The Vicious Cycle of Soft Tissue Injury Care

In the last 3 months, I have had 5 clients come to me saying that an orthopedic surgeon told them they needed surgery.

• One was neck surgery

• Two were meniscus tear

• Two were rotator cuff repairs

To this day, not a single one of them has needed surgery.

Not only that, but they can all perform activities of daily living with no pain. The plan going forward is for each of them to begin their favorite activities, including weight training, tennis, and yoga, within the next 4-6 weeks.

One of them was a young man told to replace two discs in his neck. I only had a conversation with him—I never even had to touch him. I simply offered him a new perspective, and he was able to avoid major neck surgery in his mid-forties.

(I’ll be sharing that perspective with you, too)

These 5 individuals represent a very small number of the millions of people who are recommended unnecessary procedures. Overall, an estimated 7 million orthopedic surgeries are done annually in the United States. Individuals between 50 and 64 make up the most of that 7 million.

I contend that most of these surgeries are unnecessary and could be avoided.

Why is this happening?

The current model of working out, injury prevention, rehabilitation, and pain management is a flawed system that will lead you to 1 of 3 places:

1. You need surgery

2. ​You must give up an activity you enjoy

3. ​Sometimes both

Let me say that I do believe there is a place for orthopedic surgery. There is a time when the injury is bad enough that it needs repair. But, this is the minority of the cases, and the proper intervention would have prevented most from becoming "bad enough” to need surgery.

In this article, I am going to focus on the areas of traditional rehabilitation and pain management. I call it the "Vicious Cycle of Soft Tissue Injury." In part two of this article, I will share a way that you can address soft tissue injury.

The Vicious Cycle of Soft Tissue Injury Care: The 4 Phases

There are 4 phases in the Vicious Cycle of Soft Tissue Injury.

The average person who comes to see me is already at one of the phases listed below. Unfortunately, they’re usually at Phase III or IV.

Phase I: Discomfort When Performing an Activity

In this phase, most people find ways to work around it, shake it off, do a quick stretch, and keep doing their thing. It usually isn’t bad enough to stop them from doing what they want. The better you compensate, the longer you can last in this phase, but the higher price you pay down the road.

This is the ideal place I'd love to intervene with my clients. As I say at my clinic, “Yellow flags are much easier to address than red flags.”

Phase II: You Give In and See an Orthopedic Surgeon

Typically, that is when the discomfort manifests into actual pain, to the point that you can no longer work out or perform your favorite physical activities.

On your first visit, you’ll get an X-ray. Unfortunately, an X-ray doesn't tell you much. You can't see any soft tissues—you only get a picture of your bones.

Why’s this a problem?

95% of the time, the injury is in the soft tissues. Only an MRI can provide a picture of the soft tissues. If you want more valuable information, always push for an MRI.

More often than not, there is not enough damage to justify surgery, so pain management is the approach. This looks like prescription medications or some type of injection, like cortisone.

The best-case scenario is that this buys you some more time.

Inevitably, the pain returns, and you’re back to being hindered from your workout or physical activity. This can lead to a second or third cortisone shot that is less effective than the first. If you got months of relief from the first one, you’ll most likely get weeks or days out of the second and third.

Phase III: You’re Referred to a Traditional Physical Therapist

During Phase III, a more direct approach to physical therapy can occur. Getting to a good physical therapist who operates outside of the traditional physical therapy paradigm can be super helpful. I will dive deeper into this topic in Part II.

For now, just know if your Physical Therapy sessions include some ice, electrostimulation, and a printout of some isolated exercises, you are at a traditional PT.

Phase IV: It's Bad Enough That You Need Surgery

It is now months later, if not a year, and you feel like you’re back at square one—or worse.

This time, when you return to your orthopedic surgeon, the surgeon presents a stronger case for surgery. The idea that you have tried "everything else" and it hasn't helped becomes proof that surgery is the only option!

I’ve witnessed hundreds of individuals fall into this cycle of soft tissue injury care over the last 20+ years. In the worst cases, I've seen this cycle play out multiple times with the same individual.

The Vicious Cycle is Fueled by Further Injuries

Once you are in this care loop and continue to stay active, it’s not uncommon to develop other injuries.

One of the most common scenarios I've seen over the years is people who have low back pain and knee pain. For reasons I will go into in Part II of this article, having knee and lower back pain simultaneously is very common because they share the same joint—the hip. This is a major signal that your hip is the cause.

Since the traditional model of care only focuses on the broken parts, and every orthopedic doctor has his/her part they specialize in, nobody is looking beyond the injured area.

I’ve had clients ask the knee specialist if the hip pain they’ve had for years may be contributing to their knee pain. The responses they receive are mind-boggling. A few of the doctors tell them things like:

"The hip has nothing to do with the knee. If you have hip pain, see the hip specialist down the hall."

This is not a jab at orthopedic surgeons—it simply illustrates their training and perspective.

They are specialists for individual parts, not specialists of movement. A knee specialist focuses on the knees, and they’ll perform knee surgery. Studying the knee and the different types of orthopedic repairs for the knee is a lifelong study.

Therefore, understanding chain reaction biomechanics and the intricate play of the foot, ankle, and hip and how it influences the knee when walking, jumping, hiking, or playing golf is not something they need to know to perform surgery.

But, you must understand that none of these things are even considered when inside the "Vicious Cycle."

I'd also like to reiterate that orthopedic surgery has a place. I have supported some of my clients to get surgeries. However, this is the minority of my cases.

I'd also like to say that I don't blame orthopedic surgeons for offering orthopedic surgery. When you ask a surgeon how they can help, surgery will be an option—that’s their training and what they know best. As Warren Buffet said,

"Never ask a barber if you need a haircut."

In Part II of this article, I will introduce a new soft tissue care model that breaks this vicious cycle. This model has prevented over 90% of my clients from avoiding a "necessary surgery."

This model is one that I’ve recently refined over the last year after re-engaging with a mentor of mine. It has 4 Phases.

• ​Phase I: Acute Inflammation Care

• Phase II: Joint & Region Strengthening

• Phase III: Integration into Movement Patterns

• ​Phase IV: Activities of Daily Living (ADLs) & Sports

I will break down each phase and share the core principles that differentiate it from the current model.

The three core principles of the new model of soft tissue care are:

• ​Addressing Connective Tissue vs. Muscles

• Tension vs. Compression in Manual Therapy

• The Cadaveric Anatomy Lens vs. The Lens of Chain Reaction Biomechanics

Here’s a quick checklist that you can go through when, and if, you have a soft tissue injury to avoid the "Vicious Cycle:"

• Ask your body what the discomfort is communicating to you. Assume your body is on your side.

• ​Consider the regions around the area that are symptomatic. Start addressing adjacent areas with stretching and self-massage.

• Do your best not to mute the pain to work through it. Your body's ability to compensate is incredible, but it never considers the long-term impact of the compensation.

• ​Only go to the orthopedic surgeon if you are considering pain meds, injections, or surgery. After all, that is all they can offer.

Stay tuned for Part II, where I’ll go more in-depth on my soft tissue care model.

Yours in Vitality,

Matt