As physiotherapists we have a great relationship and work closely with many surgeons. But despite this, much of what we do is trying to put these guys out of work. When musculoskeletal pain or injury strikes there is a relatively narrow range of treatment options. It often comes down to surgery or physio. And as our understanding of the human body progresses and more research is published, in many situations the case for surgery has diminished. In conditions such as tendinitis, non-specific lower back or neck pain, osteo-arthritis, ligament strains, labral tears and runner’s knee, 20 years ago surgery was routine management, but now they are rarely operated on.
Now when we say ‘put them out of work’ we do it with tongue in cheek as we certainly don’t want to make out that orthopaedic surgery is never a suitable treatment, as for many acute injuries such as fractures, tendon ruptures, joint replacements and more, it can be essential and result in better outcomes than conservative treatment, but the list is continually shrinking. Even in our specialty area of Anterior Cruciate Ligament (ACL) ruptures recent research is showing many people do very well without the operation as we discussed in this blog post.
Surgeons face an ethical test every day consulting patients with an injury where the evidence for surgical intervention is mixed, but they are financially motivated to perform the operation. We tend to have the best relationships with the surgeons who are the least likely to operate. Interestingly there are a few conditions where the case for surgery has grown recently. Shoulder dislocations in young men are one condition where operations are being done sooner as the re-dislocation rates are so high. Conversely with meniscus injuries and osteo-arthritis of the knee the traditional ‘clean up’ operation where the arthroscopy is done to have a looky-looky, trim some loose edges and report back on the state of affair son the inside, has been shown to produce worse results than people who did not have the operation.
Lower back pain management has also seen a big shift away from surgery. Recent studies have shown that in patients with severe pain, surgery can provide some short term relief but -2 years post operation, the people who had surgery were back where they were, and often even worse.
So how to know if your problem is better solved by surgery or conservative management? That’s a tricky one! But feel free to take advantage of our special offer of a free phone consultation with a Physiotherapist to see if physiotherapy could be right for you or not.