Soft Tissue Injuries Rarely Need Surgery (Try This Assessment First)

When managing your soft tissue injuries, MRIs, X-rays, and other tests will send you down the wrong path.

Which can lead to you having an unnecessary surgery.

After working with active adults and athletes for the last 20+ years, I've seen over 1,000 cases of knee, shoulder, and back problems. Many of them came in with MRI reports with things like:

• 6mm disc herniations

• Disc degeneration

• Complete tear of ACL

• Meniscal tears

• Various rotator cuff tears

• Disc obliteration (one of my most memorable)

The majority of these individuals were told they needed orthopedic surgery.

But after working with them personally, less than 10% required surgery.

This statistic may seem surprising. And I'm not suggesting that surgery has no merit. But I do believe that most surgeries are unnecessary.

In this article, I'll discuss why too much emphasis is placed on MRI results and share with you what needs to be considered in the assessment process. Then, I’ll teach you how to perform a functional assessment of your soft tissue, so you can find the root cause of your injuries—and hopefully avoid the operating room altogether.

The Main Problems with the Traditional Medical Model and Surgery

Before I go on, we need to establish the three main problems when engaging with the traditional medical model:

1. The medical model is on a search-and-destroy mission.

2. The medical model aims to find what is wrong, fix it, destroy it, or cut it out.

3. If the pain or symptom can be correlated in ANY way to an abnormality or imperfection on a scan or test, it is assumed to be the cause.

And two important things to understand about surgery:

1. It may or may not help with the symptoms.

2. It definitely won't address why it was damaged to begin with.

With that in mind, let me explain how these problems lead to unnecessary surgeries (along with a few cases where I helped prevent it—and one where I couldn’t).

Correlation Is Not Causation

The general approach to the traditional medical model is search-and-destroy.

Most tests look for dysfunction, damage, or issues related to your symptoms.

These tests include:

• MRIs

• PET Imaging

• Ultrasound

• CT Scans

• X-Rays

• Angiograms

• Echocardiogram

• Electrocardiogram

Not to mention the variety of blood tests you can have:

• Complete blood count

• Basic metabolic panel

• Thyroid panel

• Lipid panel

• Coagulation tests

• Liver tests

• Inflammatory markers

• HbA1c for diabetes

• BNP testing for heart failure

• and countless others

All these tests aim to identify something "wrong" in your body that could correlate to your symptoms. But none of these tests can pinpoint the cause of the problem, nor prove that what they find is related to your symptoms.

These tests and scans only tell a tiny part of the story, and this couldn't be more true in the case of soft tissue injuries.

The Limitations of MRI-Like Imaging

When scans like MRIs are done on injured joints and soft tissues, they produce an image of the area. Radiologists and doctors then interpret this image.

This is NOT an exact science.

In Malcolm Gladwell's New Yorker article, "The Picture Problem," he discusses the problem with these types of images:

"There are few cultural reflexes more deeply ingrained than the idea that a picture has the weight of truth . . . We have put ourselves in a position where we see more and more things that we don't know how to interpret."

According to the University of Vermont and the University of Southern California, nearly 70% of Body MRI interpretations have at least one discrepancy.

In another study, 100 board-certified practicing orthopedic surgeons were surveyed on the value, reliability, and diagnostic utility of MRIs in preoperative planning in shoulder and knee surgery:

• 93% of them reported that there was a problem with the accuracy of MRIs in the setting of prior surgery and/or if hardware was present.

• 91% of these doctors also reported that they would prefer an intra-articular view of the knee and shoulder with a camera prior to surgery instead of an MRI.

All this to say, more information is needed to assess different orthopedic injuries accurately.

The Day I Almost Closed The Doors to My Clinic

One of the most life-changing moments I had as a Movement Specialist was an incident with a member of a family I worked with.

I primarily worked with this family’s son, a professional basketball player. I also worked on rehabilitating the father's shoulder and had grown close to the family. I knew that they trusted me.

But I didn't realize how much they trusted me.

One late afternoon, I received a frantic phone call from the mother. She told me that her daughter, a high-level volleyball player, came down on a volleyball during practice. She severely sprained her ankle.

She couldn't put any weight on it, and they wanted to bring her straight over to me for an evaluation.

"What?!?!" I thought to myself. Why wouldn't they go straight to the emergency room and find out if she did severe damage?

