Back and shoulder surgery is often worse than useless
economist.com
economist.com
I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada.
I just thought it an amusing anecdote until COVID, and then realized it’s less that said virus would be developed here and more that we have the business idiots to let it loose.
I'll note that COVID-19 "broke out" in Wuhan a city which has a virology laboratory nearby - the Wuhan Institute of Virology, who perform research on viruses.
I'm sure that is completely incidental to the pandemic of 2020-21. Clearly, some rather nasty live food markets are to blame.
It wasn't your numpties wot did it then, it was another lot that time!
It took about 12 hours, much of it waiting for his blood pressure to subside low enough to get admitted (a pre-requisite for the MRI).
This is in a city with of about 750k people and nowhere near Massachusetts.
Don't even get me started with mental health therapy...
My impression is this is a modern civilization stupidity in general.
apropos Dead Kennedys track: https://www.youtube.com/watch?v=lVULKYbAeEo
Long wait times (6-12 months+) for MRIs (due to a lack of both machines and technicians) are a frequent complaint by Canadians.
I think private MRIs have been around, at least in my province anyways, for close to 30 years.
Jesus... I can get a chest-abdomen-pelvis MRI on US insurance for less than half of that, and the lead time is measured in weeks at most.
I mean if you have insurance I don't know why it's costing you anything but regardless it's hardly surprising that you're cost is less than the person paying cash ?
To me it's crazy that people are waiting an average of nearly 3 months to get imaging. This is probably after waiting a couple months for their doctor's appointment to get the MRI scheduled in the first place.
It's sad that seemingly the top result for this search term is an AI slop lead-gen site, rather than the actual source:
>Disclaimer: Wait times shown are estimates based on publicly reported data from the Fraser Institute, CIHI, and provincial health authority reports.
https://www.statista.com/statistics/282401/density-of-magnet...
Japan is a standout, and then you see most of the West just below them... Canada is way down the list.
Canada is towards the bottom. I see what you did there. I guess I never considered Canada a poor country or one with a bad healthcare system. But at the same time I was only there a few times to a major city and never interacted with their healthcare system.
Think of Steve Jobs jumping to the head of the line for a liver transplant
the article below is interesting, as it goes into the hearsay you repeated and the facts of how the system works.
https://globalbioethics.org/2013/12/11/did-steve-jobs-cut-th...
To restate my now better informed opinion, Jobs money allowed him to increase his chances dramatically of getting a liver transplant.
Is meant to encourage rich people to support the health system since everyone's in it. But in reality the very wealthy go to Buffalo and immigrants visit their home countries.
It's also not lost on public policy experts that MAID has the potential of "solving" a lot of structural problems in Canadian health care and... long and behold MAID has expanded tremendously in ten years.
[1] with some exceptions largely grandfathered in
That's what it means. In Australia it can mean something different.
This has to be a brand new sentence (post 1950s anyway).
Introducing parallel private health care is just accelerationism for privatization wonks who want to just see the death of universal healthcare by sucking it dry for those willing to pay.
There's no magic wand with the resources available for healthcare. Creating private systems so rich people can skip the line doesnt magically create that capability, it means taking that capability from someone who maybe needed it more in the public side of things.
Consider, say, food distribution: McDonalds has traditionally made far more money as a private business catering to the tastes of the poor and middle-class than any fancy restaurant ever made catering to the rich. Do fancy restaurants like Per Se "suck up all the resources" needed to cook and serve food? Does the existence of fancy restaurants hurt McDonald's by making it harder to find burger-flippers? And does McDonalds in turn "suck up all the resources" thereby making it harder for people in some other context to find and acquire food? If not, what makes healthcare so different?
If there were a limited number of licensed cooks like there are doctors, it would be far different.
> Diagnostic Testing: Private labs and clinics provide quicker access to diagnostic tests such as MRI scans, blood tests, and X-rays, which can expedite treatment plans.
https://schwartzcohenlaw.com/does-canada-offer-private-healt...
Not only did I have to wait for my MRI, but as the date approached, I got a call saying that they had canceled it because the insurance refused to cover it. I offered to pay out of pocket. Nope, they simply canceled it.
Of course if you can pay for quicker care in another country, it will seem like care in that country is quicker, but the people living in that country might not have the same privilege. Most of the people I know who move here from outside the US think our system is insane.
There's a billboard on my way to work for a private medical imaging service that offers shorter wait times.
I'm also quite fond of pointing out that Canada and the state of California have roughly the same populations.
Canada's population is incredibly spread out, but also concentrated in about 5 major cities.
When I needed an MRI on my brain is was roughly a week, and that was in a smaller (under 100K people) city.
