For decades now we have been told that bone on bone is bad. Everybody knows that our joints are lined with cartilage. The joint structures can gradually become eroded over time as a consequence of wear and tear.
And when it is degenerated the joint becomes unbearably painful and needs replacing.
Wrong!! The dawn of MRI scanning has brought us many huge benefits in terms of understanding anatomy and how it changes over time. One of the many, perhaps less well-known benefits, however, is the research that has been done into joint pain, MRI scan correlation and subsequent surgery.
Many people have joint replacement surgery due to the unbearable pain in their joints. Having been presented with the results of their MRI scan which shows drastic deterioration of the joint surfaces, surgical joint replacement seems to be the only way forward.
There is a problem with this conventional, accepted view, though. More and more studies are highlighting the very poor correlation of MRI scan findings with joint pain. It is one thing to scan the joint of someone in great pain and point out the degenerative joint changes. It is entirely another to attribute that pain to the apparent structural change of the joint.
One large study published in 2012 studied over 700 people over the age of 55 (the age at which people are considered to be ‘older adults’). MRI scans were conducted for each participant to assess the presence of knee osteoarthritis. The results were then analysed with respect to age, gender, BMI and pain.
The overall prevalence of any knee abnormality was 89% – almost 90% of participants had evidence of some form of knee degeneration. Where the participant had reported experiencing knee pain there was over 90% prevalence of at least one type of knee abnormality.
This matches wonderfully and would therefore show a good correlation between knee joint degeneration and pain.
Until you expand the results to also look at the participants that had reported no episodes of knee pain. In this group, there was a prevalence of at least one type of knee abnormality in up to 88% of individuals – almost 90% of participants had evidence of some form of knee degeneration with NO PAIN!
I see so many patients at The Moballise Physiotherapy Clinic in precisely this situation. Of course, the patients I meet are experiencing pain. Generally, they have bounced from professional to professional with no joy thus far in reducing pain. Occasionally they are already considering some form of surgical intervention. I take a huge amount of delight in leading them towards reduced pain and improved mobility whilst avoiding surgery. It is a surprise to me that this is rapidly becoming my speciality!
I beg all of you to make sure that your loved ones exhaust EVERY possible option prior to considering surgical intervention.
REMEMBER – just because your MRI scan says your joint is worn out, it does NOT necessarily indicate or confirm that your joint is the source of your pain!
