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Orthopedic surgery vs sports medicine

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Le gion · · Unknown Hometown · Joined Oct 2010 · Points: 15

Which one of these "specialties" is better for climbing-related injuries?

I tweaked my knee after a steep approach and descent carrying a heavy pack. Not trauma, just lots of pain and loss of motion when I squat. It's not serious but it definitely hinders my climbing and other physical activity.

An orthopedic surgeon looked at my x-rays and said my knees were "age appropriate" (I'm in my 40's) and that I should feel fine with some rest.

It's been about 4 months and the soreness and loss of motion is still there. It occurred to me that orthos typically deal with the elderly so my little pain is not worth their attention. I'm wondering if a sports medicine doc would have a more fine tuned approach.

Has anyone here gone to both these types of docs and have opinions on which is more appropriate? Will a sports medicine doc say the same thing or do they have a different approach?

flynn · · Unknown Hometown · Joined Feb 2002 · Points: 25

Absolutely, go talk to a sports medicine doc, ideally one who is physically active. They tend to get it more than somebody whose idea of physical fitness is the ability to sit at your computer all day. I don't know where you are, but if you're in or near Boulder, you are surrounded by competent folks.
Good luck.

mountainhick · · Black Hawk, CO · Joined Mar 2009 · Points: 120

Uh, sounds like a misconception, it's not either/or... or you just went to the wrong doc.

Do your homework and find an ortho that works on athletes. There are tons of them.

Erik Pohlman · · Westminster, CO · Joined Dec 2006 · Points: 4,035

See a good physical therapist. Many injuries, including those with clear trauma to tissues, can be resolved non-operatively. Half of my referrals come from 'sports medicine docs,' anyways, so skip the middle man if you can and go straight to your physical therapist.

Jesse Newton · · catskills · Joined Dec 2011 · Points: 145

I personally had an olympic orthopedic surgeon fix rotary cuff, labrum and ac joint repair almost fully torn from car accident, the best way for significant damage is surgery with religious physical therapy and a pain threshold high enough to not puss out.

marty funkhouser · · Unknown Hometown · Joined Dec 2007 · Points: 20
Jake Jones wrote:no ortho worth a damn will make a diagnosis on an xray alone. I agree with the "wrong doc" assessment. If you have decent insurance, switch docs and get an MRI first.
Orthopedists can certainly make a diagnosis without MRI. There are certain indications during the exam that he/she looks for that would justify the need for imaging, but many presentations of knee pain simply do not justify imaging. Part of the decision making has to also take into account the very high prevalence of MRI findings in patients with no symptoms, and the equally high prevalence of patients presenting with knee pain that have no findings on MRI. It's a complex issue that ultimately costs the health care system a lot of money.

Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study
marty funkhouser · · Unknown Hometown · Joined Dec 2007 · Points: 20

Jake, unfortunately OCD is rare and presents identical to more common and benign injuries so your opinion is certainly justified. Best of luck with your rehab.

Dave · · Tahoe City · Joined Mar 2007 · Points: 200

1. Second opinion from knee-specialist ortho doc
2. MRI to diagnose extent of soft tissue injury

Working in the health care profession I see first hand the overuse of medical imaging but if this were my knee, and the injury was affecting my functional movement and ability to climb, I would want an ACCURATE and IMMEDIATE diagnosis by getting an MRI. Soft tissue injuries can not be accurately diagnosed by x-rays alone.

Le gion · · Unknown Hometown · Joined Oct 2010 · Points: 15

No, I did not get an MRI, only xrays. Seems like the consensus is it's worth getting a second opinion.

What I'm still not clear on is whether a sports med doc or a PT would be best. I guess it just depends on my injury and I'll start with one of them and see where it leads. Not looking forward to rehab... I know from past exp I'm too lazy for that.

If anyone wants to throw out some names in the LA area, particularly south bay/long beach/oc, that'd be much appreciated. Thx all.