It's a triage system, although I wouldn't want to suffer through a "less important" issue.
I'm a doctor working in a government funded public healthcare system, where there is every incentive for the system to NOT do investigations and procedures where there is a poor evidence base. Yet we still waste $BILLIONs every year on them and the majority of this is driven by patient demand.
I frequently get patients where the evidence is for intervention A - that requires the patient to do N amount of work (for example physiotherapy, strengthening exercises) with slow, but real, results. After 15 years of medical practice I can honestly count on one hand how often a patient has genuinely taken an interest in this approach and committed to it. This sentiment is shared across colleagues. The vast majority of patients want a 'quick fix', even when there is no evidence that a quick fix exists.
So they push for intervention B, creating long waits for patients who would genuinely benefit from seeing the interventionist who offers B, resulting in worse outcomes for that cohort.
As the system is free at the point of access patients can simply 'doctor shop' and see as many doctors that are needed until they get one who agrees that intervention B is what is required.
I think it comes from an assumption that lay people have that the body is a machine and if a part of it is broken it can simply be 'fixed'. The truth is, is that the human body and biology are messy. We can't even define broken in a lot of cases, you can have two people with the same finding on a scan and one is in pain and the other is completely symptom free. People find this concept really hard to understand, but most of biology is happening on a microscopic level for which we don't have tests and scans, which again people find hard to accept, that we do not always have an answer. Human biology is not a solved science, not even close. There is also the whole complicated factor of human perception.
Two people can have the exact same experience but have completely different feelings and ideas about it. For one person, post-nasal drip maybe completely distressing and make their life miserable. Another person may have the exact same level of post-nasal drip but it does not bother them at all and they live their entire life with it without ever consulting a doctor. So what partly drives health demand is a patients tolerance and perception of their symptoms, which can change over time.
Many MRI “abnormalities” are, well… normal. “Age-appropriate” findings on MRI readings are vastly under-appreciated. If you are over 50, have no pain, and place you into an MRI, you have at least a …
A 20% chance of having a meniscus abnormality. An 80% chance of something being listed as an abnormality in your knee. A 10-15% or higher chance of having a rotator cuff tear. An 80% chance of having a disc bulge in your back or neck.
I really need to figure out whether it's going to make things better or worse, but unfortunately, that feels like something a doctor can't guarantee one way or the other.
Any anecdotes or other experiences/thoughts are appreciated.
He was a regular golfer until last year when the pain got too bad to play through. He just started playing golf again at the beginning of September. He told me after three or so rounds he can’t even tell he had surgery or any previous pain in that shoulder.
He’s had one doctor do his knee surgery and the aforementioned shoulder surgery and he’s really happy with all of their work.
I hope you have as good of an experience as my dad has had.
I used to suffer from chronic low back pain. It hurt to get out of bed every day for years. 1-2 years after getting into bodybuilding the pain disappeared and didn’t come back. Not only that, but I’m not physically limited by my back whatsoever.
I’m not suggesting you start bodybuilding. But the things I think that helped was 1) weight training, 2) mobility work / stretching, 3) physical therapy. That combo can be really powerful.
One side note: There are core strength/posture issues but also issues that need medical attention. The tricky part is figuring out which.
I still wouldn’t stop weight training, as it’s a part of my life that I love. However, despite never going for ambitious PRs, I have chronic pain that I never had prior to starting - and no amount of physical therapy has resolved it.
As always, YMMV.
I would recommend doing band work and calisthenics and also highly recommend analyzing your kinetic chain and form in any activity you do and figure out how to reduce shoulder arm and wrist for any force generation in sports such as tennis, golf, throwing etc.
After playing college tennis and developing bad shoulder issues with MRI indicating that surgery would be recommended. Two years prior my high school friend had had the same surgery and ultimately developed a opioid dependence during the crises and subsequently died of an overdose after 18 months of spiraling.
I ultimately was able to attribute the onset of flare ups to weeks where I was hitting a lot of serves and at first simply instituted a “pitch count” and later studied my form and discovered that I was not loading as much as I should have been from the base of my kinetic chain and a lot of that load was being put on my shoulder.
About 12 years later and I’ve recently switched to pickleball (no over head serve) and jokingly refer to myself as a tennis refugee.
You yourself recommend band work which is putting your shoulder under load
The real answer is the shoulder is complicated mechanically and you need to work on reinforcing or building the smaller groups (Is, Ys and Ts type of exercises and many others), if you can actively stabilize your shoulder this way you will reduce pain, inflammation and decrease the propensity for injury, allowing you to do traditional shoulder exercises like press etc without issue. I suggest working with a good PT
My mother-in-law has spinal surgery last christmas, the pain for her, prior to the surgery, was unbearable so it's hard to justify not running from that into the arms of a surgeon. The surgeon showed exactly what was to repair though so it was simple enough to understand and clear in the way it was going to help her.
