Avoid Pain Treatment Traps


The healthcare system is full of traps for people with common painful conditions. People with aches and pains get tests. Based on the test results many get treatment they may not need. That’s why we call the tests traps.

This is important if you are approaching middle age, are middle age, or are older. It’s things like shoulder pain, knee pain, neck pain, back pain, hip pain, or hand pain. How do you know if it’s your rotator cuff, a meniscus tear, a disc problem, arthritis, or carpal tunnel? That why you want the test – right? To get the results to find out what is wrong. That’s where you fall into the trap.


How Can Common Medical Tests be Traps


If you do a shoulder MRI on 100 people that are 50 years old and don’t have shoulder pain 50% will have something wrong – like a rotator cuff tear. If you are 50 years old and have aches and pains in your shoulder and get an MRI it’s normal to find a tear. Unless you know tears are normal it makes sense you need surgery to fix it. Most people don’t know the tears are normal – that’s why we call tests like MRIs traps. It’s a trap because some people end up with surgery they don’t need.


If you do an x-ray and an MRI on 100 people that are 50 years old and don’t have knee pain 50% will have something wrong – like a meniscus tear and some arthritis. If you have aches and pains in your knee and get these tests, it’s normal to find arthritis or a meniscus tear. Unless you know that people without knee pain have the same arthritis on the same x-rays it makes sense that you should take medications or get an injection for the arthritis. Or if up didn’t know that people without knee pain have the same meniscus tears on the same MRIs it would make sense that you need surgery to remove the torn cartilage. That’s why we call the tests traps.

The story is the same for tests of your neck, back, hip, and hand. It’s normal in people without pain to have things show up on these tests. You can see it on the test. Treatment with medications, injections, or surgery makes sense if you don’t know these are normal findings. It’s a trap.


How Do We Know What We See on the Test Isn’t Causing the Aches & Pains?


Studies show:

  1. People Treated with Only Therapy Do the Same as People Treated with Surgery then Therapy

  2. People Treated with Fake Surgery then Therapy Do the Same as those Treated with Real Surgery then Therapy

And our experience with people that have real surgery and don’t get better until we treat the cause of their pain, and then they get better.

People Treated with Only Therapy Improve as Much as People that have Surgery and then Therapy


In these studies people are randomly assigned to treatment with therapy or surgery.

Down the road their recovery is evaluated. It turns out there is no difference in recovery if you get just therapy compared to surgery and then therapy. In a recent study in Spain of people with carpal tunnel syndrome, they found that people that had therapy for issues in their neck, shoulder, elbow and wrist did just as well as people that had carpal tunnel release surgery.

How Do People Get Better with Fake Surgery?


In the fake surgery studies people are told they are in a study, but not if they are having the real, or the fake surgery. These studies have been done in the shoulder and the knee. It goes something like this. You take 200 people that have a knee meniscus tear on an MRI. They all know about the study. All get an arthroscope put in their knee. Half have the surgery to clean things up. The other half get the scope put in and a look around but no surgery. The people don’t know if they had real or fake surgery. All of them go to therapy. There is no difference in the recovery for people that have real or fake surgery and then therapy.


People that Have Surgery and Still Have Pain


It not uncommon for us to treat people after surgery that still have their pain. Say they have knee pain and have knee surgery. Time goes by and they still have knee pain. They end up in the office. We treat their back and hip and their knee pain goes away. Both the back and hip can cause pain felt at the knee. I am sure their x-ray and MRI showed something in the knee and the surgery was done to address what was seen. It’s just that the surgery wasn’t done on the cause of their pain.


How Come the System Works this Way


We don’t think surgeons are out to trick people into having surgery they don’t need. If you are in pain, you want to know what’s wrong. You want to see the picture. Surgeons are trained to look at the pictures and find things to fix. It’s not that they are trying to trick you – it’s the way they are trained. It’s what you are asking for. Now you know.


The System Is Changing – But Don’t Fall in the New Traps


Because of all the studies showing therapy works so well, a lot of insurance companies won’t approve an MRI or surgery until you “fail” therapy. Don’t fall into the new traps and fail therapy.


  1. Don’t get mad at the insurance company. Don’t go to therapy thinking it’s a waste of time and just something you have to do to get what you need. If you want to fail and expect to fail, there is a good chance you will fail. You fall into the trap and get surgery you don’t need.

  2. Find a good therapy office. Make sure you get looked at for other causes of pain. If your knee hurts, are they checking your hip and back. Are they just running you through simple knee exercises you could just do at home? Like anything else there is good therapy and therapy that is not as good. Find a good therapy practice so you don’t fall into the unnecessary medications, injection, or surgery traps.

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Christopher DiPasquale, PhD, PT, OCS, SCS, CHT is a physical therapist at Performance Physical Therapy & Sports Medicine with offices in Hebron and Colchester, Connecticut. He is board certified by the American Board of Physical Therapy Specialties in Orthopedic Physical Therapy and Sports Physical Therapy and a Certified Hand Therapist by the Hand Therapy Certification Committee. For more information visit pptsm.com or call the office: Colchester 860-537-3014 or Hebron 860-228-4883

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