Contemplating a total joint replacement? Hopefully, I can help in your decision. After teaching joint replacement classes, the pre and post op, I've made several observations while doing so, but I would like to start by saying that pain will change your decision making and some tolerate it better than others. Sometimes, it will drive you into the quickest pain reducing decision which is understandable. I think we can all agree that keeping your original "parts" is always the best option and exhausting all of the conservative treatments prior to surgery should be recommended by your physician. One of those treatments should be physical therapy. I've spoken about mechanics in the past and how they influence the wear and tear on your joints like the tires on your car. If they are not balanced properly, you will get less life out of them. The hip musculature is often overlooked in knee rehab and is crucial in knee health because it controls the rotational forces at the knee. Ever stand up from a chair and feel like your knees want to move inward? That's glute weakness - yes, your butt is weak! Your knees, of course, do not want to move in that direction and it will cause stress on the structures surrounding the knee. Strength of the lower extremity will also help to distract the knee joint providing increased joint space. Just because your x-ray shows decreased joint space, that does not mean it is the source of your pain. If I had a dollar for everyone who said they had "bone on bone" in their joints, I would have my student loans paid off! You could x-ray the entire population of those over 55 and find poor joint space on x-ray, but it does make a good selling point. In health care, we need to start treating the patient first and not the imaging. There are several structures that surround the hip and knee joints that can mimic your pain and believe it or not, your physical therapist is trained to figure that out! I'm not here to discourage you from having a joint replacement, I just want to educate you on your options. You have to go through the extensive rehab after and you will benefit greatly from doing some strengthening before, so why not try therapy and possibly avoid the surgery altogether?!
Thank you for reading and please share so that we can all BeneFIT!!!
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Dr. Mark Giovanini
Scott Rusin is the Director of Physical Therapy at the Sandestin Executive Health & Wellness Center in Sandestin Resort, Miramar Beach, FL. He has a degree in Physical Therapy, is a Certified Strength & Conditioning Specialist (CSCS) and Nike Golf NG360 Performance Specialist Powered by the Gray Institute.