Last updated date: 28-Oct-2023
Originally Written in English
Bone, muscle, and joint injuries can occur for a variety of causes, including sports injuries, falls, accidents, and normal wear and tear as we age. Just as the causes of injuries differ, so do the treatment choices available, and knowing what options are available is key to finding the best answer for each patient and condition.
While surgical treatment is sometimes the best option, for certain orthopedic problems, conservative, non-surgical treatment measures may be a superior option before surgery. The general consensus is that simply though surgery is possible, it does not always mean it should be done. Patients like the fact that they have options, such as non-surgical or non-invasive treatment.
Even though surgery is a possibility, some people aren't surgical candidates due to other medical issues that enhance the risk of surgery. Patients may also be hesitant to undergo surgery due to a fear of the unknown or worry about the extended recovery period. Regardless of their motivations, both groups of patients choose to live with and manage the pain caused by their injuries.
Non-operative orthopedic treatment aims to improve a patient's quality of life, reduce pain, and maximize function without requiring any cuts or tissue removal. Instead, the specialist looks for non-surgical options and provides the most tailored treatment plan for their needs to relieve pain as rapidly as possible.
Patients benefit from non-surgical treatment methods in a variety of ways:
- No incisions ensure no wounds, scars, or infection risk.
- A patient's progress and improvement can be in his or her own hands.
- There is no hospital stay for non-surgical treatment because they are performed as outpatient procedures.
- Patients frequently experience a gradual restoration of normal function with less disturbance in everyday activities.
- These non-surgical treatments are effective alternatives to surgery and typically result in quick recovery and pain relief.
Why do We Need Non-Surgical Treatment?
Younger patients are more prone to injuries and weight gain, and as a result, we are seeing patients develop osteoarthritis earlier. It is a top goal to assist young people to avoid joint replacements because registries show that patients under the age of 55 wear them out more quickly. Given that the typical life expectancy is around 83 years, a patient under the age of 55 will almost certainly undergo a second, much more invasive (revision) surgery during their lifetime.
Conditions Treated with Non-Surgical Treatment
The following are examples of diseases treated with nonsurgical treatment:
- Early hip or knee osteoarthritis. In young patients with severe osteoarthritis, controlled, guided weight loss and exercise can bring a tremendous improvement in pain and function. PRP, Hyaluronic acid injections, and now Pentosan are all adjunctive therapies that can be utilized to postpone the need for joint replacement surgery.
- Anterior cruciate ligament (ACL) rupture. The Anterior Cruciate Ligament (ACL) is responsible for the rotational stabilization of the knee. In the past, it was thought that reconstructing this ligament was required to return to sports or pivoting activities. When given the right conditions, there is growing evidence that this ligament can and does recover. You may be a candidate if your meniscus and cartilage are in good condition.
- Achilles Rupture. In the past, scientists believed that an athlete with an Achilles rupture could only return to sports after surgery. So long as the diagnosis is not delayed, the evidence currently shows that non-surgical treatment with early mobilization produces fairly similar results. Patients who have surgery have a minor advantage in terms of calf muscle strength. They believe that patients, especially those who are detected early, should have the option (Achilles ruptures are commonly missed).
Complications such as wound disintegration, infection, and surgery failure are common in patients with diabetes or obesity. Doctors use an evidence-based procedure that includes a customized cast for the first month and early functional mobilization in a heel-lifted boot for the next four weeks to allow the tendon to recover properly. Then there's a six-week physiotherapy strength and range-of-motion program, with a six-month average return to sport.
Good Candidates for Non-Surgical Treatment
Nonsurgical treatments are available to practically all patients, although some may find the advantages particularly appealing. The following are some examples of such people:
- Athletes who do not want their training plans to be disrupted by treatment.
- Patients with various issues that make surgery a high-risk procedure.
- People with arthritis who are unable to benefit from surgery.
- Patients who do not have the time to heal for long periods.
- Patients who had tried surgery before but had no success.
Don't put up with pain just because you're not a suitable candidate for surgery or don't have the time to recover. Non-surgical treatment is extremely effective. Patients may experience an instant reduction in discomfort after just one treatment. Make an appointment with your doctor to discuss non-surgical treatment options if you've been turned down for invasive surgery or would want to avoid surgery if at all possible.
