I constantly get asked this one question by new patients, “Do you think I need surgery?”. The answer to that question can sometimes be very loaded due to multiple factors, but from a research standpoint surgery is being shown to not be needed as often as we think. This was issue came to forefront of many conversations this past year when elective surgeries were cancelled across the US. When looking through the research in preparation for this blog post I found that the research was estimating that 10% to 20% of surgeries might be unnecessary and that in some specialties such as cardiology and orthopedics, that number might be higher. The reasons for so many unneeded surgeries being performed are varied, but the most common are that more conservative options aren't tried first, or lack of knowledge by the operating physician. Back Pain happens to be number #1 on this list. For more information on that topic please check out last months blog post.
Physicians undergo long and rigorous training programs to become surgeons, but if they don't work hard to keep learning, their knowledge often stops growing when they leave residency. Recent research is showing that certain common surgeries aren't any better than a placebo. Two such examples are kyphoplasty - a procedure for spinal compression fractures, and partial meniscectomy - a procedure used to treat tears of the meniscus in the knee. If a surgeon hasn't continued to learn, they won't know that these surgeries often don't offer any more benefit than a non-surgical treatment and will continue to perform them.
Every surgery, even "minor" ones carry risks. These include complications from anesthesia, blood clots after surgery, delayed healing of the incision, infection, and unintended damage to nerves or other organs near the surgical site. Some of these risks cause discomfort for a period after surgery and go away, but others can result in permanent disability or even death. For some patients and conditions, surgery is a great treatment option, but with all the associated risks, when surgery can be avoided, it should be.
For musculoskeletal problems like back and joint pain, sprains, and strains, seeing your PT before a surgeon can help keep you out of the operating room and get you back to life without surgery. Studies have shown that physical therapy is just as good if not better than surgery for a multitude of conditions and carries less risk. Some examples would include rotator cuff tears, meniscal tears, spinal stenosis, low back pain, and osteoarthritis.
Physical therapy can't fix every problem, and for some patient’s surgery is the best choice. However, research is showing that surgery isn't a cure-all, and is sometimes just a very expensive and risky placebo. In most cases, starting with physical therapy is the right choice, and for many patient’s PT is the only treatment necessary.