BY MEREDITH WARNER, MD

I have spent more than twenty years treating orthopedic conditions—first on the front lines of New Orleans’ streets, then as an orthopedic surgeon during military tours in Afghanistan and Iraq, and now in private practice.

I am also honored to serve as clinical faculty for Louisiana State University (LSU) Orthopedics.

Throughout my decades of experience, I have seen little progress in musculoskeletal care. Rising rates of narcotic use, chronic pain, and unnecessary surgeries—alongside a surge in disability claims—highlight the need for a more evidence-based, conservative clinical approach that prioritizes non-invasive therapies as the first line of treatment.

Don’t get me wrong, if you fall down a flight of stairs or tackle a rough ski slope and break your femur, you’re going to need surgery! I perform surgeries for traumatic injuries every week at my clinic.

But that’s not what I’m talking about here. I’m referring to elective surgeries recommended for what you (and your surgeon) may see as the “inevitable aches and pains of aging.” The persistent stiffness, clicking and popping joints, the gradual loss of mobility that seemingly “sneak up on you.” But here’s the truth: so-called age-related symptoms are not inevitable, and many elective surgeries may be unnecessary.

In fact, large datasets reveal that the primary driver of surgical recommendations isn’t necessarily your symptoms but rather where you live! In fact, the availability and concentration of magnetic resonance imaging (MRI) machines in your area—along with your surgeon’s personal inclination to operate—can strongly shape the course of your treatment plan.

After controlling for race, gender, education, income, and access to providers, studies show that for a given condition, the recommended treatment depends on your location more than anything else.

MRIs and Abnormalities

When you see a doctor for a pain complaint, the most common tool that will eventually indicate you for an orthopedic procedure is magnetic resonance imaging. Let’s take a closer look at what MRI does and does not show before some physician waves an MRI report in front of you with the pronouncement, “You’re gonna need surgery.”

Magnetic resonance imaging is an amazing technology that literally allows physicians to look inside the body and identify spots that we consider “abnormal.” In traditional medical practice, the assumption is that by “fixing” these abnormalities, we can resolve the problem and eliminate symptoms. However, the findings provided by an MRI may not, in fact, be the true source of pain.

Before you respond, “Yeah, but my MRI shows—” consider this: Landmark MRI studies of large groups of people show abnormalities in patients with no symptoms. That goes for MRIs showing abnormalities in the cervical spine, lumbar spine, knee, hip, and shoulder of a patient! The same “defect” that your surgeon found on your MRI and said should be fixed is probably on the MRI scans of countless people with no pain or symptoms at all.

To be clear, millions of people are walking around with rotator cuff tears, arthritis, or torn meniscus at the knee—but they have no pain. They’re enjoying full, normal function. In fact, the prevalence of biomedical “abnormalities” on MRI is so common, the abnormalities are now considered to be normal!

The logical conclusion follows that the abnormality, protrusion, herniated disc, or arthritic tissue may or may not be the cause of a patient’s symptoms. Rather, the symptoms may stem from other factors such as chronic inflammation, poor diet, lack of exercise, or poor sleep.

In other words, the MRI does not take the root cause into account. MRIs serve only to demonstrate that there is a finding, or there is something that can be pointed to as a biomedical “abnormality.” In reality, the pain experienced by the patient is usually a symptom of another underlying condition or disease that is not going to be seen on that MRI.

Some doctors simply take the easier path to diagnosis. Instead of taking the time to identify the underlying cause, they refer only to MRI scans and routinely recommend surgery. In fact, if I order lumbar MRIs in my clinic, I can almost guarantee the scan will reveal something—and that a procedure will be suggested as a result.

I do not own an MRI or have a share or financial relationship with one, but many physicians do. Between 2000 and 2005, the growth rate of MRI procedures completed was 254 percent for non-radiologist-physician-owned MRI machines, as opposed to only eighty-three percent for those owned by radiologists. Naturally, procedure volumes have also grown along with the number of MRI scans completed.

For this reason, I often encourage patients to take a more proactive role in their health—starting with asking targeted questions, exploring diagnostic and treatment options, and working collaboratively with their doctor to make well-informed decisions about their long-term care.

A Proactive Approach to Care

I like to teach my patients that there’s a standard of care and then there’s optimal care. Achieving optimal care involves identifying root causes and staying informed about your health status—and biomarkers play a key role in that process.