Physical therapy and rehabilitation are important parts of recovering from an injury or managing pain caused by musculoskeletal or neuromuscular conditions. It is the most natural and frequently the most effective form of healing. A physical therapist can construct a regimen of particular exercises, modalities, and activities that target specific problem areas and treat them in ways that reduce pain while also preventing it from returning. Physiotherapy and rehabilitation are two very efficient ways to help the body recover from injuries that aren't serious enough to require surgery.
Muscle, ligament, and tendon injuries are frequently stretched and massaged until symptoms subside, then the tissues are strengthened to prevent a recurrence. Disease-related pain, such as degenerative disc disease or arthritis, can also be managed with regular therapy. Symptoms are often relieved using modalities such as ice or heat while strengthening specific areas makes the affected parts more resilient to pain.
When recovering from an operation, physiotherapy and rehabilitation are also essential. Though surgery can fix an injury or malfunction, the healing process is vital to restoring a body part's function. Stretching and massaging the surgically treated area will improve flexibility and reduce internal scar formation, allowing the body to recover properly. After periods of injury and rest, surrounding muscles and tissues become weak, thus it's critical to increase strength in the targeted area to support the corrective procedure.
Your doctor will normally prescribe anti-inflammatory drugs and muscle relaxants to help you recover from an orthopedic injury or disease. An orthopedic specialist will first propose over-the-counter pain relievers before recommending prescription pain relievers. If they don't work, you'll be given a stronger prescription.
Steroid injections or pain-relieving drugs can help reduce inflammation and discomfort. They can be done under fluoroscopic guidance, which involves utilizing ultrasound imaging or a low-grade X-ray to help position the needle, particularly near joints like the hip. Experienced orthopedic specialists can perform a variety of injections.
Cervical Epidural Injection
Compressed nerves in the cervical spine produce pain in the neck, shoulders, and arms, which can be relieved with this treatment. Conditions like a herniated disc or spinal stenosis can pinch nerves, causing inflammation and pain, and the drug injected minimizes nerve swelling. Intravenous sedation and local anesthesia might be used to numb the injection site. The larger needle is directed into the epidural area in the neck, which is where the spinal nerves go, using x-ray guidance and a fluoroscope. The needle is then positioned correctly near the damaged nerve or nerves by injecting a contrast dye into the space. The epidural area is injected with a mixture of anesthetic and steroid solution to reduce nerve swelling and relieve pressure. Some patients may only require one injection, while others may require two or three injections spaced weeks apart to achieve significant pain control.
Lumbar Epidural Steroid Injection
This injection relieves the lower back and radiating leg discomfort caused by spinal disorders such as swelling and inflammation. The skin and tissue along the lumbar vertebra bone are numbed using a local anesthetic. The doctor guided the needle toward the epidural area between the problematic vertebrae with a fluoroscope and administered a contrast dye to check the needle tip's exact location. The steroid-anesthetic combination is then administered into the epidural space, bathing and relaxing the nerve root. To relieve discomfort and swelling, the treatment can be performed up to three times.
Sacroiliac (SI) Joint Injection
The SI joint is the link between the spine and the pelvis. Injections into this joint can help with discomfort in the low back, buttocks, groin, and thighs.
Steroid Injections into Other Joints
Arthritis, injury, or degeneration can all be relieved with steroid injections into the joints. They may also help you in determining the source of your discomfort. Steroid treatment and a numbing substance are administered to your knee, hip, ankle, or other joints during this treatment. The steroid reduces inflammation and pain over time, whereas the numbing agent relieves pain more quickly.
Individuals with osteoarthritis, or wear and tear arthritis of the knee, who have a lower-than-normal content of hyaluronic acid in their joints may benefit from viscosupplementation. Hyaluronic acid, a gel-like liquid, is administered into the knee joint during this treatment. The synovial (joint) fluid contains hyaluronic acid, which is a naturally occurring chemical. It acts as a shock absorber for joint stresses and as a lubricant to help bones to glide over one another easily. If your knee is swollen during the treatment, your doctor will drain the excess fluids (aspirate) before administering the hyaluronic acid. Although some doctors prefer to use two separate syringes, this can usually be done at the same time with only one needle inserted into the joint. You will receive one to five doses over several weeks, depending on the product chosen.
The nerves that are producing your discomfort or transmitting pain signals to your brain are injected with numbing medication. Nerve blocks numb the nerves and prevent pain signals from reaching the brain.