About 9 months out from that surgery and she doesn't have anymore pain.
I dunno if spinal surgery is comparable to shoulder surgery.
I had spinal surgery; the scans were conclusive (specific disks had ruptured), the surgery to put in prosthetic disks (2x in total) is apparently quite routine, and the procedure itself is simpler (limited 3D motion in each vertebra - if you lose motion between any two vertebra after surgery, you might not even notice).
Compare to shoulder surgery where the scans are frequently inconclusive ("we think this surgery might fix the pain, but we are not sure"), and the surgery is uncommon, and the procedure itself is complex (large range of large movements across a large number of axes).
I know about a dozen people in real life who have had spinal fusions, but not one who has had shoulder surgery.
However, if available I would try to find a good Pilates/dance/sports instructor that has a Gyrotonic machine, which is built for repairing and strengthening shoulder muscles. I had debilitating back issues from sitting in a chair all day and a good instructor fixed it over a year through low impact Pilates. YMMV and group classes tend to be ineffective because so much of it is doing the exercises precisely correct - they were built for injury recovery
100%. But I do like to hear anecdotes, since I know no one personally that's had shoulder surgery.
But agree that everyone's different, and everyone's experiences are different, so I take it with a grain of salt for sure.
But still appreciated!
I've been on and off with being consistent with that over the years and was dealing with lots of back pain. Having a desk job doesn't help.
But when COVID hit, I dedicated myself to Olympic weightlifting and pilates by paying (quite a lot) to have coaches and trainers. Since then I've had zero back pain. I recently quit both to get into long distance running because I was getting to be pre-diabetic, despite eating decently well and doing the aforementioned exercise. (Probably genetic - my dad's mom and my mom's dad were both diabetic.)
After all that - my one anecdata point is that pilates is the absolute best and most sustainable for life. My increased flexibility and core strength have totally changed my life. I couldn't even tie my shoelaces before but now I can squat almost to the ground to pick up my son. I'd put running second because I genuinely think the human body is designed to run and your body will figure itself out once you get into running shape. I love Olympic but you'd really need a good coach and be committed to do it well and not injure yourself.
All the above took me years of consistency and commitment, but now I'm on pace for a 3:10-3:15 marathon next month and I'm in the best shape of my life with zero back pain. I think losing a ton of weight from running has also lifted the stress from my back.
That's my experience, fwiw. Good luck man, hope whatever you end up doing will improve yourself.
Previously if I coughed my arm would fall entirely out of socket and I would need a propfol shot to allow the doc to relax it to get it back in.
In my case I was basically immobilized and in excruciating pain and fear 100% of my day.
Now thats only like 50% of the day
As an anecdote: Family member has a partial lateral meniscus tear in the knee. Surgery was considered as if successful then returning to running might have been possible. Specialist opinions varied as did their reading of the MRI scans.
After a lot of research there was emerging evidence that long-term, surgery was more likely to result in osteoarthritis. So had to weight up long-term mobility over short-term pain relief and not having a major lifestyle change.
You see professional athlete undergoing surgery the next day, but their income relies on regaining usage as quickly as possible. The alternative is physio exercises to strengthen the supporting muscles and avoiding anything that might cause a re-injury.
At the least I would heavily consider exhausting conservative treatment first. All but the worst tears can heal on their own, it just takes time and steady effort.
No matter what you choose to do, the adherence to rehab will determine your ultimate outcome.
That doesn't mean that surgery is always the appropriate treatment (I'm living with a shoulder labral tear that's untreated). But it is not even remotely true that tears heal on their own. Example, I just had an MRI on my tear, and the ortho said it looked exactly the same as the last MRI I had 8 years ago- no better, no worse
Labral tears look bad, yes, I'm talking more about tendon partial tearing here, which I think is more common than labral tearing (though I think, like the meniscus in the knee, after a certain age we probably all have tears in these tissues that are asymptomatic, so it's really a matter of degree).
For a long time it seemed to be accepted wisdom that even a partial tendon tear required surgery, but there's a lot of newer evidence that the body can recover from these with the right rehab protocols and time.
To be honest I'd forget and correct it all the time.
I’ve had a Stanford orthopedist (remotely) review my records, and he feels that surgery may be the only thing that can get me back to 100% (RoM or pain).
PT may help, but it can’t heal the damage that’s been done.
