In any medical condition there are two basic strategies for any condition. You can either treat the condition or manage the condition. The problem with this model is that very few medical providers and/or patients fully understand this concept of healthcare. The larger issue is that the insurance industry, those that we pay thousands of dollars to each year have no clue about this model and refuse to participate in it. This is evident through, their notorious delay and deny policies. The short explanation is that the insurance industry has created a menu of “plans” that restrict treatment before it happens and deny management from the day you purchase the plan.
The idea of treating a condition involves several aspects. First the condition must be fixable. For example, if you have a sinus infection, a condition that is correctable. Your doctor prescribes you an antibiotic to fix the problem. The infection resolves. This is an example of treating a condition. When you have an orthopedic or musculoskeletal type injury or condition one of the most difficult issues is matching the treatment with the condition. If the condition involves inflammation then the method of treatment should be anti-inflammatory in nature; such as anti-inflammatory medication, ice, various physical therapy modalities, etc. If the condition is degenerative then a structural approach is more appropriate; strengthening and flexibility exercises, manual soft tissue therapies, joint mobilization, manipulation, etc. Once the underlying process is matched with the right treatment approach the intensity and duration of the rehabilitation program should match up with the patient’s functional goals. These can vary greatly from being able to walk in the community to participating in a sporting event such as a 5k race.
When the decision to manage an illness or injury has been made it automatically implies that the condition cannot be resolved. For example, if a patient has spinal stenosis in their lower back secondary to degenerative arthritis resolution of the stenosis can only occur through surgical decompression. Unfortunately the surgery creates other issues so there is never truly a resolution to the condition. This is an example of a disorder that will continue to be managed on and off over the course of the patients life. Another example of a condition that is managed and not treated is migraine headaches. Because there is a large genetic and physiologic component to the underlying cause of migraine headaches that varies in each patient, it is rare to pinpoint one exact cause and thus treat it. So patients suffering from migraine headaches fare much better when they accept that managing their headaches through preventive measures is a better approach than trying to treat each episode as it occurs. Essentially a patient that requires their condition to be managed will have a management plan to perform on their own at home. They will more than likely find themselves seeking a variety of therapy options including but not limited to physical therapy, chiropractic, acupuncture, massage therapy, etc.
Traumatic injuries such as high speed accidents seen in skiing or motor vehicle accidents, generally use a treatment approach in the early or acute phases and may have to transition to a management approach in the chronic phases. High-speed trauma results in a very random and unpredictable mechanism of injury. This type of injury is the most difficult to treat and manage because many body regions, tissue and structures are damaged to a very high degree making it difficult to focus treatment on any specific injury. The degree of damage to the tissues and structures usually result in faulty healing. It is this severity of damage and injury that creates the chronic recurrent post-traumatic symptoms. This is why high-speed injuries result in chronic pain patterns that require a management strategy.
Age is another factor that will impact the effectiveness of any treatment. Regardless, if the treatment is physiological such as medications or physical such as manual therapies or therapeutic exercises, aging tissues do not respond as quickly or completely as younger regenerating tissues. When joints begin to degenerate the arthritic changes of the joint surface roughen the once smooth surfaces. It is difficult to treat this change in the underlying architecture and usually requires far more dedication to lifestyle changes than the patient is truly willing to undertake. When the architecture becomes so faulty that the joint becomes unstable and the surrounding muscles, tendons and ligaments can no longer hold it together the patient is left with the joint replacement option to restore the architecture synthetically or accept the limitations brought on by the degeneration.
Patients should speak to their healthcare providers about their condition and establish what phase of treatment or management they are in. Having realistic expectations and coming to terms with the appropriate strategy can help reduce frustration and create a better long range plan for keeping the patient active.