Recovery - Winning the Outcome
This website is designed to help patients become physically resilient to prevent illness and injuries. The goal is to improve your current state of health, but not to reach perfection. Ultimately, everyone will get sick or injured, and some may even need surgery to overcome that sickness or injury. At that point, your focus will switch from prevention to recovery. The goal is now to put your body into the best position for a full and rapid recovery. Attention to all the areas previously discussed, such as nutrition, exercise, sleep, stress management and medicines/supplements, will aid in recovery. In many ways, the patients who are the most resistant to injury are also the best candidates for a successful recovery. With most injuries or illnesses your physician will discuss the treatment options with you. They will often tell you the probability that each option will result in a successful outcome. These probabilities are useful information in making an informed medical decision, but your ultimate concern is reaching a successful outcome. If there is a 80% chance of success, you just need to be in that 80%. Western medicine has a tendency to just look at the equation as a lottery that determines the lucky winners, or we believe the person with the excellent outcome just had better genes. However, I believe we all need to aspire to have great healing abilities. Greatness is not some rare DNA strand reserved for the fortunate. It is in all of us. Eastern medicine and Eastern philosophy recognize this idea of greatness in us all and have much more emphasis on the mind body connection. The trick is to use your mind and your body to move towards improved health and a better recovery. While physical health is important, your attitude and mentality towards recovery also plays a major role. Sometimes an illness or injury is the catalyst to make a lifestyle change or to further dedicate yourself to healthier living.
A placebo is any treatment with no active properties. In a medical trial, a patient group gets the placebo (sugar pill) and another group gets the medicine. The medicine needs to be better than the placebo to be considered effective. We know this is a high bar for any medicine to jump because the patient's belief that a medicine (even a fake medicine) could work is powerful. A nocebo is the opposite. Basically, the persistent thought of being sick or treatment failure can contribute to a bad outcome. Many things are still a mystery regarding human health, and how a patient’s mindset toward treatment impacts recovery is one of them. Many studies are supported by evidence based medicine that proves a treatment works. In some cases, we understand exactly why the treatment works but in other situations we only have theories to help explain why the treatment works. There are also treatments where the placebo effect is the only explanation. Often, patients are less concerned with the ‘how and why’ and simply care about the treatment’s results. An example in orthopedics would be chronic rotator cuff tears in which the first line of treatment is often physical therapy. The greatest factor that determines if a patient will improve and avoid surgery or fail and ultimately have surgery is whether or not they believe therapy will work. As physicians, we understand that a weak and stiff joint is a painful joint. The therapist can use modalities to decrease the inflammation and pain, and use targeted exercises to regain motion and strength. We know the body can make a full recovery and improve the inflammation even though there may be lingering tissue damage as the body is capable of compensating for the damaged tissue. Despite this, studies show the patient must believe the treatment will work to fully recover. I just saw a 63 year old man with a complete rotator cuff tear who had full motion, full strength, and no pain in his shoulder. How is this possible? Well, his other muscles must have compensated and he must have low levels of inflammation in his body overall. This is not the normal prognosis for full rotator cuff tears but it is something I see monthly. Asymptomatic partial thickness tears are something I see weekly or even daily. Now if at some point in the future this patient needed surgery he would likely have a great outcome. The goal if you want to heal, and put yourself on the good side of the statistics is to turn your life into a placebo effect. This means not only doing things that move your body towards health but using your mind to add to the activities’ effect. Dr. Joe Dispenza has some great books and YouTube videos on how to use the placebo effect to your benefit. I do not mean to imply everything can be healed by “mind over matter” or to ignore conventional medical advice but it can help move your recovery in the right direction.
In orthopedics, we see a whole array of injuries and illnesses. In many cases, you can only turn your attention to recovery after the injury. In other instances, such as elective surgery you may have weeks or months to prepare to improve your chances of having a good outcome. Many joint replacement candidates have years to prepare as they realize the conservative measures to control their pain may ultimately stop working. I urge you to use every tool in your health toolbox to improve your odds of success.