I suggested they go to the emergency room. They said they planned on it but wanted to get my thoughts first. Wow! I was humbled to think they had that much faith and trust in me.

To say I was nervous and wanted to make sure I did right by their daughter was an understatement.

While preparing for their arrival, I remember telling myself to trust what I've learned and do what I do. That’s why they’re coming for me to do what I do. I don't have to do anything more than what I do.

At this point, I'd only been alone—without my mentor across the hall—for a little over a year. This was my first challenge without a safety net.

When they arrived, they carried her into my office and put her on my table. I could tell she was in a lot of pain and scared.

I began to go through a functional evaluation of her foot/ankle complex.

A functional evaluation assesses how the region is moving and functioning in isolation and then through the kinetic chain.

I gently palpated her foot and ankle region, trying to understand what movement was available to her. Based on how they described the ankle sprain, I meticulously assessed the region so that it would not affect the traumatized area.

With any injury, one of the most essential things to facilitate the healing process is to move the area in as many ways as possible, while avoiding ways that aggravates the injured tissue.

As I started moving her heel, mid-foot, and forefoot in specific directions, I noticed she began to relax, but with a puzzled look on her face.

She was surprised that what I was doing wasn’t hurting her.

Next, I moved her rear, mid, and forefoot in opposite directions of where they were strained. Then, I gently pushed into the motions where the tissues were strained.

Once again, I was able to move into the injured tissue gently without any pain.

The overall movement of the region was improving to the point where I asked if she could stand up and put any weight on it (keep in mind, she could barely put an ounce of weight on it when she walked in.)

She got up off the table, and to her surprise (and her mom’s), she could now stand—putting maybe 30% of her weight on it.

From there, I started teaching her how to move her foot and ankle into the dimensions that would not strain the injured tissues. I told her to submerse her foot and ankle in a bucket of ice water, go through these motions, and slowly move it into the ranges where the tissue was injured.

I told them that my perception was she didn’t tear or rupture anything, but that it seemed like a nasty sprain. I did recommend they get X-rays and MRIs to confirm.

They were relieved with my assessment, and I felt good about how I was able to help them.

Well, that lasted less than 48 hours…

A few days later, I got another panicked call from her mom.

She informed me they’d gotten an MRI and met with an orthopedic surgeon. The surgeon told them that she had ruptured a ligament in her ankle and should have been in surgery days ago!

I felt awful. I should close up shop and find another career. How could I have been so wrong?! And these people trusted me—I let them down. It was not a great moment.

Then it dawned on me.

Wait a minute… if she ruptured that ligament, there is no way I could have done what I did with her a few days prior. I snapped out of feeling sorry for myself and shared my thoughts.

I told them I felt something didn’t add up and strongly recommended getting second and third opinions. They agreed.

The next day, I got a call from her mom. This time, she didn’t sound panicked at all—she sounded relaxed and optimistic.

Upon consulting with another orthopedic surgeon, she did NOT have a ruptured ligament. The doctor explained why the image could easily be misinterpreted due to swelling in the area. He said she didn’t need surgery. At most, it looked like a nasty strain.

Phew! I was so relieved. For both of us!

If this young lady had gotten surgery, they would have gone in, found out it wasn’t ruptured, and stitched her up. This would have created additional trauma to the area and would only delay healing even more.

Spine Degenerations and Herniations

Unfortunately, this is the first of many cases I’d run into, where images and scans were dictating treatment.

I recently had a gentleman I worked with years ago reach out to me randomly via text message. He thanked me for helping him with his back and said he was still doing well.

Then he asked if I remembered what I said to him when he showed me his X-rays and MRIs of his back, which showed all kinds of degeneration, herniations, and structural problems.

I asked him, "Uh oh, what did I say?"

He reminded me that I said, “Thanks, nice, I’ll look at those later. Let’s see how you move, first.”

I laughed because that sounded about right.

Rotator Cuff Tears

Last year, a good friend of my wife came to see me. She was told she needed rotator cuff surgery.

In this case, the orthopedic surgeon's office called her a few times a week, telling her how critical it was to get this surgery done. She was told that if she put it off any longer, it would only get worse.

When she came in and told me this, I thought this shoulder must be terrible if they were calling her multiple times a week to get this “critical” surgery. I did a functional evaluation on her shoulder girdle and was quite surprised with what I found. I told her she didn’t present to be in crisis and that I thought I could help her relatively quickly.

