Timing of Treatment if you have Pain.

-If you have pain, what are the first steps you should take?
-If those steps fail, what should you do next?

Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly live broadcast, it’s August 26, 2020. I hope everyone’s doing well and welcome. So today I want to talk about timing. People say timing is everything in life, it may not be 100% but it’s obviously a significant part of it. When it comes to your own musculoskeletal treatment and health, I think timing is really critical here.

In large part because you can do a lot more and a lot better if the timing is correct. And in part, because it’s important for people to know when is the time to actually get evaluated and treated. So there are a number of things that I think of when it comes to timing of treatment, when it comes to your joint, tendon, back sort of health and wellness.

First and foremost is do you have any kind of pain or limitation? That may sound obvious but the reality is that most people typically wait until things have gotten significantly worse and debilitating before they actually decide to address something. Well, that’s very normal for how humans act and kind of proceed with their life. The reality is that that’s not very healthy for optimizing your life. And an example of that in a different field of medicine would be diabetes or blood pressure. You would never wait until somebody’s diabetes or blood pressure is so bad that they’ve had multiple heart attacks and strokes. You would want to address that at a earlier stage before they actually have those kinds of complications. In the same way, if you have a joint or a tendon problem, you don’t want to wait till it’s so disabling and problematic that you’re no longer able to do your activities that you enjoy, you’d rather take these on at an earlier stage.

So initially, if you have pain or functional limitations, that should be your trigger to do something about it, to take some kind of initial action. And whether that’s correcting biomechanics, posture, some adjustments to your physical activities, you want to be thinking about that right off the bat. So some things that come to mind right off the bat for me would be if you happen to be, I mean, the whole world right now is sort of working at their computers at their desks. And if you’re someone who’s starting to develop some neck pain, some shoulder pains, if there’s issues with your biomechanics at your workstation, with your posture, those are things that you can address fairly straightforward and easily. And you want to make a conscious effort to do that. Easy way to kind of jump in and make a difference for your symptoms right off the bat. On the other hand, if you have pain, that’s really related to specific activity, let’s say sporting activity, you want to address that as well.

So, as an example, I’m using my brother as an example a lot nowadays, but he’s someone who plays a lot of tennis these days and he’s in his 40s now. And he’s got some various pains, elbow, shoulder. Well, he needs to make some changes, figure out some of the biomechanics, some of the strokes that he’s doing while he’s playing tennis, overhead activity and figure out how to improve some of those so that he has less stress on his shoulder and his elbow. If he’s not already doing that, that’s your first step.

Other good first-line steps would include over the counter supplements. The ones that I recommend are glucosamine chondroitin, Omega-3 and turmeric. Glucosamine chondroitin has been shown to help in 50% of folks who’ve got near arthritis. That’s actually pretty good in the world of musculoskeletal medicine if you’re wondering 50% may not sound overwhelming, but that is actually a good number. Omega-3 can help if you’ve got inflammation in the joints and turmeric or curcumin has been shown to help equally as well as anti-inflammatory medications, if you have arthritic pain as well.

So good first line options with your goal of being able to get back to your baseline activity or continuing your baseline activity without significant pain. Good first-line way of kind of jumping in and doing something. The timing there is, hey, you’ve got pain, you’ve got some functional limitations, there’s something abnormal. Recognize pain as what it is, which is a signal from your body that there’s something wrong here and address it, treat it properly, do something about it. Next steps, if you’ve done all that, and you’re still having pain, I wouldn’t wait.

I wouldn’t just ice it down, putting on anti-inflammatory meds, that’s the traditional way of treating it. It’s a traditional way of treating something like pain is let me just take something for pain in terms of pain medication, let me suppress it, let me take an anti-inflammatory medication to suppress that pain, rather than trying to actually get to the root cause and try to make a more longterm decision to actually improve things. Icing and anti-inflammatory meds, they have a role short term, longterm, not ideal, not the only approach that you want to take.