Or for those who need an excuse to eat steak:
What you are eating is the building blocks for your body's recovery efforts. You should be eating some variety of lean meats, eggs, fruits, vegetables, healthy fats, and whole grains. The nutrients aid your body’s healing cells to replenish and rebuild tissues and remove waste products. While you are eating to win, you should avoid unhealthy foods and our greatest enemy is sugar. Processed sugar is one of the biggest toxins that promote inflammation and feeds many cancers. If your body is spending its energy processing sugar and unhealthy foods then it has less strength to heal. Many of us are old enough to remember the classic cartoon Popeye the sailor man who turned into a superhero with one can of spinach. It is the same concept. Prime your body for peak healing potential using nutrition. In addition to sugar, alcohol is a toxin regularly consumed by many, and should be avoided during healing. I would urge you to consider your alcohol consumption, and how it may be impacting aspects of your health. The final common toxin is tobacco. Smoking decreases blood supply in every body tissue and will impair healing. Now is a great time to consider quitting and your injury may be the motivation you have needed. Now, do not forget hydration. “The solution to pollution is dilution”. Water is a key nutrient in all body processes and thus proper hydration is very important. Many nutrition experts are recommending adding electrolytes to your water to both aid in water absorption and replenish electrolytes we may be low in.
Exercise has huge benefits for recovery. Not only are stronger and more flexible body structures less likely to be injured, but they also recover much faster. As you exercise your muscles release all the chemicals and hormones that aid in recovery and remove the toxins that are making you sick. Visualize your muscles doing this for you. Do not let an injury of one body part deter you from all exercise. If your legs are injured use your arms. If your arms are injured, use your legs. If you can not run then walk, bike or swim. If you are bedridden do isometric exercises. There are many ways to modify your exercise routine in order to not only stay active but also promote healing of the injury. If you do not know how, use the computer in your pocket and learn. If you can not do anything due to the extent of the injury then do breathing exercises. Simply search “breathwork” on Youtube and get started. Breathwork can not only help improve oxygenation of your tissues but it can be a great tool to decrease stress during recovery. Breathwork can be an excellent substitute for exercise if you are bedridden. Getting some sunlight, walking in nature, or swimming in the ocean must have some benefit to recovery. I do not know if it is a placebo effect or stress relief but it seems to help.
There are many breath work videos available. This video by Professional Surfing legend Laird Hamilton is a nice introduction:
Sleep may be the most useful tool in recovery. As we sleep, our bodies remove toxins and waste products and secrete hormones that help our cells and tissues grow and recover. When you are asleep your subconscious can be fully dedicated to healing without the distractions of everyday life. If you are a good sleeper, you just need to dedicate the time to sleeping. If sleeping is already an issue then you need to research all the ways to improve sleep including steps to clear your mind of stress before falling asleep and a pain management plan if pain is something that interferes with your ability to sleep. You need to have a strong belief that sleep is the best time for your body to recover without distractions. The section on sleep and videos on this website are a good place to start. In specific consideration to orthopedics, it is critical after surgery to have a postoperative sleep plan designed for the surgery you are having. For example, if you can not climb stairs you may need downstairs sleeping arrangements. You may need to sleep upright or on your back after certain surgeries. YouTube is another good source to search for sleeping suggestions specific to your surgery.
There are many videos available for sleep recommendations after specific surgeries. Here are two examples:
When you are injured or sick it is especially important to minimize stress, or at least improve how you deal with stress to accentuate your healing potential. Consider watching comedy instead of murder mysteries. Laughter is the best medicine after all. Consider upbeat music or spending time with upbeat people. Of course life keeps moving forward and you don’t want to have to walk on eggshells to try and stay positive. If you feel this is an aspect of life you are struggling in, you may need to change how you see things. If someone is complaining about things, put it in perspective and laugh to yourself. Most of these things are usually trivial anyway. Do not waste your time on things that are beyond your control and add to your stress. Watching cable news programs or arguing about politics will not help your stress and will certainly not help you heal faster. On the other hand, relaxing, focusing on healing, and enjoying life could drastically improve your chances of healing. Nothing makes managing pain more difficult than stress and anxiety. You need to stay above the drama because you have healing to do.
Some medical research shows that prayer does help in recovery. The patient does not even need to know that they are being prayed for or believe in the power of prayer. So if you are religious, pray for yourself or your sick loved ones, if you are not religious there is no harm in letting others pray for you. It may be an excellent time to learn to meditate. Just improving focus on positive thoughts, decreasing stress, and relaxing can improve healing. There are plenty of apps and Youtube videos to teach you how to meditate. There are many meditations directed to healing and pain management which could be beneficial.
