Commercial Drive - East Vancouver; Dr. Dominic Chan DC - "FYI: Torn Meniscus - A Common Misdiagnosis"

I thought I would write this post today because lots of people are gearing up for the Vancouver Marathon coming up in May. In the last 2 weeks I have noticed a handful of patients coming in complaining of knee pain. They are aware the likely cause is increased running as they train harder for the upcoming marathon. However, two of these patients have presented in my office saying their family doctor diagnosed them with a "torn meniscus". Their doctor has gone on to say that this type of injury is very common in runners and they will have to stop running in order to relieve their pain and allow their knee to heal, if not surgery is the answer. 

Misdiagnosis in both cases! The patients in question were understandably concerned about the news their doctors gave them and came to me to see if I could offer any assistance. As with any patient who visits my office, I perform a thorough physical exam including orthopedic tests. Orthopedic tests are tests designed to specifically rule out possible causes for a patient's pain. For the knee in these cases, I performed what is known as Ober's test. The result of Ober's test in both these patients revealed injury to the Iliotibial (IT) Band. This is a long band of connective tissue that runs from the side of your hip, down your thigh to the side of your knee. If overused, it can come under stress and become injured or inflammed. Often times causing pain on the outside of the knee. 

The common course of care in a medical clinic is to order an MRI for these patients. However, an MRI is so sensitive that a majority of the time, it will reveal tears in the meniscus (a cartilage lining within your knee joint). But the catch is, the tears may not be the reason for pain. "Nine times out of 10, it's normal wear and not the source of the pain," says Ronald Grelsamer, M.D., an orthopedic surgeon at Mt. Sinai Hospital of New York. Surgical treatment "will lead away from the real problem."

So what's the solution? After suggesting a slight change to the patients' training routine, home stretches and Chiropractic adjustments, they saw improvements in a short amount of time. The recommendations included interval training such as running for a minute, walking for two. Icing the affected IT band as soon as training was over to limit the amount of inflammation training induced. Appropriate stretches to alleviate tension on the IT band. Finally, we also used Chiropractic adjustments to re-align and stabilize the pelvis and knees. This was done because both patients noticed pain more on one side compared to the other side. This in turn affected their running motion or 'gait' which only made the problem worse. I explain it like riding a bike. Imagine if one of the wheels was severely bent and warped. How well do you think you could ride that bike? Probably not very well, but even if you could, I bet your ride would be very uncomfortable. Now think of your pelvis and two legs/hips. Same idea.


Moral of the story is, Chiropractors don't just treat your back. I'm routinely encountered by patients who see me for issues separate from their backs and they get great results! Not only that but they are so relieved that there are other options for them. So the next time you are suffering from problems with your joints, whether it be in the neck, shoulder, knees, ankles or back, ask a Chiropractor!


Even better, if you're in the Commercial Drive area of East Vancouver, come visit the clinic or check out the website here; COMMERCIAL DRIVE - EAST VANCOUVER CHIROPRACTOR; DR. DOMINIC CHAN DC HERE!!!

Commercial Drive - East Vancouver Chiropractor; Dr. Dominic Chan DC - "Chronic Back Pain Sufferers; Beware of Surgery!"

Many sufferers of severe low back pain, especially if it is chronic in nature, have weighed the option of surgery to treat their condition. However, this study is another example of why it is prudent to consider other, more conservative options like Chiropractic more seriously. The study in question focuses on the long term outcomes of patients who have undergone spinal surgery and how it has affected their work specifically. 

The conclusion in general is that spinal fusion surgery, an increasingly controversial procedure that has exploded in the last 20 years, leads to HIGHER rates of permanent disability in workers. This is in comparison to those who were treated more conservatively and without the use of surgery.

The researchers in the study randomly selected 725 patients who underwent spinal fusion surgery to treat their chronic low back pain, compared to 725 patients who opted for more conservative treatments. All the patients were chosen from a pool of worker's compensation claims from the American state of Ohio and all patients suffered from chronic low back pain. The selected cases came from the years 1999 to 2001 and further analysis was done 5 years later in 2006 to see how the patients recovered.

The results will definitely surprise you! When the study ended in 2006, nearly all outcome categories were WORSE in the surgical group. Only about a quarter had returned to work after two years, compared with two-thirds of non-surgical patients. About 11% were considered to be permanently disabled compared to only 2% of those who did not undergo surgery. However, another sobering finding was that the use of prescription pain killers at least 5 years later was at about 85% for those in the surgery group! This compared to 49% in the non-surgical group. As an aside,  the researchers also noted that the patients in the surgery group steadily increased their usage of prescription pain killers over the years.


But unfortunately that's not all,  36 percent of the spinal fusion group had complications from the surgery, including meningitis, kidney failure and death. The re-operation rate was also 27 percent in the surgery group, and included three people who underwent four re-operations. And total days off work was also greater in the spinal fusion group (1140 days vs. 316 days).

 "I'm not saying don't have lumbar fusion surgery . . . but it should be carefully evaluated before it's done," said lead study author Dr. Trang H. Nguyen, who practices occupational medicine in Cincinnati and conducted the research while a doctoral candidate at the University of Cincinnati College of Medicine. "The chances are it will have a poor outcome." However, to be fair surgery may be the best option for certain patients, including those who suffer from an unstable spine or who have suffered severe fractures. The problem is that these patients are a very small percentage of patients who suffer from chronic back pain. 

The perplexing side to this story is that these results and results from similar studies have cast doubt on the rationale of surgery for chronic back pain for years now but the rate of surgeries continues to grow exponentially. In spite of continued improvements in surgical equipment and procedures, it seems the long term results for surgery patients is still astonishingly poor.

Now from my own clinical experience I have seen dozens of patients who have seen me because their family doctor or even specialist recommended surgery to treat their back pain. These patients arrive to me looking for another solution that doesn't require surgery and frankly, often see me as a last resort. This is when I get really honest with the patient. First off I inform them that yes, Chiropractic is a conservative form of therapy that has been successful for other people with the same problem. After a thorough history and exam, I often propose a 'trial' run of several sessions to see how the patients respond to care. If they respond well and get relief then everyone is happy and a surgery could be avoided. But, I also inform my patients that they will have to put in significant effort to get better as well, complying with prescribed home stretches and exercises that will help their recovery. 

Now what's my opinion on surgery? I think for some patients, it's the way to go. In my years of practice I can say I have told three patients that, "yes, I honestly think surgery is your best option". But for the vast majority, they respond very well to Chiropractic and are very happy with the results. Most importantly, they just avoided a major surgery and everyone wins!

If you have any questions about this post or questions in general, leave them down below. Even better, if you're in the Commercial Drive neighborhood of East Vancouver, come by and visit or check out the website;COMMERCIAL DRIVE - EAST VANCOUVER CHIROPRACTOR; DR. DOMINIC CHAN DC!!!

SOURCES: Trang H. Nguyen, M.D., Ph.D., occupational medicine specialist, Cincinnati, Ohio; E. Kano Mayer, M.D., staff physician and physiatrist, Cleveland Clinic for Spine Health; Leah Y. Carreon, M.D., clinical research director, Norton Leatherman Spine Center, Louisville, Ky.; Feb. 15, 2011, Spine.