I was in the same position at age 42-ish. Shoulder pain in right shoulder so bad that I could not even lift a cup of coffee.
> I really need to figure out whether it's going to make things better or worse, but unfortunately, that feels like something a doctor can't guarantee one way or the other.
I heard the same thing from 3x different surgeons (orthopedic, I think), which lead to...
> Any anecdotes or other experiences/thoughts are appreciated.
... not having any surgery. Over the course of the next 3 months it remained the same in severity (did not get worse, may have gotten better slightly or else I started learning to live with it). The subsequent six months the pain started abating. Over the next 6 months the pain went away almost totally. Now, 8 years later, I don't feel any pain at all.
Of course, I am diabetic, so make of that what you will. When the first surgeon checked my scans (MRI, Xrays and something else - ultrasound, maybe), and said they are not sure if surgery would fix it, I went to a second surgeon with the same scans, got told the same thing. When the third surgeon said the same thing, I decided to wait and see.
Good thing I did; surgery doesn't always turn out well.
Just my anecdote but I would say it clearly matters a lot how good your surgeon is and also how seriously you take recovery (which is a slow and painful process in itself). If you have a good surgeon and you do your physio exercises like a good invalid it seems to make a big difference.
I would say ask your surgeon what the reasonable expectation for recovery would be. Mine was pretty frank with me that there isn’t 100% relief in 100% of cases but I felt comfortable enough with the error bars she gave me that I went ahead and in my case that turned out to be a great decision (whereas for example I talked to an eye place about Lasik and it turned out my current vision is within the range of what they would consider successful surgery so I decided not to go ahead in that case).
Of course, many people don't like the recurring PT appointments, nor do they like hearing that you need to continue the exercises to some degree even after the sessions end. But I've incorporated them into my regular workouts, and a year later have completely functional shoulders. Best of luck.
I suffered from peroneal tendinitis that was partially caused by not properly activating my calf/quads/glutes while running, so addressing this fixed the problem.
Most recently, I started to feel some extensor tendinitis swelling up in my foot, looked into it and it was suggested that properly stretching/massaging the tibialis could help this issue. My extensor pain was significantly less / almost gone after.
I had a shoulder injury that was effectively treated by several months of twice-weekly sessions of PT. This was the embarrassingly difficult sort of PT involving doing exercises with carefully supervised form that looked very, very easy and were almost impossible. Before this experience, I never knew that half-pound barbells were a thing or that they might be very difficult to lift the way the PT wanted me to lift them.
Back surgery on the other hand is only recommended for crazy illnesses.
Most surgeries are followed by more surgeries.
And the hard truth is that most surgeries happen because most people do not have the discipline to do what's needed over many months to solve the problems they are having with the chronic pain they are in. They want a faster solution and are never really told by anyone that the only real permanent solution is one that will be difficult and take months.
Rather than change their habits and their environments and their bodies, people opt to do things that have surprisingly low rates of success and more often than not result in a state than can never be fixed.
Some people get past the point of no return. For those people, surgery may be the only option. But for most people the only real option is a change in lifestyle that is more or less like deciding you are going to get very fit. It takes months and in the mean time, theres a lot of effort and discomfort.
In addition, most people don't really get how much of their back pain and ailment is due to ergonomics. That their bed is wrong. That they are sitting in a bad office chair or couch.
But more than that, most people don't get how central exercise and core strength are for maintaining the health of your back.
So before you get back surgery, consider getting a new office chair, exercising more, and facing that pain for a few more months. Work toward a real solution.
While I’m fortunate now to be able to dedicate time to the gym and other physical fitness, this was not always the case.
We lack the societal incentive structure to allow someone working 60-80 hours a week to reduce their workload to physically recover. We do allow that same person to spend 5-10 years income on surgeries which have 4-6 week recovery times.
https://www.bls.gov/charts/american-time-use/emp-by-ftpt-job...
Note how two job holder average is barely above single job holder average. These are probably people working two part time jobs with a 4-5 hour shift each.
How about activities? BLS has some data there.
https://www.bls.gov/charts/american-time-use/activity-by-age...
Note the leisure column.
Screen time average is about 7 hours a day (not the best source I guess compared to say if apple published their data): https://www.demandsage.com/screen-time-statistics/
You could do a lot of good with a 3 day a week 30 min compound lift strength training workout. Deadlifts, squat, bench press, overhead press, pull ups.
However, given that people "graduate" their 20s without having done this, then everything you say becomes true, people end up so weak that they have to rebuild even basic core strength and posture. So practically what I suggested is useless except for maybe the next generation.