So next steps would be if you’re still having pain, despite making the right smart decisions in terms of altering your biomechanics, over the counter supplements, will then be to actually see a musculoskeletal trained physician. If your physician is not nuanced in terms of treating your musculoskeletal health, you really should see someone who is. If you’re not, it would be like seeing someone for heart problem who isn’t really an expert at heart disease, that’s not ideal. So the next steps really are diagnostics. Based on your examination and imaging, what’s really causing a problem. I think a great first-line imaging test for a lot of musculoskeletal conditions is an ultrasound. You can take a look at a lot of subtle things in terms of ligaments, tendons, joints, inflammation. You can make some decisions right off the bat with that. Sometimes x-rays can be helpful. Sometimes even an MRI can be helpful. The key is you don’t want to get the imaging just for the sake of getting the imaging, you want to make sure it makes sense based on your symptoms, your exam, and working with a trained appropriate physician.

At that point, as you come to a decision as to what’s causing your problem, the next steps are then to properly treat it. Treatment on a nonsurgical level, hopefully first-line. There’s some things that do need surgery kind of upfront, but most things, 75% of musculoskeletal issues, 80% can be treated non-surgically. And at that point, you should be figuring out, look, is your problem coming from a joint or tendon problem? Is there possibly a pinched nerve that’s kind of driving issues? Do you have an inflammatory issue? Do you have an instability issue? Figure out what’s going on with your physician and then come to a treatment algorithm. So at that point, if you’ve already failed physical therapy, over the counter supplements, some activity modification, then you want to consider actually doing a regenerative medicine treatment.

I think a good first-line option for a lot of things that are mild to moderate is platelet rich plasma for things that are more significant then you want to consider something like bone marrow derived stem cells, but that’s generally the algorithm. Have you sort of failed some things that are relatively mild and then what are the next steps? In terms of timing to know when you should take some of those next steps, certainly if you failed the conservative options, but in addition, you may be able to get back to your normal activity level or exercise, but there’s some sort of things that might indicate you still have something low level or underneath the surface that’s still driving problems. That may be an issue as you get further down the line. And so, as an example, if you notice with exercise that the area that been affected, let’s say your knee or your back, there’s just a little bit more weakness or fatigue in that area, compared to the rest of your body, more so than what you normally have at baseline, that could be a sign that you have an ongoing problem that really would benefit from treatment. Or really sort of finding of instability, meaning where a ligament or tendon has been damaged and is not really providing a lot of protection, is that kind of easy fatigue in that area. So, one way that I’ve heard that explained to me is someone who’s got knee pain, they feel okay, but when they walk more than let’s say a mile or two, they start to notice that the leg starts to feel a little bit more tired or weak or cramping. It’s a sign that there’s some instability there that probably needs to be evaluated and treated. Subtle ways, I think some other subtle ways to figure out are you kind of having an ongoing issue that might be under the surface would be, let’s say you have a knee issue, and then you start to find, hey, I’m starting to compensate and now my back and my hip is starting to cause a problem. You found a way around it. The body’s an incredible machine in terms of finding ways to get around the problem, but now you’ve kind of offloaded and now put that into another area, that’s a problem. And is something that be addressed by addressing the root cause, which is that initial area that was injured or painful.

To me, timing is key in the sense that, recognize pain for what it is, which is a signal from your body that something needs to be evaluated. Recognize that the timing when you have that kind of problem should be relatively soon and immediate, make decisions that are correct longterm, improving your biomechanics, posture, taking the right kind of over the counter supplements, not relying on anti-inflammatory or pain medications, trying to maintain that overall baseline physical activity. If you’re not able to, then transitioning to actually seeing someone who knows how to properly evaluate that, using the right diagnostics, ultrasound, x-ray, occasionally MRI to properly make a diagnosis based on what’s going on, not just relying on the imaging, but correlating it with what other symptoms and examination findings you have and then kind of progressing if needed to a regenerative medicine treatment.

Timing is everything in life or at least a large part of it. And I hope this gives some better clarity on how timing is important when it comes to your musculoskeletal health and wellness. Thank you for your time. As a reminder, I do a live streaming event every Monday and Wednesday, and until next time, have a good day and live well, bye-bye.

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***About this video***In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses timing of treatment if you have pain.