Facet Joint Injection
The facet joints, which are positioned on both sides of the back of the spine, can become inflamed and irritated, resulting in pain. During the treatment, the doctor injects a local anesthetic into the skin and tissue above the facet joint to numb it. A fluoroscope is an x-ray instrument that helps the doctor guide the needle through the numbed tissue and into the facet joint, where a contrast dye is administered to ensure placement. A combination of anesthetic and anti-inflammatory steroid medication is administered into one or more facet joints once the needle is properly installed. To relieve discomfort and inflammation in the neck and back, up to three injections may be administered every year.
A tiny needle will be placed into the location where you are in pain by your doctor. Through the needle, a microelectrode is inserted, and radiofrequency radiation is sent via an electrode to burn your nerve, causing it to stop sending pain signals to your brain. RFA can help with arthritis pain, as well as lower back and neck pain.
Joint aspiration may be advised if moving your joints is painful owing to fluid accumulation. Your doctor will use a needle to extract fluid from a joint to relieve pressure, relieve pain, and enhance the range of motion. The fluid can be analyzed for arthritis, gout, joint infection, and other inflammatory disorders if indicated. Joint aspiration is most commonly performed on the knee, although it can also be done on the shoulder, elbow, wrist, hip, or ankle.
Immobilization for Fractures and Sprains
Casting and Splinting
Broken or fractured bones and joints are supported by casts and splints (sometimes known as partial casts). They help keep the bone in place till it heals completely by restricting movement. Splints are less supportive than casts, but they can be adjusted to accommodate swelling and have a wider range of motion. Depending on the severity of your injury, you may be provided with a splint for a few days before being placed in a cast once the swelling has subsided.
Bracing and Booting
For various ankle, foot, and lower-leg injuries, particularly sports injuries, braces and boots can be used instead of casts. They're also used to treat arthritis and as a post-surgery recovery aid. Braces and boots are less bulky than casts and may be changed and removed more readily. Orthopedic doctors can custom fit a range of orthopedic braces and boots to meet your specific needs.
The term orthobiologics refers to the use of biological substances that are known to help with injury repair. They are chemicals that occur naturally in the body. Orthobiologics, when taken in high concentrations, may help reduce pain and repair a variety of orthopedic problems. As the future of non-surgical orthopedic therapy, these treatments are attracting growing interest and excitement. The following are examples of orthobiologics.
The injection of an irritant, usually a sugar solution, into a joint or wounded soft tissue is known as prolotherapy. According to the medical concept, the irritant will cause a healing reaction in joints or related tissue, alleviating pain.
Platelet-Rich Plasma Treatment
Platelet-rich plasma is one of the latest treatments for a variety of orthopedic disorders and injuries, ranging from sprained knees to chronic tendon damage. It's currently being used to treat Achilles tendonitis, Jumper's knee, acute ligament and muscle injuries like a pulled hamstring in thigh and knee sprains, knee arthritis, fractures, and even some surgical procedures. Blood is made up of solid components such as red cells, white cells, and platelets, as well as a liquid referred to as plasma. Platelets are well known for their role in blood clotting, but they also contain hundreds of proteins known as growth factors that aid in the healing of wounds. PRP is plasma that contains much more platelets than normal blood. The increased concentration of growth factors may accelerate the healing process. The damaged area can be injected with PRP. The heel cord becomes swollen, inflamed, and painful in Achilles tendonitis, a condition seen frequently in tennis players and runners. PRP and anesthetic are mixed together and injected directly into the inflamed tissue. For some ailments, PRP can also be used following surgery. A damaged heel cord may require surgical repair, and PRP injected into the torn tissues may accelerate the healing process.
Bone Marrow Aspirate Concentrate Injection
Bone marrow aspirate concentrate is made from the fluid in the bone marrow. This concentrate contains stem cells and platelets, among other cell types. These concentrated cells are administered into injured areas to hasten healing or alleviate arthritis symptoms.
Fat Derived Stem Cell (Micronized fat) Injections
The patient's own fat can be used to collect fat-derived stem cells. Fatty tissue containing these cells can be broken down or micronized and then administered into arthritic joints or damaged soft tissue after being extracted under local anesthetic using a technique similar to liposuction. This has been demonstrated to improve the microenvironment in the joint or other tissue, making it more suitable for healing and, in most cases, minimizing pain.
This is a rapidly growing field of medicine dedicated to giving non-surgical alternatives to people who might otherwise be required to undergo surgery. Doctors are becoming more aware of the body's innate ability to heal when given the correct settings. Sport and physical exercise physicians are exposed to the complete range of care, both in non-operative rehabilitation and when aiding at surgeries. They recognize the value of this capability and intend to use it to increase the likelihood that a patient will not require an operation.