Dubai’s medical tourism relies on healing power of the sun

English Premiership footballer Andy Carroll was flown to Dubai in March for knee surgery rehabilitation, in what was described by West Ham football club as: “Warm weather conditions”. Antonie RobertsoShow more

Dubai is marketing itself as a medical tourism destination, but doctors are divided over whether warm weather can help with a speedy recovery, particularly when it comes to joint pain.

Any tourist who has escaped a cold European winter for a holiday in the UAE will testify to the benefits of short bursts of sunshine on our mental and physical state.

Now doctors are establishing that warm weather could have much wider effects on our health, spelling the end of creaky and painful joints.

That was certainly the case for the English Premiership footballer Andy Carroll, who was flown to Dubai by West Ham United Football Club in March for knee surgery rehabilitation, in what was described by the London club as: “Warm weather conditions”.

In December, Liverpool’s Daniel Sturridge left the cold UK for sunny Los Angeles to undergo rehabilitation after a thigh injury, while National Basketball Association (NBA) player LeBron James was sent to Miami for a week in January, by Cleveland Cavaliers doctors.

Even charities and health groups working with sufferers of chronic pain swear the warm weather can do wonders for discomfort in the joints.

But not everyone agrees. Some doctors say warmer weather has nothing more than a positive psychological effect.

While there is little scientific research on rehabilitation and joint pain in hotter climates, some experts say the results speak for themselves.

“There is no scientific evidence on this – not yet – but it’s something we know,” says Dr Charalampos Harris Zourelidis, a UK-trained orthopaedic surgeon known to his patients as Dr Harris.

“I used to deal with sports injuries in the UK and even comparing weather in the summer and winter, the recovery was faster in the summer time,” says Dr Harris.

“And if I compare my patients there to here, where the weather is nice and they get a chance to go outside, the recovery is faster.”

Warmer weather also provides some relief for patients with chronic joint conditions such as arthritis or chronic tendinopathy, he says, because the joint is “like a barometer for the weather”.

“We have certain receptors in our joints and certain pains can get worse when the weather changes, the pressure changes.”

Most doctors are unsure why weather speeds up recovery from surgery. It is most likely to do with the improved blood circulation, Dr Harris says, but the evidence to prove it has not yet been established.

“When we perform a surgery we remove the cause of the pain but initially we cause damage to the joint. Then there are several phases of recovery.

“First we try to limit the inflammation. For a sports injury we might use ice for one or two weeks.

“The second phase is where the body is trying to repair the damage. At this stage, if you have better circulation it helps. That’s where we can apply the warm weather principle.”

Dubai has set its sights on becoming a medical tourism destination, hoping to attract people from countries including the UK and Russia. If rehabilitation in warm weather helps recovery, it could be a lucrative way of attracting more than just professional sportsmen and women to the country.

Last year the emirate launched the Dubai Medical Tourism Programme, aiming to "be the fastest growing medical tourism destination globally", and to contribute to the city's economic development.

In the same year, Dubai Healthcare City (DHCC) treated about 180,000 medical tourists. More than half of these were from outside the GCC, with a quarter coming from Europe.

Plans are under way to expand services, including rehabilitation.

Dr Harris says the numbers of people needing joint surgery is increasing as we push our bodies farther, and not necessarily in a healthy manner, so rehabilitation centres could do lucrative business.

In his early career in the UK he performed three hip replacement operations for every one knee replacement.

Now it has swung the other way as a generation of “baby boomers” do more short bursts of intense exercise in a gym environment.

This puts excessive strain on the joints if they do not exercise properly. “In the ‘50s no one regularly went to the gym,” he says.

There is also greater pressure on children to exercise, sometimes beyond healthy limits, because sport is seen as a career option, and some parents think “their kids will be champions”.

Dr Harris sees a handful of patients who travel to the UAE for surgery or recovery, and the numbers are growing.

“We get quite a number of patients who work in countries with not so advanced facilities,” he says. “When they plan the surgery they could go to Europe or the US but most prefer to come here. I think it’s now a trend to have rehabilitation in warmer climates.”

Not everyone agrees on the reasons for the trend, and without any sort of controlled studies it is hard for either side to say for sure.

Dr Rami Hamed, another orthopaedic surgeon trained in the UK and working in Dubai, disagrees that climate plays any role in surgery or recovery beyond a possible psychological effect.

“I would love people to come to Dubai because we can provide the same level of care as the UK, but I don’t think warmer or colder weather has any certain effect on the mechanism of the surgery or recovery,” says Dr Hamed.

“What does play a role is a proper diagnosis, proper surgeon and proper timing of surgery. If we have to allow for hot or cold weather to play a role, it would not be more than a 1 per cent effect. I don’t think there is any science behind that.”

The only way to know for sure is to conduct random controlled studies of patients needing the same surgery in different climates, says Dr Hamed, founder of the Dr Rami Hamed Centre in DHCC.

The centre treats many patients who live in East Asia, he says, and a lot of them are British.

“They come for treatment here because of the lack of experience in that part of the world. But what’s missing in western Europe? It’s just a matter of change of scenery, that’s all.”

The US Arthritis Foundation says changes in temperature and barometric pressure trigger joint pain, but researchers “aren’t entirely sure why”.

It gives the example of one study, performed on cadavers, that showed when pressure in the joints is the same as pressure in the atmosphere, the ball of the hip joint moves one-third of an inch off track.

Simon Case, a sports physiotherapist in Abu Dhabi, agrees that warm weather can help joint pains and rehabilitation. But like most of his peers, has no idea why.

“There is definitely improvement with regards to warmer weather and people having operation and arthritis, but to tell you the specifics, there’s nothing hard and fast,” says Mr Case. “It’s a difficult one to study because in a study you’re trying to change and isolate just one element and test it.”

For a scientific study to be accurate, he says, patients would have to undergo the same operation with the same surgeon, under the same conditions, and then be split to have their rehabilitation in warm and cold climates.

“It seems so simple but it’s not,” says Mr Case, co-founder of BounceBack Physiotherapy on Yas Island.

The phenomenon of warm weather equalling less pain is more obvious in the UK, he says, especially when patients return from holidays in sunnier climes.

“The whole time they are away there were no problems at all, then the problem would start as soon as they got back. It was as black and white as that.”

While the growing body of anecdotal evidence is useful, Mr Case says, it is not likely to be life-changing for most people needing joint operations or suffering with chronic arthritis.

The cost of having surgery or rehabilitation in a foreign country is out of most people’s reach.

“Sports teams like West Ham have got the budget to do that,” he says. “If someone suggested, ‘Hey, why don’t we sent him here, there, anywhere, and it might take three or four days off his rehabilitation’, he is an investment for them so they will do it.

“If money is no object and you don’t have commitments, and being in a hot country makes it 1 per cent better, why not?”