Muscle Medicine: The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints (43 page)

SUMMARY AND EPILOGUE

Maybe
you’re familiar with the Indian fable about the blind travelers who come across an elephant in the road. One man feels the trunk, another a tusk, another the flank, and the last one, the tail. As you might guess, they arrive at very different conclusions about what that elephant looks like. The way that Western medicine treats musculoskeletal problems is something like that: trauma surgeons look at the body and see bones that need to be fixed, sports medicine orthopedists see joints that need repair, chiropractors want to mobilize joints, muscle therapists want to work directly on the muscles, and physical therapists want to strengthen the muscles and make them more flexible. Between these groups, they’ve got that elephant pretty well covered, but they all need to work together!

As we’ve often said, to understand injuries and treat them effectively, you’ve got to deal with the whole elephant—bone, joint, and muscle. Ignore one or two of the elements and you could miss the big picture. Recall the soccer player in
chapter 1
who tore his ACL: classic sports injury, textbook surgery, and yet he didn’t really attain the full benefit until Dr. DeStefano addressed the muscle damage in his thigh in
rehab. Or the businesswoman marathoner we discussed in
chapter 12
. Dr. DeStefano won her some symptomatic relief by manually treating the muscles, but she wasn’t really going to get better until Dr. Kelly surgically dealt with both bone (the impaired mobility in the hip socket) and joint (torn hip cartilage).

By now we hope you appreciate the importance of muscle in the overall health-care puzzle. And beyond that, how important it is to treat a musculoskeletal problem in the proper sequence. First, tight, damaged muscles have to be addressed and the body’s healing process mobilized. Then we move on to muscle conditioning—stretching and strengthening. That’s how we work with our patients, and that’s how you will work on yourself when using our self-help program. That, in sum, is muscle medicine, a philosophy about how the musculoskeletal system works and a strategy for treating it.

In this final chapter, we’re going to do two things. First, we’ll quickly summarize the tools for healthy living that we offer throughout the book. Then we’ll present a guide for skillfully using these tools in the real world; in other words, how to be the smartest consumer of musculoskeletal health care—muscle therapy and surgery—that you can be.

MUSCLE MEDICINE REVIEW

Chapter 2
explained the basic biology of how your muscles, joints, and bones work together as an integrated system.
Chapter 3
went deeper into how this system commonly breaks down. When you’re dealing with an injury, it’s easy to get bogged down in the Latinate names that your doctor might be tossing at you—
patellofemoral syndrome
or
iliotibial band syndrome,
for instance. You should know that there are many of the same underlying causes behind the different muscle problems that we discuss. Appreciating that will help you talk intelligently with your doctor, or to do your own online research.

Chapter 4
addressed the psychological dimension of injuries. Self-awareness is the tool to reduce your own contribution to physical wear and tear. Everyday stress can cause your muscles to tighten up. So can fear about a physical or medical issue that you don’t adequately understand. All these things can feed into a cycle of distress and pain.

Chapter 5
was a general introduction to good nutrition. The right diet is an important
part of maintaining a healthy musculoskeletal system, and for many readers weight loss is crucial. The simple truth about weight loss is: eat less, exercise more. The number of calories you consume must be less than the number you expend.

Chapter 6
offered some ideas about smart and effective exercising in an all-around fitness program broad enough for almost anyone to use as a guide. If you’re unsure of any of the advice in this chapter, seek out a qualified personal trainer to teach you the basics of good form and how to construct a balanced exercise program. The trainer should be willing to work with you to achieve your fitness goals, and with any health professional involved in your care.

Chapter 8
through 14 dealt with what we call the hot spots. The chapters discussed in detail some of the most common musculoskeletal problems occurring in the neck, the shoulder, the elbow, wrist, and hand, the lower back, the hip, the knee, and the ankle/foot. In these chapters, we went from discussing what a therapist or an M.D. can do for you to what you can do for yourself. And at the end of each hot-spot chapter, you were shown the muscle medicine self-help program, which moves, in logical sequence, from muscle self-treatment to stretching to strength work.

As we explained in
chapter 7
, the introduction to the self-help program, many treatments exist to manually address tight and damaged muscles, including chiropractic, acupuncture, physical therapy, as well as hands-on techniques such as ART and Trigger Point Therapy. We’ve applied elements of these techniques to create our method of self-treatment that you can effectively do yourself. For the stretching and strength work—the conditioning part of our self-help program—we’ve tried to distill the best of the best from the exercises that health professionals give their clients and patients.

If you are ready to move from a doctor or a therapist’s care, discuss with your doctor whether our self-help program would be safe and helpful for you. We’ve designed it to work for a broad collection of people: people in good health; people with minor musculoskeletal problems that don’t interfere with their everyday activities; people with more serious problems who have been cleared by their physicians to supplement professional care with this program; and for people who have been through treatment for more serious conditions and now, posttherapy or postsurgery, have been cleared by their doctor to continue to work on their health with this program.