After one session, she was sleeping without pain. Within five sessions, she had about 80% of her function back without any pain.

Fast forward to today, she lives pain-free and is fully functional as a busy mom and real estate agent.

“But If Something Is Torn, Don’t I Need Surgery?”

This is a question that I get asked regularly at my clinic.

And the answer is NO. You don’t need surgery because something is torn.

Is there a place for surgery, though? YES!

In my experience doing this for 25 years, over 90% of the people I’ve worked with who were told they needed surgery did not.

Unfortunately, many orthopedic surgeons have never witnessed these things healing without surgery. They, therefore, put the fear of God into people to get the surgery.

This is what the surgeon of my wife's friend was doing. Intuitively, she could sense that something wasn’t right, and she knew there had to be another way.

However, this trust in one’s intuition isn’t always the case…

“The Machine Knows Better Than My Body”

I worked with a woman who had horrible back pain. It radiated all the way down her leg, to the point she couldn’t walk.

After working with her for a few months, we were not only able to eliminate the day-to-day pain, we also created enough strength for her to go skiing with her family.

She was so grateful when she returned. When I asked her about continuing her program, she said she had spinal surgery scheduled for the following week.

WHAT?!?! Did she have a major setback and was suddenly in excruciating pain?!?!

Nope. She was fine. In fact, she felt better than she had in a long time.

She was “better than ever,” but said she knows she has that herniated disc and that, “it’s not going to fix itself.”

She was convinced. There was nothing I could say that changed her mind.

This was the first time I witnessed a client putting more value and trust in a machine’s scan than in her own body and experience.

How to Perform a Functional Region & Movement Assessment

Although X-rays, MRIs, and other scans or tests can be helpful and provide valuable information, it's essential to understand that they only tell part of the story. Other assessments must accompany these tests.

When you get too close to something, you lose perspective.

We must zoom out!

Regarding soft tissue injuries, I mean zooming out far enough to assess the physical capacity of the injured region and the body.

In an ideal scenario, it is essential to ZOOM OUT all the way. Assess not only the physical components, but also the mental and systemic components. I go into this in great depth in my book, Health to Vitality.

Here’s a general guide that I take clients through when assessing the physical capacity of the injured region.

1. Identify if the pain occurs in specific positions or motions, and not in others.

For example:

• “My knee hurts going downstairs and not going upstairs.”

• “My back hurts when I turn to the left, not to the right.”

• “My shoulder hurts when I’m sitting in the car and reaching into the back seat.”

2. Assess if the joints adjacent to the injured area have a limited range of motion.

• If you have low back pain, are your hips tight? Is the upper back stiff and rounded?

• If you have knee pain, are your hips tight? Are foot and ankle tight or compromised?

• If there’s shoulder plain, is the shoulder blade moving? Is the upper back stiff and tight?

3. If you change how you execute the movement that creates the pain, does it eliminate it?

Try:

• Bending over to pick something up with better hip engagement and spine flexed instead of straight.

• Engaging the hips more by tilting it forward when bending the knee.

• Lifting the arm overhead, but making sure upper back and shoulder blades are involved.

If you can identify pain-free positions and movements, improving the movement capacity in that area will help the body heal the injured tissue.

The key is to put the body in a position to heal what is injured.

If the compromised area continually takes on a force it wasn't designed to take on, it will never heal. It would be like having a black and blue bruise on your arm that you continuously tap with a hammer all day. Not only will it never heal, but it will get worse.

When to Seek Additional Help

If you experience pain with every movement and position, and adjusting your movement doesn't relieve the pain, it may be necessary to explore other interventions or treatments.

The best thing to do is get a functional movement evaluation from a Movement Specialist.

If you live in Southern Florida, you can see me at my office in Palm Beach Gardens. If that’s not feasible, I can also do a movement evaluation over a Zoom call:

I know I threw a lot of information at you in this article, but I hope you’re now more informed and empowered to trust your body’s healing ability.

The trick is to provide the proper environment and stay out of the way of the healing process.

You and your body are stronger than you may think,

Yours in Vitality,

Matt

References

Discrepancy Rates & Errors a Bigger Problem with Body MRI Than Realized

Reliability and Accuracy of MRI in Orthopedics