What’s wrong with the state of musculoskeletal medicine? Everything. At some point almost everyone will have some sort of joint or tendon problem. It’s happens to all of us because of a little something called living. Whether you are a couch potato who sprains an ankle reaching for the fridge door, or a hyper intense athlete who injures herself playing the sport they love, we all get injuries at some time in our lives. In our modern age, as we get older we don’t simply accept that we should give up the things we enjoy doing, playing, or competing in. We desire to continue to live our lives fully. Our expectations for what we want from life have changed from what was expected in the past. The problem is that the practice of medicine hasn’t adequately caught up.
The current model of medicine amongst physicians who treat musculoskeletal problems is off base. We accept that until someone has a severe injury, aggressive treatment should be avoided. We treat mild to moderate injuries with anti-inflammatories and steroid injections, which help temporarily with pain but don’t address the core problem until a condition has progressed further. We use physical therapy on a short term basis to treat acute injuries, but don’t routinely try to improve biomechanics to not only improve current functional limitations, but to also prevent future problems. We ignore cell based therapies such as PRP and stem cells because they are relatively new, forgetting that the risks of these treatments are lower than steroid injections and anti-inflammatories, and offer higher potential reward as well.
There are various reasons for why musculoskeletal medicine is still living in the dark ages. Misguided payors crediting the wrong kinds of treatments, patients accepting the status quo, and physician herd like mentality resulting in not pushing for more. My recommendation is that you start expecting more. Expect more treatment options than simply short term band aids. Expect more from yourself in regards to diet, exercise, and correcting your own self inflicted nutritional and biomechanical mistakes. Expect your physician to want more as well. If you accept the status quo in regards to your health and treatment options, why would things improve dramatically?