BEING AN EDUCATED HEALTH-CARE CONSUMER: CONTRACTORS VS. SUBCONTRACTORS

It’s important to have a good foundation of musculoskeletal self-knowledge. In today’s fragmented health-care system, you’re going to need it to be a smart healthcare consumer. Let’s take the first decision you face when a chronic problem surfaces or you suffer a trauma (one that doesn’t send you to the emergency room): whom do you call?

We can make this decision less daunting by making a simple comparison. Imagine that searching out musculoskeletal health care is like building a house or undertaking major renovations. You can find a contractor you trust and leave the major decisions to him. Or you can play that role yourself and search out the subcontractors you think are best equipped to handle the many jobs involved in your project (lay the foundation, handle the electrical, and so on). In the case of serious joint injury, the orthopedist will most likely serve as your contractor. An alternative is a physiatrist or an osteopathic physician (D.O.). These days, osteopathy has many functions—drugs are prescribed, surgeries are performed—but the profession’s roots are in manual manipulation, and some D.O.’s combine conventional medicine with hands-on expertise. If your problem has more to do with muscle or nerves (a backache or a sore wrist from overusing the keyboard), a chiropractor could make a first-rate contractor.

The contractor may be calling most of the shots, but of course the onus is on you to find the right one! Let’s consider the search for an orthopedist to manage a joint injury. It’s likely that your primary-care doctor will refer you to someone. That’s a start, but it doesn’t have to be the final word. Talk to your friends and colleagues. Is someone particularly satisfied with their surgically replaced knee, or dissatisfied? Web research can be helpful. To begin, check out
www.bestdoctors.com
and the Web site for the American Academy of Orthopaedic Surgeons (
www.aaos.org
). You might want to talk to any college or professional sport teams in your area and find out which surgeons they entrust their athletes to. The same holds true when you’re searching out manual therapists.

As you narrow your list of candidates for surgeons, take a closer look at their résumés. Where did they intern? Do they have teaching responsibilities? The hospital and the surgeon you settle on should routinely perform the procedure you are

Dr. DeStefano

I had a patient, a female runner, with terrible groin pain. I treated her for weeks and weeks and she only got moderate relief. But she was convinced that the problem was muscular. Finally, I persuaded her to get an MRI of her hip, and it came back negative. I treated her some more. She got a second MRI at an MRI center that was covered by her insurance, but it didn’t have the best reputation. Again, negative. Finally, I persuaded her to go to the Hospital for Special Surgery and pay half the cost out of pocket. They found an impinged hip and an absolutely shredded labral cartilage. The difference in quality between radiology centers can be amazing. Dr. Kelly cleaned out the joint and repaired it. My patient is back to running, pain-free, and it had much more to do with the joint than the muscle!

considering, many times a week, if not every day. Practice makes perfect. Just how high you need to set the bar for your prospective surgeon depends on the procedure you’re in the market for. Minimally invasive surgery to repair a torn labrum cartilage in the hip is a new field. You want a leader in that field, not someone who does the operation occasionally. But even for something as seemingly straightforward as an ACL reconstruction, different types of procedures must be considered. Do your research!

When you choose an orthopedist, the doctor should be ready to enter into a working partnership. It’s not an equal relationship—the orthopedist knows more about orthopedics than you do—but the right doctor and support staff can help educate you with printed materials on surgical procedures and tips on how to find reliable information on the Web. The Web site for the Hospital for Special Surgery (
www.hss.edu
), for instance, is packed with downloadable instructional videos for most any orthopedic procedure you could imagine.

Beyond the technical ABC’s, an orthopedist should provide straight talk. What functional gains can realistically be expected from this surgery? How does that stack up against the costs: the risks on the operating table; the time lost at work or at home; the length and difficulty of the rehab. Sometimes what patients fail to grasp is that the goal of the surgery may be a joint that works
better
than it did before surgery, not one that works perfectly.

Finally, your best surgeon may be the one who chooses
not
to operate. Any
board-certified orthopedist can do a procedure. But it takes experience, and the judgment that comes with it, to know when not to operate. In the hot-spot chapters, you’ve seen cases where surgery was a plausible, maybe even expected, solution to a musculoskeletal problem, but in our view it wasn’t the best option at that time. Especially in areas where judgment calls can be toughest—a piece of torn meniscus cartilage in the knee, a herniated disk in the lumbar spine—you want an orthopedist who is secure in his practice and in his conservative judgment. Even when due diligence has paid off and you’ve found such a surgeon, as a rule of thumb, you should get a second, possibly even a third opinion, before deciding to go forward with a procedure. Orthopedic surgery can work wonders, but all potential options should be explored.