Margaret McCartney: When can I get back to running after my operation?
BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4299 (Published 02 October 2017) Cite this as: BMJ 2017;359:j4299
All rapid responses
Your dilemma echos many others in medicine. It is yet another example of the fine line between science, psychology, art and alchemy that truly defines 21st Century healthcare, much as it has for the last 150 years.
What you are describing is the reality - there is no 'scientific', EBM answer to your question, just 'expert opinion'. And of course, experts being human and opinions being, well, opinions, every one will be slightly different. Some experts will be hip, with the times, and all for getting moving at the first opportunity. Others will be cautious, and delay as much as much as possible, perhaps to avoid risk of undoing any possible benefit to the patient, or maybe they are protective of their work or worried about (operative) failure.
Margaret, you have waxed lyrical about realistic medicine, and the negative impacts of unrealistic expectations from patients and professionals alike when the reality is we know only the tip of the iceberg.
Call me a heretic, a maverick or just a lunatic, but my answer to your question, as a non-specialist, but an expert in being human goes something like: 'There is no straight answer, only opinion. No-one knows for sure if this will work for you, or how long it will take you to recover. Every person is different and will heal differently, every operation is different. Recovery will depend a lot on your frame of mind, determination, and expectations. You should start off slowly, build-up gradually, but the real answer is - there is only one way to find out...'
Competing interests: No competing interests
Discectomies, chronic back pain, vertebral fractures and other spinal problems in postmenopausal women could have been prevented or greatly postponed, if long term HRT was administered.
Hormone Replacement Therapy(HRT) does not influence womens' long term survival. [1]
Unrealistic fears, erroneously spread by the media, have led to a complete negation of patient compliance to HRT interventions, and a sharp rise in preventable orthopaedic surgeries.
Reference
[1] http://www.bmj.com/content/358/bmj.j4230
Competing interests: No competing interests
I suspect that - as for many things we would 'like to know' - there is not a really helpful answer to this question.
I feel sure that we all tend to heal at different rates, so there will not be a definable period after which increased activity definitely becomes benign - and we all exercise rather differently anyway.
But most 'athletic' people will already know, that injuries which are left to heal without surgery, are complicated in terms of resuming 'training': you only find out afterwards, if resuming training 'damages' the healing injury or not.
As with many things - all is clear, only in hindsight.
Competing interests: No competing interests
Re: Margaret McCartney: When can I get back to running after my operation?
I wonder if McCartney missed an alternative approach to finding out what is best advice(1)?
At a fundamental level, it is recognised that in general RCT derived guidance, if followed results in sub optimal treatment and recovery in almost all patients (2). However, where local practice is based on what produces the best outcomes locally: Often starting from nation guidance.
One mechanism to this is in a QIC (Quality Improvement Collaborative) (3) then outcome results are generally significantly and clinically importantly better at a population level, and though practice varies (as her piece suggests it does in this case) this actually improves population outcomes despite the differences between centres (4)!
I recognise this is counter intuitive, but the evidence really does suggest well informed clinical judgement based deviation from national or regional guidance is probably better for patients than treating them as all identical widgets!
So I disagree that producing nationally standardised leaflets is a good way to go. As we recently pointed out in the Journal of the Royal College of Physicians of Edinburgh there are both staff and patient benefits from following this route (5), not to mention very large medium term cost reductions. But unless the one size fits all approach (population wide uniformity) is abandoned by those in power then we are condemned to increasing cost, poorer outcomes, lower staff morale and productivity, and widening inequity in outcomes.
1 McCartney M. Margaret McCartney: When can I get back to running after my operation? BMJ 2017: j4299.
2 Rothwell PM. External validity of randomised controlled trials: “To whom do the results of this trial apply?”. The Lancet 2005;365: 82–93.
3 Berwick DM. Broadening the view of evidence-based medicine. Quality & safety in health care 2005;14: 315–6.
4 Eppstein MJ, Horbar JD, Buzas JS, Kauffman SA. Searching the clinical fitness landscape. PloS one 2012;7: e49901.
5 Temple M, Pontin D. The case for using an evolutionary professional protocol for improving care: act local, think global. J R Coll Physicians Edinb 2017;47: 10–2.
Competing interests: No competing interests