This is an explanation of a breathing technique to reduce stress. It is good for relaxation in general but could also be beneficial in relaxing before meditation or prayer.
Often a patient's overall attitude towards recovery is critical to a good outcome. By attitude, I mean preparing yourself to be the best patient possible. Some surgeries such as joint reconstruction or replacement, tendon or ligament repairs, certain spine surgeries, and many traumas require an extended recovery and patient effort. An example of this is total knee replacement. After some surgeries you would expect a full recovery with just rest and keeping the incision clean, but many surgeries such as knee replacement are different. Most studies report 80-90% of patients are satisfied after knee replacement. These patients report a decrease in pain and stiffness and an increase in vitality and function. About 10-20% are not satisfied with their surgery however. The goal should be to make sure you are in the group who has a successful outcome. Certainly, having your physician clear you medically greatly reduces your risk of serious medical complications from surgery. However, optimizing your fitness reduces your risk even further. Infections are rare, but can be devastating. Serious infections could require removing the whole prosthesis. Unfortunately, there are instances where infections occur, but being in optimal health certainly makes infections less likely. Being at a healthy weight further increases your chance of success. Patients with a body/mass index (BMI) less than 30 have much higher patient satisfaction scores than heavier patients. Many surgeons, surgical facilities, and insurance companies will not even consider knee replacement in patients with a BMI greater than 40 due to poor outcomes and significant complications.This means if you are a 5’5” women you have a better chance of success under 180 lbs. If you are 5’5'' and 240 lbs. you may be told you should lose weight before considering surgery. BMI has come under some criticism lately for labeling some people overweight who are actually at a healthy weight but there’s not much debate that BMI’s around 40 are detrimental to health.
The most common complication from knee replacement surgery and many other surgeries is stiffness which is often associated with pain. When the surgery is complete, the patient will have full motion on the operating table. However, after surgery the patient will swell, get stiff, and be in pain. Regardless of this, the patient must bend their joint to maintain the motion. Some patients can do this on their own but the majority will need therapy. The therapy is hard work and can take several weeks to several months. Patients who do not get moving will have a stiff knee and a stiff knee is often a painful knee. Even when the patient regains motion, strengthening the thigh muscles is critical to full recovery and pain relief.
Some patients still have pain despite full motion, good strength, and an excellent surgery. This is because the surgeon replaces the knee but the tendons, ligaments, bursal sac, muscles, and nerves are still the ones the patient was born with. Any of these can be painful and it is likely due to chronic inflammation. Doing your best to decrease your chronic inflammation can certainly help avoid this type of postoperative pain. Take a look at the 5 baskets and included videos on this web site to get started.
To summarize, if you have poor nutrition you have an increased risk of infection and medical complications. If you have poor fitness you will have more problems with therapy and mobilization after surgery. Simply put, you need leg strength to walk, climb stairs, and bend your knee to regain motion. You need upper body strength to pull yourself up, use crutches or a walker. Strength allows you to get to a more normal life quickly. This will help speed your recovery. If your sleep is chaotic it will only get worse after surgery. If stress is an issue this could greatly impede your pain management and therapy. You can see there is a lot more involved in a successful knee replacement surgery than what happens in the operating room. Knee replacement surgery is one example, but many surgeries are affected by these same factors.
If you want a successful outcome you need to consider whether you are doing everything possible to improve your odds. Not much in life is guaranteed, but you can definitely stack the odds in your favor. Before going into surgery, understand the expectations. It is important not to compare apples to oranges as there is a tendency to compare surgical outcomes with your friends, family, and acquaintances. Just because someone you know had the same surgery does not mean you should assume the same postoperative course. You do not have the same body or mindset as another patient and no two surgeries are the same. Our goal as surgeons is to help manage reasonable expectations. Informed consent requires discussing the complications that could occur with any surgery. We do not want the “ Nocebo effect” to interfere with healing where a patient only focuses on the negatives. The goal is a confident patient who is actively working to improve their chances of success, but is aware that unexpected challenges could arise that the patient is prepared to overcome.