Erik Pohlman · · Westminster, CO · Joined Dec 2006 · Points: 4,035

In my (biased) opinion, a good PT should be where everyone starts for musculoskeletal issues or pain. They will do more than just ultrasound you, ESTIM you, and hand you some exercises. They should also be more than capable of determining if referral to another provider is necessary. You don't need imaging first thing, and it may even lead to over treatment (like unnecessary and expensive injections or surgery.)

Sure, an ortho or sports surgeon is extremely knowledgable, but do you need that right away for something that will likely resolve non-surgically, based on the research coming out lately? PTs are also very knowledgable about musculoskeletal issues

biomedcentral.com/1471-2474…

and study only on non-operative interventions, again suggesting that would be a reasonable place to go first.

Unfortunately, I don't know any in the LA area, but shop around. Find one on one care and if you walk into a place with 10 treatment tables lined up in a room, consider turning around and shopping some more. Not saying that is always a terrible place, but Just like in other healthcare professions, there are some clinics that seem more profit driven than others.

Erik

mountainhick · · Black Hawk, CO · Joined Mar 2009 · Points: 120
Jawon wrote: Not looking forward to rehab... I know from past exp I'm too lazy for that.
You reap what you sow. If you need rehab and don't do the work, seems the first doc was right. May as well live with it.
Dave · · Tahoe City · Joined Mar 2007 · Points: 200

Disregard the idea of a "sports medicine doc." And contrary to a few of the above opinions I believe that you need to diagnose an injury (MRI) before you can rehab it (PT).

Consider this: A guy blows out his knee while hiking and goes to the ER. ER doc gives him a brace, crutches and prescibes RICE and ibu. Two weeks later no improvement. Guy goes to his doctor who prescripes PT. Six weeks later minimal improvement but still noticeable weakness and instability. Doctor refers him to a knee specialist ortho doc who orders an MRI. MRI shows ACL tear.

Between RICE and PT and waiting for appointments the guy has wasted three months in the recovery process. Why not cut to the chase and get the diagnoses first?

dranshu · · Unknown Hometown · Joined Jul 2015 · Points: 0

Deformity correction treatment at Dr Anshu’s clinic

Visit Dr Anshu’s The Knee Klinik for the treatment and surgery of deformity correction with latest technology and at very affordable cost. Visit us @ kneeandjointsurgery.com/def… or contact us: +91 020 6500 0249, 9923406258 Deformity correction treatment at Dr Anshu’s clinic

FrankPS · · Atascadero, CA · Joined Nov 2009 · Points: 276
dranshu wrote:Deformity correction treatment at Dr Anshu’s clinic Visit Dr Anshu’s The Knee Klinik for the treatment and surgery of deformity correction with latest technology and at very affordable cost. Visit us @ kneeandjointsurgery.com/def… or contact us: +91 020 6500 0249, 9923406258 Deformity correction treatment at Dr Anshu’s clinic
Your "Klinik" is in India? Holy cow! (pardon the pun)
boo · · Unknown Hometown · Joined Jun 2008 · Points: 0

I was lucky in NC. My primary care provider was a sports medicine doc. Wake Forest houses the sports med in the family practice offices.

All injuries were triaged through them. They would order PT/OT as needed. Better at managing pain with non-narcotics and able to direct nutrition/exercise specific to whatever the injury was. Recommend surgery when necessary and help field which one. (That's worth a lot.)

Most (and I said most not all) surgeons will do as they are trained: assess for structural damage that requires repair.

VanessaK · · Unknown Hometown · Joined Jun 2015 · Points: 0

I agree with Zirkel - you should get the MRI done first so you can receive your diagnosis, then get the appropriate PT done.

Surgery should be the absolute last option. Along with PT, I recommend the below conservative treatment methods (while I personally used these methods to treat plantar fascia issues, it seems many people have had success in healing their knee injuries).

Healing Knee Injuries

Guideline #1: Don't be a jerk.

Injuries and Accidents
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