Hardly a day goes by that we don’t experience some type of ache or pain. Is it a muscle or ligamentous strain? Could I have a fracture? Do I need an x-ray or MRI? These are all good questions. Let me give you some rules of thumb as to when you might need to see a doctor if natural remedies are not helping.
Do I need an x-ray? Only Superman has x-ray vision, so if in doubt you can always arrange to get an x-ray. Most fractures will show up, but not all. Hair-line or “occult” fractures might be missed upon the initial x-ray, but picked up on a repeat x-ray about a week later due to changes incident to fracture healing. Typically, if your injury is already feeling better after a few days, it is unlikely a fracture and probably does not need an x-ray. Again this is a general rule of thumb, but has held up over time.
I have knee pain, what should I do? The simple answer, see a doctor. Many disorders cause knee pain, some of which could be concerning. If the pain has come on gradually over time, it is less likely to be limb threatening. If the knee pain came on within a few days with no history of trauma or physical injury, and is also swollen and red it is most likely an infection and should be seen right away by a doctor experienced in examining and treating such infections including knee arthrocentesis, or the removal of knee fluid to test for infection. Other forms of chronic knee pain that come and go are most likely due to some type of arthritis, such as gouty arthritis or osteoarthritis. Of course, there are other forms of arthritis as well that could be causing your pain and would be treated differently. However, more commonly, knee pain is due to a strain or sprain of one or more of the ligaments of the knee, or to a tear in one or more of the menisci. A knee examination by a trained professional will help to determine which of these is most likely. We’ve come to rely on MRI’s and CT scans to tell us what could still be determined by a good physical exam. Nothing against knowing for sure, but if you have a tight budget and would like to do what is practical, without causing harm, and avoid unnecessary expense, then a conservative course of action may be an option for you.
For example, a real story: M.C. is a 63 y/o man who experienced increasing left knee pain after moving furniture. He noted the pain was worse with walking, but fine with his left leg elevated. He tried ice, an ace wrap, a knee brace, but nothing seemed to help. Finally, he saw an orthopedic specialist with extra-training in sports medicine. He first had an x-ray of both knees. The non-painful right knee was the worst looking osteoarthritis I’ve ever seen (the result of a right knee dislocation while playing high school football at age 16), the left, painful knee was normal appearing on plain x-ray. M.C. then had an MRI of the left knee showing a meniscal tear, common in older folks. The options of doing nothing and allowing the tear to scar over versus excising the injured cartilage were given. M.C. initially decided to schedule surgery. After searching on-line for recent studies on conservative outcome with taping versus surgery, and the potential complications of surgery, he opted to take the conservative route. He began using K-T tape (see https://www.kttape.com) as instructed by the package insert. Over the course of several weeks, he noted decreasing pain, and increased ability to climb stairs, walk and run until his knee was back to baseline within a few months. He might have been back to normal more quickly with an operation, or just as possible, requiring the same amount of time to heal as the conservative treatment, but at much greater expense and potential for complications.
As an emergency physician all those years, I saw my fair share of post surgical complications–including knee replacements. Of course, I didn’t see all those operations that went as expected so my sample was biased. Still, any surgery has a potential for complications including infections or even death from anesthesia. Why take the risk if a simple remedy will work? You are getting my bias obtained from years of seeing all kinds of patients. I am no different from other doctors in this regard. Some would say that doctors are often not the best patients. Many doctors would refuse the same procedures or treatments recommended as standard therapy to their patients. Seems hypocritical. Ever wonder why?
There are many types of strains and sprains and other causes of musculoskeletal pain and discomfort. If you want an idea of what is going on, and you cannot sort it out yourself, I’d be happy to see you in my clinic. Click on the Tab below and schedule a “Quick Visit”.