Are Your Joint Pains Rapidly Reversible?

I didn't really want to get into this quite yet, but I was reading a twitter post from one of my mentors, Jarod Carter, PT, DPT, MCT, on meniscal tears and thought how different it would be if everyone knew this.  Check out the article titled Fake Surgery Just as Good as the Real Thing for Meniscus Tears.  Say What?  This is what my cohorts and I have been saying for many years in our practices!  Not exactly in those words per se, but something close, like I wonder why this patient is doing so well after his meniscal surgery and this one isn't, given that most variables are the same.  As clinicians we see of lot of things that make us say hmmm.  This is one of them.

I  work in a busy orthopedic clinic for 6 orthopedic surgeons 2 days a week where I treat patients for them.  One surgeon there (guess who?) has seen the value in sending patients to PT before operating to see if there isn't an easily treatable condition we refer to as joint derangements.  This improves favorable outcomes for his surgeries.   A derangement syndrome is  defined as "Internal dislocation of articular tissue, of whatever origin, that causes a disturbance in the normal resting position of the affect joint surfaces.  This deforms the capsule and periarticular supportive ligaments resulting in pain, which will remain until such time as the displacement is reduced or adaptive changes have remodelled the displaced tissues.  Internal dislocation of articular tissue obstructs movement attempts towards the direction of displacement."¹  This is just another way of saying that you have something in your joint that feels like a pebble in your shoe.  Will you need a lot of foot therapy or surgical repair once you take that pebble out?  Obviously not!

 Let's look at it this way.  Basically, when we injure our peripheral joints the body will put a little fat in the area to protect it.  When we begin to wear out or degenerate, our body creates nooks and crannies in the bone and, since we don't really like nooks and crannies our body will put fat into these areas for moisture, nutrition, and cushion.  However, if that fat gets too big it is going to get pinched.  Like catching your finger in the door.   Here is a great study by a clinical anatomist that found fibroadipose meniscoids in all joints   Her paper is about elbow joints but she mentions that all joints have these.  I am convinced that most of these derangements (and there is no solid proof of this) are fat based since they are so rapidly changed.    So my question to you is, do you know if this pain and obstructed motion  is from your bone on bone, your rotator cuff tear, your meniscus tear or the extra fat that is sent there to protect you?

We will never really know because when they cut the bone out to give you a new joint they cut all the fat out too, or repair your rotator cuff or your meniscal tear.  It will only take me (or any other certified MDT practioner)  a couple of visits to find out if a fat pad is your problem.   Theses fat pads are malleable, they can change size and shape and you can do it with repetitive movement.  Just like dissolving  a piece of raw bacon by rubbing it between your fingers.

Yum!  BACON!

 Maybe it is the fat that got caught under your rotator cuff tear and not the tear itself causing you all the pain.  You won't know til you give it a try.

In your knee, this derangement could be anything from a fat pad to a torn meniscus that is blocking motion and producing pain. Generally we find increasing symptoms in one direction of movement and decreasing symptoms with increased movement in another.  This helps us to decide what directional preference for treatment would be.  You are then sent home with one or two movements that are designed to abolish your symptoms.  If this works, surgery and endless therapies can be avoided and you can be taught how to self-treat your current problem, how to minimize recurrence and how to manage symptoms if they do happen to reoccur.  Wouldn't you want to avoid surgery if you could?

I would.

Bring your knee, hip, ankle, elbow, shoulder, wrist, hand, finger, and toe pain in today for a mechanical assessment to see if you have rapidly reversible joint pain.  As I am fond of saying "You Deserve a Good Mechanical Assessment!"  Call or text Grimm Physiotherapy at 504-228-0524 to schedule your evaluation and visit us on the web at grimmpt.com.


¹  McKenzie, Robin, and May, Stephen (2011).  The Human Extremities:  Mechanical Diagnosis & Therapy, Spinal Publications, New Zealand Ltd.

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