The Iatrogenic Cascade

knee replacement

The definition of iatrogenesis is: of or relating to illness caused by medical examination or treatment.

I have seen this first hand in my practice. With back surgery, the statistic is 50%. 50% of all people who have back surgery will be no better off, or worse off, after the treatment.

Recovery rates from other types of surgery are even worse. Rotator cuff and shoulder surgery is notoriously difficult to recover from, some never do.

Western medicine certainly has its benefits and its place. I believe in using medications, injections, and surgical procedures as a last resort. Treat an injury with conservative care first, then if that doesn’t work try something more invasive such as medications or surgery.

My father once joked that according to western medicine, all of our illnesses and ailments are caused by not enough drugs or too many parts in our bodies. Whenever we go to a medical doctor, they treat us by prescribing drugs, injecting us with drugs, or surgically altering the body.

While this is not 100% true, it does have some basis in fact.

Medical doctors are very good at what they do. Unfortunately, they are not well prepared to deal with pain, and especially back pain.

People get into trouble when they expect their medical doctors to have all of the answers. Many people want to see a doctor, get a pill or procedure done, and then never have to worry about the issue again.

Unfortunately, most health issues are long term issues. You can’t expect a medical doctor, or any doctor for that matter, to be able to reverse the health effects of neglecting your body for 20 years, with 1 treatment.

I commonly have patients come in with a pain that has been around for ten years, and they want me to fix them in one treatment. This is just not realistic.

These false expectations are what leads people into an iatrogenic cascade. Commonly I see people who have had a surgery to fix an issue, only for the surgery to create another issue. Or the surgery got rid of one type of pain, but left 2 other types of pain. So the patient, who knows no better, goes back in for another surgery. Maybe the surgeon gave the explanation that they “didn’t get all of it out,” and they need to go back in to clear out the rest of the scar tissue, or cartilage or whatever else they can think of.

Just cutting into someone produces scar tissue. Surgery to get rid of scar tissue commonly produces more scar tissue. Studies show that arthroscopic surgery is no more effective than a sham surgery, 20 years out. Physically going into a joint to look inside causes damage. Puffing up the joint capsule with air to take a look inside causes damage. Never give consent for exploratory surgery.

The iatrogenic cascade describes all of the side effects and issues associated with any medical procedure or pharmaceutical. Commonly people will have a surgery to get rid of a pain. Then have to get another surgery to deal with a side effect from the surgery. This cycle can continue for years.

How many of you know someone who has to take a medication to deal with a side effect from another medication? It is very common. This is iatrogenesis.

My opinion is that many people fall into the cycle of iatrogenesis because they don’t know how to properly treat an illness or health issue. More pertinently, they don’t know how to prevent an illness or injury.

Many times a medical doctor will recommend exercise to prevent , or treat, a health issue. Unless you have training in exercise, then you won’t know where to begin with exercise.

Most people, when told to exercise, will try to start running. Many people associate running with exercise. While running is exercise, it is extremely tough on your body. It is too high impact to stick with long term, for most of us.

Running is one of the worst activities to start out with when beginning an exercise routine. It is very high impact, and causes injuries in healthy people. If you are in pain, have health issues, have joint pain from such issues as arthritis, then running is wrong for you. You won’t be able to do it consistently enough to get any benefits from the exercise. I believe that if you want to run, then you have to get yourself in shape to run in the first place.

Most people who start running without getting into shape for it will injure themselves and have to stop running before they get any benefit from it.

Exercise intelligently. Be smart about your workout, don’t just go harder. It is more important to be consistent with exercise, rather than being intense. Low intensity and low impact exercising, especially while in, and past, middle age is the easiest on your body.

In middle age and older, our bodies cannot handle the stress and irritation from a high impact, high intensity workout. In middle age, and older, we are not going to recover from injuries as quickly as we did a decade ago. If you are not trying to become a professional athlete, then there is no reason to train like one.

Look at your health long term. If you want to feel as good as possible as you age, if you want to age as gracefully as possible, then exercise sustainably. Exercise in a way that you can maintain for years to come. In order to get the most benefits out of exercise, you have to do it consistently, for the rest of your life.

Don’t let yourself fall into an iatrogenic cascade. It is preventable. Take control of your health, put control of your health in your own hands. Take control of your health out of your doctors hands. It is possible and very empowering. You don’t have to rely on doctors to get you better. You can do it yourself. You just have to know what to do.

That is why I designed Pain Free Lifestyle. Over the years I have had many patients come into my office wanting to start exercising, but not knowing how or where to start.

Pain Free Lifestyle is designed to take you from not exercising, being overweight, out of shape, and/ or in pain, to exercising consistently and eating right. Pain Free Lifestyle was designed with easy on the body exercises that most people can do without pain or injury.

If you are in pain, then Pain Free Lifestyle is for you.

If you haven’t exercised in years, then Pain Free Lifestyle is for you.

If you are overweight, then Pain Free Lifestyle is for you.

If you are in middle age or older (or younger) then Pain Free Lifestyle is for you.

If you feel like those extreme exercise systems are too much for you, then Pain Free Lifestyle is for you.

If you fit into any of these categories, then we want you at Pain Free Lifestyle!

If you need to start exercising, but don’t want to hurt yourself, don’t want to get huge, just want to feel better and improve range of motion and activity levels, and don’t know where or how to start out, then Pain Free Lifestyle is for you.

Exercise smarter, not harder. Exercise appropriately for your age and ability. This is the Pain Free Way.



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