“Declare the past, diagnose the present, foretell the future.” – Hippocrates
Medical studies on various medical issues are used by doctors of all disciplines as guidelines for present and future knowledge. There are things like the WOMAC scale, percentages of “success”, and the scientific research base-lines which help determine results. These results can then be a tool for doctors which of course lend to helping increase patient recovery rates.
In this article, I would like to explain this behind the scenes world of medical research and how this relates to your recovery.
1. Keep in mind that medical studies get funding for ailments that are the most common and most costly to society. Is it any wonder that celebrities spend so much time promoting medical causes that are important to them? Funding is unfortunately not readily available for less common ailments and diseases.
2. In musculoskeletal medicine, many studies focus on knee arthritis, arthritis of other joints, and lower back pain because of the overall burden of these conditions to healthcare systems and the workplace. Some causes of these issues are genetic, while others are lifestyle-related.
3. Even within each specialty (in my case, sports medicine), doctors do not always agree on approaches to treatment and how to decipher and implement the data obtained from the latest studies. Of course, more accurate data can mean better treatment, and a better recovery for patients.
4. Fundamental differences in philosophy can hinder recovery. In osteopathic medicine, the body is seen as a “functional unit”. In other medical approaches, the body is seen as parts to be examined individually. For example, if a patient is experiencing pain in the lower back region, the cause might be from an area that is out of alignment at the neck, or muscles in the low back region that get “turned off” because of an injury such as an ankle sprain. Some medical philosophies would treat the lower back area only, while a DO would look at areas that may also be the reason for pain and discomfort. Again, these DOs approach the body as a “functional unit”.
Let’s talk about knee arthritis studies performed by several different hospitals, foundations, and research labs across the country. First, the WOMAC scale is a widely respected scale to determine pain – it stands for The Western Ontario and McMaster Universities Arthritis Index (http://en.wikipedia.org/wiki/WOMAC). This scale is used as a measure of function and pain associated with knee arthritis and a standard base-line comparison to help understand what patients are experiencing and how to translate this valuable information into usable data. There will usually be 3 or 4 groups studied over an extended period of time, for example:
Group 1: Patients who receive an experimental treatment or drug.
Group 2: Patients who receive prolotherapy injections separated one month apart, followed up for evaluation for a full year from the beginning of a one year study period.
- Group 3: Patients who receive saline injections (a “placebo” group) during the same intervals as Group 2.
- Group 4: Patients who do regular physical exercises at home.
Now, let’s talk about results. For example, cancer research study results are analyzed as follows: if a new drug or treatment method shows a 30% positive result, it is solid enough for future study and therefore for future funding. Over 30% improvement is called a “meaningful clinical outcome”. Results less than 30% are considered to have a “minimal clinical significance”. Of course, patients want a 100% positive result, right? But now you get the bigger picture of what might get more funding, more research time… or not.
Now, let’s talk about knee arthritis studies and the osteopathic approach. Thankfully, the WOMAC scale is very useful for understanding what a patient is actually feeling and offers an excellent standard for communication between doctors and patients. Furthermore just to reiterate: the osteopathic philosophy is to treat “the body as a functional unit”. In the case of knee arthritis, the thought is that it’s not just the knee-joint surface that is causing pain; it is also the surrounding soft-tissue support structures. Some of these support structures become worn out and develop laxity (looseness or weakness) with associated pain symptoms.
Traditionally, injections around the knee are poorly studied in past medical literature since many doctors will focus in on the knee-joint surface only. In contrast, prolotherapists over the decades have come to develop the practice of injecting these “extra-articular” structures (ligaments and tendons surrounding the knee-joint) because on physical examination, knee arthritis patients often have pain in these areas as well. Also, although ultrasound is an excellent tool for detecting visual defects, there are other “bio-mechanical” reasons for pain: lifestyle, mental attitude, posture, and overuse (every daily PC or Mac user knows what carpal tunnel syndrome is, right?). Osteopathic medicine “considers the entire body, not just where it aches.” This is key in a sound examination, an accurate diagnosis, an effective treatment, and a speedy recovery. It is also key when funding useful medical studies and correctly interpreting test results for the benefit of better patient recovery rates.
Why is any of this interesting to patients?
It comes down to a million-dollar question: Surgery or no surgery for knee pain? Surgical decisions such as joint replacement for severe knee arthritis are still common. Insurance pays for it, surgeons are good at it, people feel relief, and everyone is happy. But think about this for a moment: approximately 90% of sports and lifestyle related injuries do not need surgery. If test results show the effectiveness of prolotherapy injections for knee and knee arthritis pain without going to the hospital, would that not be preferable? Of course, sometimes surgery is recommended for some situations. AND, the non-surgical prolotherapy injection treatment is one method that works, medical studies consistently show this to be true, and patients can only benefit from this knowledge. Shifting from automatically going into surgery… to deciding on a non-surgical, alternative treatment method just makes sense. Medical Studies 101 says: think about this before making your treatment choices. Food for thought.