There are certain situations where knee surgery is unavoidable, but don’t just take your doctor’s word for it!
In today’s blog I wanted to take a moment and address knee surgery in children. Again this week we have had several young athletes in our clinic considering highly invasive and life altering musculoskeletal surgeries. These surgeries require cutting bone and reshaping major anatomical features. All in the guise of fixing some problem that is causing pain and will be a greater problem later if left unattended. Without a doubt, there are situations that absolutely require surgical intervention. I am in no way advocating not getting a surgery when needed, but how does a parent go about deciding to move forward with such a suggestion?
Colorado specifically, is a direct access state. This means a referral is not necessary from a physician to seek care or treatment from a physical therapist. In many cases, parents can seek the advice of a PT, or a chiropractor if they are concerned they are making the wrong decision. Many PT’s and chiropractors can give valuable advice and at the very least provide additional questions to ask an orthopedist at the next visit. Your pediatrician will also have resources to guide and direct you in making the best decision as well. Again, some surgeries are just unavoidable. Most times, when an acute injury has taken place, and muscle or connective tissue has totally separated, then surgical intervention is almost always required. No amount of “therapy” is going to re-attach an anterior cruciate ligament in a knee if it has been torn in two. I have however, heard arguments from orthopedists regarding ankles, some say you don’t need the ligaments in your foot, while others disagree. I have had clients in both camps, some electing to leave a torn ankle ligament as is, and other athletes deciding to have it repaired. I recommend in these situations to speak with more than one doctor before deciding what’s best. But what if your child is in pain with no direct link to an acute injury, and your doctor is recommending a highly invasive surgery like an osteotomy?
Does your child have a structural or functional problem?
Pain is almost always the precursor when children are set to undergo surgery. But is musculoskeletal surgery always necessary? Our clinic sees a variety of injuries every day and many times the pain is a result of a functional issue and not a structural one. The doctors in our clinic however, rarely distinguish between the two. This is because both structure and function are undoubtedly linked. Where it can get frustrating for a parent is when a structural change is suggested to repair a functional issue. The body is an incredibly dynamic machine and has the ability to adapt to structural deficits. As humans, we also have a very wide variety of unique structural components. What’s worse, the only time the medical field has the opportunity to collect data is when there is a problem. For example, there is very little data on knee pain based on the shape of one’s hips. The data that is available is that of those who are in pain. Therefore it is difficult to associate hip shape with knee pain because we don’t go around giving x-rays to kids whose knees don’t hurt. This becomes a problem when a doctor has suggested an invasive hip surgery to address knee pain. Are we sure the structural component of the hips is driving the poor function of the knee and thus causing pain? The answer is maybe, but maybe not. It is these specific scenarios that parents need to collect as much data as possible before taking the leap and having their child undergo major surgery. We cringe every time we hear an athlete is planning surgery to correct “knee tracking”. The cutting of bone, shortening or lengthening of ligaments, to change the function of movement in our experience rarely works and is unnecessary. These problems more often than not, are central nervous system dysfunction and not structural. I have been laughed at suggesting that an athlete go and get their vision tested when they have complained of knee pain. Oddly enough, after vision was addressed the knee pain subsided. No one is laughing now. You must never forget the incredible complexity of the human body and its amazing capacity for adaptation. If you do find yourself in the unfortunate position of considering surgery for your child, don’t take it lightly, do your homework and make an educated, well informed decision.
Do your homework
Please understand that there are multiple sources of data and that each industry is specifically built to use the tool they have developed to provide answers or solutions. Just as you use a real estate agent, Title Company, home inspector, and insurance company to sell your home, utilize all the medical resources you have available. A physical therapist will have a different perspective of that of an orthopedist. Likewise, a physiotherapist may have different suggestions and ideas just as a certified athletic trainer may give you valuable advice. I once had a very young volleyball player in my office complaining of shoulder pain. She had been to several doctors and PTs, but in the end the best advice came from a coach. The coach had seen this problem before, recognized that she was making a technical, functional change in her serve to get the ball over the net because she wasn’t tall enough. She instructed her to stop trying to adapt and just learn to serve the ball correctly, that her height would change. After some simple mobility drills and a change in her perception around serving, the pain dissipated. No surgery necessary. This may be an overly simple explanation but it is a valuable analogy when making a decision about a life altering event like surgery. Look outside the box and seek every possible correlation to your child’s pain. Our clinic’s general rule of thumb is that surgery in children should be the absolute last option available before we suggest it. Is it a solution? Yes. Is it often necessary? Yes. Is it the only option? No. Find a clinic or a professional you can trust, seek information and don’t be afraid to ask questions of your doctor. If they are unwilling to take time with you and give you objective, verified information to help you make a decision then it’s time to find another doctor.
All the practitioners at Performance Pediatrics and Human Performance and Rehabilitation are willing to help in any way. If you have questions, or would like to speak with a professional please feel free to call, we do the best we can to make time for parents and aim to educate whenever we can. We can be reached at:
402 West Garden of the God’s Road
Colorado Springs, CO 80907