Bear in mind, standard medicine will ask you to only achieve standard results on standard lab tests. One important thing to understand about standard or “normal” ranges in blood work is that they are based on the general population.

So, if the population is fifty to sixty percent obese and ninety percent metabolically dysfunctional, then the “normal” ranges are not going to be optimal for you and me.

Likewise, the recommended daily allowance (RDA) for nutrients was first developed during World War II. The point of the RDA was to increase the survival rates of soldiers. The RDA was designed to achieve the bare minimum for prevention of deficiency disease, but it is not set up for optimal health. For D3 levels, for instance, I want a level of fifty to eighty. The normal range is set at greater than or equal to thirty. The normal range ensures there will not be rickets—but it is not optimal.

So, if you’re shooting for normal ranges of micronutrients and basing your intake on the RDA, you probably won’t get scurvy, rickets, pellagra, beriberi, or other deficiency diseases. But you certainly won’t be setting yourself up for more optimal health and vitality as you age.

The last update to the RDA was in 1997, and it was based on average body weights. Back then, the average woman weighed 135 pounds—today she is 170 pounds. Back then, the average weight for a man was 166 pounds, and today it is closer to 200 pounds. Accordingly, this would make even the bare minimum of the RDA seemingly inadequate.

These points are important to acknowledge because it really matters for your joints, muscle, connective tissue, skin, and so on. If your numbers are not optimal, you are at risk of being indicated for orthopedic surgery. I realize that you are not likely to be asked about your metabolic health at a standard orthopedic clinic visit, but in my opinion, that is the core issue, and it should be addressed.

My goal is for you to optimize your health and avoid any potential orthopedic surgeries. This may not be possible for some, depending on the diagnosis, but if these biomarkers are improved, so will the surgical outcomes.

With that in mind, here are a few key biomarkers and target levels you should consider for optimizing your health—and maintaining it through the years:

High-Sensitivity C-Reactive Protein (Hs-CRP):

C-reactive protein (CRP) is a liver-produced protein that serves as a key marker of inflammation. Measuring CRP levels provides valuable insight into your overall inflammatory burden.

For a more precise evaluation, the high-sensitivity C-reactive protein (hs-CRP) test is preferred, as it detects lower levels of inflammation more accurately than standard CRP testing. It took years, but finally, the American Heart Association and other societies have recognized that inflammation is a serious problem, and now the hs-CRP is becoming more common.

In the general population, levels below 2 mg/L are considered normal. However, optimal levels are below 1 mg/L—and ideally, even under 0.5 mg/L.

Vitamins and Micronutrients:

Many Americans tend to be deficient in essential nutrients due to a diet dominated by processed foods—where vital vitamins and minerals are stripped away—while falling short on nutrient-rich whole foods.

About ninety-four percent of Americans are deficient in vitamin D3; ninety-two percent of Americans are deficient in choline; sixty-seven percent are deficient in vitamin K; up to sixty percent are deficient in magnesium; forty-four percent are deficient in calcium; forty-three percent are deficient in vitamin A; and eighty-nine percent are deficient in vitamin E.

Considering that our “normal” levels are set so low, this is quite concerning in my opinion. So, what levels should we have in our blood? Here is a short list of optimal ranges to check with your doctor:

• D3: 45-50 ng/ml, or even closer to 70 or 80 ng/ml if you are an athlete

• B12: around 180 pg/ml to 914 pg/ml

• Magnesium: 1.7 mg/dL to 2.2 mg/dL

• Zinc: 0.66 ug/ml to 1.10 ug/ml

• Vitamin C: 0.2 to 20 mg/dL

• Vitamin E: 5 ug/dL to 25 mg/dL

• Vitamin A: 30 ug/dL to 80 ug/dL

• Selenium: 23 ug/L to 190 ug/L

• Copper: 70 to 150 ug/dL

• CoQ10: 0.4 to 1.6 mg/L

• Vitamin B1: 90 nmol/L to 140 nmol/L

• Vitamin B6: 5 ng/ml to 25 ng/ml

• Vitamin K: 0.13 ng/ml to 1.19 ng/ml

A1C/HbA1c (Glycated Hemoglobin):

When sugar enters your bloodstream, it attaches to hemoglobin—a protein in your red blood cells—through a process called glycation. While some glycation is normal, elevated blood sugar leads to increased attachment. The A1C test, widely used to diagnose, monitor, and manage prediabetes and diabetes, provides a long-term view of blood sugar regulation.

