Preventive Cardiology is a mature field, and at its best can be quite personalized, incorporating genetics, biomarkers, imaging, shared decision making and ongoing assessment of the response to therapies; whether for primary or secondary prevention (prevent a first event, or prevent worsening of clinically evidence disease) it has something to offer. I've often wondered what Preventive Orthopedics would look like. Why can't it incorporate family history and genetic markers of risk? (eg, collagen genotype and tendon/ligament risk.) Biomarkers? Imaging (eg, ultrasound of connective tissues) and simple observation such as varus/valgus.... all leading to personalized recommendations for footware, exercise plans, occupational interventions, mattresses, pillows, and orthoses. Probably a 20 year project but has it started?
Thank you for this thoroughly researched article. I understand that a number of hospitals use physical therapists as the first provider to treat ER patients who present with low back pain. PTs are well trained to recognize red flag signs, and in my experience have a better knowledge of the anatomy and physiology of the lower back than most of us physicians.
You seem to have a positive impression of the utility of PRP injections; I have never seen evidence strong enough to support the use of PRP. Perhaps you could offer such evidence…?
Tough literature to appraise as volume and composition of injectate varies so much from study to study and person to person. This is a good recent appraisal of the evidence.
From the article you linked: “Despite their growing availability as point-of-care interventions, orthobiologic therapies remain an evolving area of practice. Robust, dose-dependent randomized controlled trials are needed to more clearly establish the clinical effects of PRP on patient outcomes.” Given that PRP has been advocated and in use for a decade, one wonders how anyone would expect more trials would offer the necessary evidence of utility. Statements of this sort (which I encountered all too often in my work assessing medical evidence) are the hallmarks of interventions that will likely never qualify for a ‘medically necessary’ designation.
I hear you. I think one thing that's semi-unique about PRP is that it differs from person to person. So we aren't really testing a consistent substance.
Excellent article. I’ve been training in applied neurology and so many chronic persistent symptom/pain issues can be improved simply by looking at them through the lens of the brain and nervous system along with the adaptations and habits developed over years.
Medical care, in general, is fragmented, not just MSK. We need to stop looking at people by their organ systems and start looking at the whole person. Our systems are interconnected; our health care should reflect that. Unfortunately, it doesn't and it's getting worse with specialized centers for each system.
That is why I like Lifestyle Medicine. Their 6 pillars are made for the whole person - nutrition, physical activity, stress management, restorative sleep, social connection, avoidance of risky substances. I would add to that having hope for the future. Stephen Trzeciak, MD, MPH has been doing research on this topic and its affect.
What a fantastic article I agree this is the way medicine should strive for
Preventive Cardiology is a mature field, and at its best can be quite personalized, incorporating genetics, biomarkers, imaging, shared decision making and ongoing assessment of the response to therapies; whether for primary or secondary prevention (prevent a first event, or prevent worsening of clinically evidence disease) it has something to offer. I've often wondered what Preventive Orthopedics would look like. Why can't it incorporate family history and genetic markers of risk? (eg, collagen genotype and tendon/ligament risk.) Biomarkers? Imaging (eg, ultrasound of connective tissues) and simple observation such as varus/valgus.... all leading to personalized recommendations for footware, exercise plans, occupational interventions, mattresses, pillows, and orthoses. Probably a 20 year project but has it started?
Thank you for this thoroughly researched article. I understand that a number of hospitals use physical therapists as the first provider to treat ER patients who present with low back pain. PTs are well trained to recognize red flag signs, and in my experience have a better knowledge of the anatomy and physiology of the lower back than most of us physicians.
You seem to have a positive impression of the utility of PRP injections; I have never seen evidence strong enough to support the use of PRP. Perhaps you could offer such evidence…?
Tough literature to appraise as volume and composition of injectate varies so much from study to study and person to person. This is a good recent appraisal of the evidence.
https://doi.org/10.1002/pmrj.70144
From the article you linked: “Despite their growing availability as point-of-care interventions, orthobiologic therapies remain an evolving area of practice. Robust, dose-dependent randomized controlled trials are needed to more clearly establish the clinical effects of PRP on patient outcomes.” Given that PRP has been advocated and in use for a decade, one wonders how anyone would expect more trials would offer the necessary evidence of utility. Statements of this sort (which I encountered all too often in my work assessing medical evidence) are the hallmarks of interventions that will likely never qualify for a ‘medically necessary’ designation.
I hear you. I think one thing that's semi-unique about PRP is that it differs from person to person. So we aren't really testing a consistent substance.
https://pubmed.ncbi.nlm.nih.gov/41549467/
A wise man said “ the paper will stand anything you write on it “.
Excellent article. I’ve been training in applied neurology and so many chronic persistent symptom/pain issues can be improved simply by looking at them through the lens of the brain and nervous system along with the adaptations and habits developed over years.
Great article. Where and how can the health care industry find the motive and means to change?
When you or yours end up being the ones experiencing the system.
Medical care, in general, is fragmented, not just MSK. We need to stop looking at people by their organ systems and start looking at the whole person. Our systems are interconnected; our health care should reflect that. Unfortunately, it doesn't and it's getting worse with specialized centers for each system.
That is why I like Lifestyle Medicine. Their 6 pillars are made for the whole person - nutrition, physical activity, stress management, restorative sleep, social connection, avoidance of risky substances. I would add to that having hope for the future. Stephen Trzeciak, MD, MPH has been doing research on this topic and its affect.