Surgery or Rehab- What leads to better outcomes?
There are some surgeries that are unavoidable, ruptured appendixes, severe fractures, and organ transplants, to name a few. But many people struggle with the decision between whether to pursue surgery for their joint pains or go to rehab. Research is pointing more and more toward avoiding joint surgeries when possible. In the surgery vs therapy decision, research suggests that we try non-invasive, conservative treatments, like therapy, before going under the knife.
In fact, studies are showing that the following surgeries are NOT as effective as rehab:
- Knee scopes [1]
- Subacromial decompression [2]
- Shoulder scopes [1]
- Back fusion [1][3]
For more info on this topic, you can check out the book Surgery: The Ultimate Placebo. In it, the author, an orthopedic surgeon, breaks down the evidence and research around different popular surgeries and their outcomes.
Here’s a clip of an interview that Rafi Salazar did with the author, Dr. Ian Harris:
Conservative Treatment: Surgery vs Therapy
Chances are you may have had one of these procedures, or know someone who has. These procedures are regularly recommended by orthopedic surgeons and sometimes performed without even trying conservative options first. In most cases, physical therapy will be recommended after the procedure anyways. Whenever possible, be the driver for your own health and well being. Push for more conservative options that could save you tons of time, pain, money and energy. Ask questions about long term success rates, and educate yourself!
Beyond these procedures, there are many gray areas. One of the worst phrases that health practitioners can use in diagnosing patients is “bone on bone”. So many patients hear this phrase and mistakenly believe that PT will make their joints worse, and that surgery is the only option. Targeting some of these common misconceptions about therapy vs. surgery can be hugely beneficial to the way people think about their pain [4]. Another diagnosis many patients believe there is no conservative help for is rotator cuff tears. However, a meta analysis done on rotator cuff repair surgeries showed that conservative treatment is best as the first line of treatment rather than a rotator cuff repair [5].
Do your own research on surgical long-term outcomes vs. conservative treatments on a variety of procedures and click through some of the resources provided below. At the minimum I would recommend a one-time evaluation by a physical therapist to ensure that that pain being experienced isn’t actually from a long standing tendonitis or other musculoskeletal injury. Remember, radiological pictures do not necessarily equal pain. A patient can have moderate arthritis in an x-ray without necessarily experiencing any pain from it. A physical therapist can help diagnose the cause of the pain with specific questions, tests, and palpation of the painful areas.
Summary
The reality in so many cases, is that surgery sounds like a way to avoid possible pain and time commitments of rehabilitation. But orthopedic surgery is almost always followed by physical therapy, and it could be very worthwhile to put in the effort beforehand and possibly avoid a surgery rather than view it as unavoidable. And don’t forget the many risks that come with surgery:
- Infections
- Nerve injuries
- Blood clots
- Severe stiffness
- Swelling which frequently lasts up to 12 weeks
So next time you have a consultation for pain where surgery is recommended, remember to be your own advocate, and give physical therapy a chance to improve your pain and function first. Discuss the options with your doctor and get their insight into your situation and make the best decision for you and your own situation.
And, if you’re in the Augusta area, and want help avoiding surgery, book an appointment online now!
Reference
[1] 3 orthopaedic surgeries that might be doing patients (and their pockets) more harm than good . The Conversation. March 23, 2022. https://theconversation.com/3-orthopaedic-surgeries-that-might-be-doing-patients-and-their-pockets-more-harm-than-good-179370
[2] Effectiveness of Surgical and Postsurgical Interventions for the Subacromial Impingement Syndrome: A Systematic Review. Elsevier. November 2011. https://www.sciencedirect.com/science/article/abs/pii/S0003999311003716
[3] Lumbar spine fusion: what is the evidence? Wiley Online Library. December 5, 2018 https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14120
[4] Misconceptions and the Acceptance of Evidence-based Nonsurgical Interventions for Knee Osteoarthritis. A Qualitative Study, September 2019 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000096/
[5] Surgery or conservative treatment for rotator cuff tear: a meta-analysis. Taylor and Francis Online. July 2016. https://www.tandfonline.com/doi/abs/10.1080/09638288.2016.1198431
