When to Try Physical Therapy Before Surgery
If you have an orthopedic condition, experts say you should try physical therapy first.
Lindsey Plass grew up playing competitive soccer, volleyball, and basketball. She was well-acquainted with minor injuries, aches, and pains. After she started running at 26, she was diagnosed with femoroacetabular impingement syndrome (F.A.I.). This is a common hip condition that can develop in puberty, but may not cause pain until later life.
Dr. Plass, a physical therapist wanted to look at all options and met with a surgeon. He recommended a hip replacement. She said that he told her that he wouldn't be capable of running marathons again if he didn't perform the procedure.
Dr. Plass was aware of the uncertainty surrounding which patients would benefit from the surgery. She decided to stop running after consulting with a friend and to undergo a targeted physical therapy program for her hip to strengthen it. Slowly, she returned to running and eventually began to do triathlons and marathons.
Orthopedic surgery is a revolutionary treatment for many common injuries. It can even change your life. Experts worry that popular surgeries can be overprescribed and ineffective, when physical therapy may actually be the best option.
Dr. David M. Matusz is a Manhattan-based spinal surgeon who said, "Once you have determined that the condition isn’t serious and urgently needs attention, then your first line should be P.T." It will work in most cases.
It is important to be informed when deciding whether to begin with physical therapy or surgery. Patients must have the facts in order to make an informed decision. This is what you should do if you find yourself in this situation.
Opting for surgery, or P.T.
Experts believe that there is a long history of health care providers opting for a'surgery-first' approach to treating patients, especially when it comes to common spine surgeries, such as those to relieve back pain, meniscus repair, and certain hip surgeries.
Chris Johnson, a Seattle physical therapist, said that this is the "find it, fix It" or biomedical model of pain. This model suggests that pain is primarily caused by tissue dysfunction or tissue damage, and can be treated surgically.
Many providers also have financial incentives from insurance companies to refer patients for surgery. A total of 750,000 Americans are treated for simple meniscus tear each year at a cost of around $3 billion. However, an international panel voted against the procedure in 2017.
Dr. Johnson stated that the health care system doesn't always focus on proactive approaches like P.T. It can be difficult to work within this system.
Additionally, the United States sometimes allows surgeries to be offered to the public before clinical trials are completed. Unlike pharmaceutical drugs, surgery is not approved or regulated by any state agency. It can take up to a decade for U.S. research into the effectiveness of surgery to catch up.
Surgery may be the only option in some cases. This is especially true if the injury is severe and causes a tendon or ligament rupture. Dr. Johnson said, "Say you are skiing and fall and feel a popping in your knee. That's likely to be a case of surgery." There are occasions when you will need to have an emergency doctor on the scene immediately.
Other cases may require less invasive physical therapy. In these cases, the results can be comparable to, or even better. Meniscus tears are a common problem in knee injuries. There is increasing evidence that surgery to repair a torn meniscus does not provide any more benefit than physical therapy to strengthen the surrounding tissues and promote healing.
The surgery can also accelerate the onset of osteoarthritis and increase the chance of other conditions such as staph infection. An international panel voted against the surgery in 2017 and urged physical therapy and other conservative treatments, such as lifestyle and activity modification.
On average, Dr. Matusz only sees about a dozen patients per day. The majority of them are sent to physical therapy and not the operating room. This represents a shift in his practice over the past 18 years.
He said, "People find it startling that I'm a doctor." "But most of the patients my partners see don't require a surgical intervention," he said. They require P.T.
How do you decide which approach is best for you?
Find the best specialist for you and your body, then collect all relevant information and options. Discuss with your doctor whether the injury occurred due to a traumatic event or if it is a chronic issue such as strength imbalances or age-related changes.
Ask your doctor questions if you are considering surgery. Dr. Johnson stated that they should be able to understand your life and goals. Learn if you have an isolated injury like a tear to your A.C.L. or multiple injuries such as a few ligaments or your meniscus. Surgery might be the best option in these cases.
Your doctor and you should discuss your activity and age before you approve surgery. A 20-year old Division 1 soccer player with an A.C.L. For example, a 20-year-old Division 1 soccer player with an A.C.L. might need a repair so they can return to the field at or close to 100 percent. For a 50-year-old runner, however, it is possible to avoid it by regaining enough stability via P.T. Because it is easier on the knee, this will allow them to return their sport.
According to Dr. Allison Fillar of MedStar Health, not all injuries are the same. Surgery is necessary in these cases. However, P.T. can be used to treat other meniscus tears. She said that P.T. alone is possible to work.
Dr. Johnson advised that if you're leaning towards P.T. you should ask for a complete battery of medical tests from your doctor or physical therapist. These tests could include functional assessments of the injured joint and strength tests. You might also need to have performance tests that include movements such as jumps, push-ups, calf raises, and more.
Different physical therapists have different approaches if you choose to pursue physical therapy. Dr. Matusz stated that what works for one patient may not work for another. "Sometimes, I will even switch P.T.s with patients if they are not getting the results they desire before we proceed to surgery.
Dr. Matusz believes that even if you do end up in an operating room, physical therapy is a better option than having tried it once. He said, "By the time that you have to go under the knife for surgery, whether it's for the spine or another reason, it should be your last resort."
Amanda Loudin is an independent writer who covers science and health. Her writing has been published in the Washington Post and Outside, among other publications.