Example: My town installed an outdoor "grown-up playground" in the nearby park. Probably cost a little over two complicated surgeries. Already saved 10 people from neglecting upper body workout. Just 10 people having a really low-barrier-of-entry gym available to them whenever walking their dog. I suspect its already been cost-effective. Plus, it is reusable and low-maintenance. Try to beat that in the operating room!
Working out is good, yes, but you need to actually work the body and make it suffer so that it may actually be damaged enough for high rates of muscle growth. So many people do not do enough because they don't like to push themselves, they take it easy and they end up wasting their time in the gym. Even more true as you get older and natural testosterone levels start declining and limiting your muscle growth.
This is why people end up taking spin classes when they can just do it at home on their own stationary bike. For some people, they need a jockey who will kick their ass along with the peer pressure of a room full of people dumping out sweat.
https://www.economist.com/science-and-technology/2026/09/23/...
Gift link: https://www.economist.com/science-and-technology/2026/09/23/...
Sadly I wasn’t in the first five! Thanks anyway.
I can't wave a magic wand and just put more space between my discs... that's the only thing that's going to ease off my pain as far as I'm aware.
If surgery doesn't help, and/or like the other commenter mentioned, people with similar physical characteristics don't have pain, then it's time to explore the other two.
Sitting and laying is fine, but walking I can manage maybe 10 minutes max before it starts to hurt, and only gets worse quickly from there. Then I must rest for at least as long as I was walking to get another 10 or so minutes.
Sometimes manually stretching my spine out can help reset that time limit (like lay down with knees up and push down on my thighs to stretch it, it usually pops), but it's only temporary.
If I'm walking on uneven terrain then my muscles go into wild inflammation mode and are hard as rocks... on top of the spinal/nerve pain.
Inversion table for 15min a morning also helps just to unload the spine. You can try to do the start of an abdominal crunch to build stomach muscle there while unloaded.
https://en.wikipedia.org/wiki/John_E._Sarno
https://en.wikipedia.org/wiki/Tension_myositis_syndrome
These ideas and methods cured my back pain.
but yea, everyone should lift weights for various reasons, not just to reduce the chance of random pain.
and the Dartmouth Atlas of Health Care - https://www.dartmouthatlas.org/
We humans tend to believe doing sth is superior to doing nothing.
While nothing is actually not nothing. Nature is actually pretty good in self-healing.
Sometimes it works out, I guess.
The thing is, this seems to be rather common.
https://moonshotmp.com/learn/wolverine-blend/ "Educational information only. The peptides discussed here are not approved by the FDA for the uses described, and nothing on this page is a recommendation to obtain, self-administer, or dose them. Any peptide therapy at Moonshot Medical is individualized and provided only under medical supervision after an in-person evaluation. This is not medical advice — consult a qualified healthcare provider." https://en.wikipedia.org/wiki/TB-500 https://en.wikipedia.org/wiki/BPC-157
If there are any scientific studies or governments that have approved the use of Wolverine blend, I could not find them. I'd be interested if anyone else has better information.
We have a statistics problem. Thing is, the way successful surgeries vs botched procedures are measured isn't transparent; as an example, my mother died 2 years ago victim to a routine procedure; It was a combination of both "bad luck" (something went wrong with the procedure) with laxity (prolonged weekend, nobody cared about complaints). Because she didn't died on the table, instead from "complications in recovery" (fyi they accidentally perfurated the intestine during the procedure), its "natural causes".
Many years ago, my dad died from meningitis, 8-10 months after a surgery and a very long recovery. I'd bet a couple of fingers it was a hospital-contracted infection during either the surgery or the recovery. Again, a routine surgery took 8h instead of the expected 2.5-3h. Shit happens, we know - surgery is extremely dangerous, and there is a shit ton of stuff that can go wrong.
Thing is, none of this get into the statistics; There are no reliable survival metrics; The papers you sign are riddled with medical terms to isolate you from the consequences (would you do a non-critical surgery if you could end up shitting on a stomach bag for the rest of your life?), and many many doctors are quite happy into "selling you" their trade option. To be clear, the number any doctor presents you is *wrong*; it has no connection with reality; failure rates measure deaths on the table (the best kind of death, btw), and studies extrapolate from badly measured (per-hospital metrics) or non-existing data.
Tl,DR: avoid surgery if you can; If you really need it (after asking for at least 2 more opinions), your health (and often life choices) matter - bad kidneys, weak liver, etc may be the difference between someone rushing it up or giving an extra 20 min to ensure everything is kosher.
Eventually found a doctor at Mayo who looked at the x-rays differently. He replaced my hips and life is 100x better.