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Ask the Dr - Persistant injuries

Jan 27, 2015

Ask the Doc………

“If someone has had an injury or surgery on a bone or joint that has healedbut they are still having problems, can anything else be done to help them?”

Many patients logically think that a problem they are experiencing now is due to an injury they had long ago. Although seemingly quite logical, this may be only partially true or actually not related at all. A key diagnostically is to determine the pattern of pain over the years since the occurrence. If after the incident pain continued, even sporadically, but never disappeared totally, then the incident is most likely directly related. But many who have had an injury have had no discomfort at all after healing and then years later experience pain. In these instances, the injury is most likely not as significantly related as one might think.

Those who have had a joint replacement or other types of surgery and continue to have problemsoften feel that all of their discomfort is from the surgery itself. Again, this seems quite logical. But the surgery may have altered normal function and that alteration is responsible for the discomfort. Additionally, since we all have underlying mechanical issues that often go undetected, these may have become more of an issue since the surgery.

Generally speaking, it’s important to understand that in many instances there is a great deal more that can be done for problems such as these that are often not thought of. The reason for this is usually due to our current age of specialization, which like most things, has both positive and negative aspects.

A specialist is someone who really knows more and more about less and less. So the more well versed physicians are in their own area of expertise, the less they are often aware of what may be available to help you outside of their own specialty. I see this each and every day and am quite frankly absolutely amazed. For example, having been a surgeon and taught surgery for many years, I simply cannot understand how one could do bone or joint surgery that knowingly will create a shorting on that side, and not either make corrective changes or direct that patient to do so…..and do so accurately and specifically.

It is always important for physicians that treat someone who has had an injury or surgery on a bone or joint to consider the importance of the functional aspects of that individual both beforeand after treatment. Structural problems like a longer leg or flattened foot that might not have been a problem for years, often becomes significant once an injury occurs. That’s because injuries and some types of surgical procedures put additional stress on our structurally imperfect musculoskeletal systems because they alter body mechanics. For example, ACL knee injuries are often associated with excessive pronation (a rolling in or flattening of the foot). Even surgical procedures that have been done in an expert manner, do nothing to treat this underlying factor, and so lingering pain and the likelihood of recurrence remains. Those that have had an ankle fusion or severe fractures will have a shortening on that side. Many may already have had a shortening on that very same side. Now the added shortening of an injury or surgery could cause major problems in the weight-bearing joints ofthe knees, hips and back. Putting an exact lift on the shortened side can be of great benefit in not only decreasing symptoms at the surgical site, but preventing other joint problems. But this mustbe accurately and specifically done or it can cause increased rather than decreased symptoms. You would be amazed at the seemingly endless problems like this I see that all could have been prevented.

The same is true of those that have had a joint replacement due to an injury or arthritis. These patients often think that their problem is solved. But much like putting a new tire on a car, if the frame is bent, the new tire will also wear out early and irregularly. This is well documented by the fact that many who have had joint replacements have to have those very same joints replaced yet again.

The bottom line is that I honestly feel everyone should be evaluated structurally and this is true even if they have not had surgery or an injury. We are all moving, structural entities that are imperfect and asymmetrical at best. We all have one leg that is longer, one foot that is flatter, etc. and any degree of abnormality will increase our risks of injury, hamper optimal performance in any sport, and can later cause arthritic changes. Permanently correcting these problems can truly be beneficial in many, many ways.

A former reconstructive foot and ankle surgeon, past Clinical Instructor of Medicine at Emory, and Fellow of the American College of Rheumatology, Dr. Pack practices in Greensboro and Atlanta. He treats athletes at all levels and works with patients who have arthritis and want to remain active. In the 2004 Olympics he had a silver and gold medalist, and helped the UGA Golf Team (2005 NCCA National Champions). For further information please contact him directly at 770-335-9201, via email at, or see his website at His new book, The Arthritis Revolution, Latest Research on Staying Active Without Pain Medication or Surgery, is available on or


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