CHRONIC PAIN AFTER JOINT SURGERY by Eric Winder, DC
T
he miracle of modern joint surgeries cannot be understated. The ability to restore a knee, stabilize the spine or replace a worn-out hip just keeps improving with each year. These surgeries can help individuals become more mobile and productive, enjoying their lives to the fullest. However, there are still some cases when pain still persists or increases after surgery, even if the procedure itself went perfectly. There are many possible reasons for this, and one of the most common is also quite treatable. It involves restrictions in the fibrous connective found throughout our bodies. This tissue, called fascia, contains nerve endings for position sense which af-
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Sarasota/Manatee Edition
fects muscular balance, joint alignment and perception of injury. Treating restrictions in fascia can often reduce or even eliminate unexpected pain after joint surgery. There are usually two reasons that fascia becomes restricted in a surgery area and causes pain. The first is a pre-existing injury, where the fascia has become stiffened by trauma that occurred before the surgical procedure. For example, someone might experience stiffening in the fascia of their knee and thigh as a result of slipping and falling on ice. Years later, this might lead to persistent pain after a knee surgery. The second reason for pain-causing restriction can be the operation itself, through no fault of the surgeon. The scar tissue that forms from the surgical incisions can some-
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times cause distortion or stiffening of the fascia in the surgery area. This is more likely to occur if there is problem with healing such as intense swelling, infection or putting stress on the joint too soon. In addition, procedures where sawing, drilling or chiseling the bone are required can sometimes stiffen the dense fascia that covers the bones. The case of a patient, whom I will refer to as Debbie, illustrates the possibility of relief from post-surgical pain by treating fascia restriction. Her spinal fusion surgery cured intense pain and numbness that ran from her left hip down to her toes, and she was grateful to be able to walk again. However, low back pain that she had also experienced before the surgery intensified after the operation. She was unable to ride in a car for more than 15 minutes, couldn’t do yardwork, and struggled to perform typical housework and cooking. Debbie tried various courses of physical therapy—pain management with injections and opioid medications and even acupuncture—all with minimal improvement. When she came to our office, an examination showed intense restriction of fascia around her entire pelvis, likely the result of falling
