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The Trouble with X-rays

A Tale of Two Hips
I want to illustrate a point about x rays in this next account about two people who came to me for care. 

The first is Robert. Robert is 50 and makes a living as a handyman. He noticed that his hip was hurting in the morning and also it was difficult for him to climb stairs, bend over and pick things up and to squat down. He went to his doctor and they x-rayed the hip. The x-ray showed degeneration and a “bone on bone” condition. He was advised that he would need a hip replacement.


Upset at the prospect he came to my office and asked if there was anything else that could be done. I told him that we could work on strength and range of motion in the hip and that this might buy him a little time but ultimately he would probably have to get the surgery. He signed up for 4 weeks of PT and after working on strength and flexibility he was feeling some improvement. Unfortunately he was still having problems with the hardest parts of his job and was no longer feeling confident climbing ladders or crawling though confined areas. Ultimately he decided to have the surgery and came back for rehab afterwards. Rehab was quick because he had already done a lot of the strengthening prior to his operation. In no time he was back up ladders and bending over to pick up toools with no problems. 
The second is Liz. Liz is also 50 and was at her doctors office complaining of shoulder pain. The doctor asked if there was anything else that was bothering her and she said “yes, my hip is hurting me too, particularly at night” . One x-ray later and the news was not good. She had  degeneration and loss of cartilage in the hip joint and was looking at a possible hip replacement. She was shocked and came to my office for help with her shoulder but also asked me to take a look at her hip and tell her what I thought. I told her the same as Robert, that PT was a good course of action regardless of whether she ended up in surgery or not. She decided to try PT. Four weeks later she had no pain in her hip and was walking several miles a day with no pain. Also the night pain she had complained of in the doctors office was gone. 
The point of this story is to illustrate that your x-ray may show some changes or wear and tear but this doesn’t necessarily lead to a certain course of action. Many things visible on xray that are designated “degenerative” are simply part of the aging process. Having these things does not necessarily imply that there is something wrong or that “fixing it” will make you feel better. Surgery, although much less risky than it used to be is still a big deal and unless you are in an emergency situation you should take some time to decide if it is the right course of action for you. Part of the decision process should always be trying Physical Therapy to see if that helps. In Roberts case, it helped but not enough for his needs, and ultimately he had to have surgery. In his case, the value of trying PT first meant that as he went in for surgery he was 100% certain that this was the right course of action, there was no second guessing. Psychological studies show that people who are convinced that surgery is the right option typically make better recoveries and are happier with the results than people who had doubts going into the OR. 
In Liz’s case, PT was all she needed at that time in her life and she was able to continue on with her normal daily activities. She may need a surgery in the future because there is a some degeneration present in the joint but for now she is OK. Her attention to strength and fitness will serve her well when the time comes as active people recover faster and with fewer complications than sedentary patients. 
To summarize this tale. Xrays and MRIs do not tell the whole story and taking time to try Physical Therapy pays off no matter what the ultimate outcome. This is especially true with spinal surgery where the outcomes can be a lot less predictable than a joint replacement. 
Have you been told that your Xray or MRI shows something that is “degenerative” or “not going to get better” and now you are wondering if you are going ot have to take medicine for the rest of your life? If you have questions, reach out to us at info@jonesphysicaltherapy.com and lets see if PT can offer some solutions. 

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