Keeping A1C levels in check helps reduce inflammation, prevent metabolic dysfunction, and support optimal circulation—all essential for the health of your muscles, joints, skin, and overall musculoskeletal system.

The HbA1C test reflects your average blood glucose levels over the past three months. Ideally, you should have a level of <5.0 percent.

Metabolic Health:

As I mentioned earlier, almost ninety percent of this country is metabolically dysfunctional. The National Institutes of Health define this syndrome as having three of the following five issues:

(1) A waist that is >35 inches for women, or >40 inches for men

(2) Blood pressure of 130/85 mm/Hg

(3) Reduced HDL with levels of <40 mg/dL

(4) High triglyceride levels of >150 mg/dL

(5) Fasting blood glucose of >100 mg/dL

A quick blood test—available online for direct purchase or through your local lab—should give you this information. Suppose you remain insulin resistant, inflamed, and have high levels of oxidative stress. In that case, you’re more likely to develop aches and pains, joint problems, stiffness, arthritis, tendinitis, fatigue, weakness, clicking and popping joints, and other conditions that seem to just sneak up on you.

Ultimately, stay proactive in your health and don’t hesitate to request these tests. However, be aware that if your doctor works for a hospital or a large medical group, they may be pressured to limit testing. A little-known issue with the Affordable Care Act is the Accountable Care Organizations (ACOs) to which such doctors belong. In this operation, if a system saves money, the hospital and doctors receive a bonus payment—meaning fewer tests can lead to financial incentives.

Cue Up the Questions

In addition to ordering blood tests, optimize your care by preparing informed questions to ask during doctor visits when considering an orthopedic procedure:

• Why are we doing the X test or MRI? Will this change the management of my problems?

• What will the X test or MRI show?

• What are the data on the asymptomatic population undergoing the same MRI?

• Is it possible that any of my current medications or supplements are causing or complicating this condition?

• Do you see any negative interactions between my medications, supplements, or over-the-counter medicines?

• What are the potential risks or side effects of this procedure/surgery?

• How much function will I realistically gain from this procedure?

• Is your recommended treatment aimed at controlling symptoms or as a cure for the problem?

• What is the success rate (track record) of this procedure/surgery for people in my condition?

• What can I expect during recovery, and how long will the typical recovery take?

• How specifically can I expect to improve after the treatment/surgery?

• Are there symptoms that will not improve even after treatment?

• How long will your recommended treatment last? Will I have to have a redo at some later point?

• Is your recommended treatment the typical one nationally for my condition?

• What other options do I have to resolve this issue/problem besides what you’re recommending?

• What natural treatments or therapies might accomplish the same positive outcome?

• What will likely happen to me if I do nothing to treat this condition?

These are, in my professional opinion, basic questions. However, what you should really be asking is, “Why do I have arthritis or tendinitis or pain?” Once you’re armed with the necessary data, you can start exploring answers and the most effective solutions—no matter what your ZIP code is.

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MEREDITH WARNER, MD, founded her Baton Rouge Clinic, Warner Orthopedics & Wellness, in April 2013. Having served earlier in the US Air Force as a surgeon and in practice since 2005, Dr. Warner understands how poor diet, stress, lack of restorative sleep, and lack of energy lower the body’s ability to self-repair. The result: prolonged recovery and pain.

An expert in surgical and nonsurgical treatments of orthopedic conditions, Dr. Warner focuses on identifying and treating the root causes of most musculoskeletal/orthopedic problems. Her mission is to help as many people as possible avoid surgery, injections, and other costly treatments through the latest research about diet, natural treatments, and alternative methods to protect and heal the body.

Dr. Warner teaches physicians at Louisiana State University’s Department of Orthopedic Surgery. She is also the inventor of The Healing Sole Footwear and The Well Theory, a breakthrough wellness protocol designed to empower people with the tools they need to treat their pain naturally, improve sleep, and extend their health span.

Well Being Journal adapted the above excerpt from Bone on Bone: An Orthopedic Surgeon’s Guide to Avoiding Surgery and Healing Pain Naturally by Meredith Warner, MD. Copyright © 2024 by Meredith Warner, MD, and reprinted with permission by Benbella Books, Inc.