilage, etc,) tend to harbor long-term, low grade inflammation, which adds to the rate of deterioration of that joint at varying rates. This is almost always accompanied by weakening of the associated support muscles through neurological mechanisms. Untreated "internal derangements" of the knee (or any joint for that matter) lead to instability and much more rapid deterioration of that joint. Often with secondary problems as compensation, such as chronic low back pain from adapting to a bad knee, for example. This accelerated deterioration is often largely independent of pain. In other words, you may think you're fine because you don't hurt that bad or can control the pain with meds or avoid it by adapting your daily activities and behaviors. Very slippery slope. Incidentally, I will have to disagree with my friend Angie on the use of MRI in diagnosis. Arthroscopy is an invasive procedure, and MRI can show us the extent of damage, thereby preparing the surgeon better for what awaits him at surgery, or possibly giving permission to skip surgery and go to therapy instead. I have had several patients who underwent arthroscopy who were informed afterwards that nothing significant was found. Meanwhile, the joint had been unnecessarily invaded to find that out. Lastly, a word of caution against trying to play the "I'll wait until I have insurance to have the procedure done" game. Or " I'll withhold information about my pre-existing injuries from the insurance company, so I can still get insurance later." These strategies constitute fraud, something that insurance companies take VERY seriously. Proceed at your own peril. In short, most of us wouldn't dream of asking our horses to go down the trail with a possible or known joint tissue compromise, and without prompt, thorough diagnosis and treament. Why would we treat ourselves any differently? Bruce Weary =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= Ridecamp is a service of Endurance Net, http://www.endurance.net. Information, Policy, Disclaimer: http://www.endurance.net/Ridecamp Subscribe/Unsubscribe http://www.endurance.net/ridecamp/logon.asp Ride Long and Ride Safe!! =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=
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