Physiotherapy Is As Good As Surgery For Meniscal Tears

Last week Yahoo! News reported that physiotherapy was as good as knee surgery. The claims were based on results of a recent study by Jeffrey Katz, Professor of Medicine and Orthopedic Surgery at Harvard University. The randomised controlled trial involved symptomatic patients aged 45 years or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on imaging. They randomly assigned 351 patients to surgery and postoperative physiotherapy or to a standardized physiotherapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). The patients were evaluated at 6 and 12 months.

They did not find significant differences between the study groups in functional improvement 6 months after randomisation; however, 30% of the patients who were assigned to physiotherapy alone underwent surgery within 6 months. “Since both the patients who received physical therapy and those who received surgery had similar and considerable improvements in function and pain, our research shows … there is no single ‘best’ treatment. Patients who wish to avoid surgery can be reassured that physical therapy is a reasonable option, although they should recognize that not everyone will improve with physical therapy alone.” Katz said.

Having undergone a successful menisectomy last year I can personally attest that surgery can sometimes achieve results that physiotherapy can’t but conservative management such as physiotherapy should always be the first port of call.

Dwelling On Stressful Events Can Increase Inflammation

A new study by Zoccola and colleagues found that people that were asked to dwell on a stressful event had higher levels of C-reactive protein (CRP). CRP is produced in the liver and its blood levels rise in response to inflammation e.g. infections, injuries, rheumatic or other inflammatory diseases, etc. Patients with high CRP concentrations are more likely to develop stroke, myocardial infarction and severe peripheral vascular disease.

The fact that rumination increases inflammation means that dwelling on negative thoughts has an adverse impact on pain and recovery from soft tissue injuries. Yet another brilliant example of the mind-body connection at work!