September 15, 2013 by inspiritpt
This posting is a great example of how medical practice must change in this country. We have become so easy to convince that surgery is “easy and quick” especially compared to 8 weeks of therapy or other conservative management. But surgery is expensive and the cost of the procedure is just the beginning—there’s time off from work, extra expenses, follow ups and even therapy AFTER the procedure if it doesn’t turn out perfectly. We see this frequently in the clinic—people need treatment after surgery anyway. And this is true for all surgeries: back surgeries, knee scopes, Carpal Tunnel releases and bladder slings and hysterectomies often fail to give the desired results and patients require therapy anyway.
Now don’t get me wrong—sometime surgery is the best way to fix an injury or improve function. There are times we try therapy and then say, “Well I guess surgery IS necessary” But there is still a benefit to doing therapy before surgery—more range of motion, more strength, healthier tissues and a lot of knowledge about the surgery and what to expect afterwards. Both your body and your mind will be better prepared for a procedure with even 2-3 therapy sessions beforehand.
I encourage everyone to ask questions about alternatives to surgery. Ask if therapy is beneficial. Your surgeon may discourage it because he/she doesn’t know what therapy might do for you or because they know they could help you, so call a local physical therapist (make sure you talk to an actual therapist, not a receptionist!) and ask them what therapy could do for you before surgery—besides save you thousands of dollars!
A new study reveals that physical therapy can be just as effective as knee surgery to treat a torn meniscus. The federally funded study compared arthroscopic surgery with physical therapy as a means of treating a torn meniscus, and researchers at seven major universities and orthopedic surgery centers in the United States assigned 351 people with arthritis and meniscus tears to get one of the two treatments. The physical therapy program was nine sessions, on average, and included at-home exercises.
Patients given standardized physical therapy had the option of “crossing over” to surgery if significant improvements were not achieved.
The results of the study showed that after 6 months, both groups had similar rates of functional improvement, and pain scores were similar as well. In addition, the results indicated that 30% of patients assigned to the physical therapy group elected to have surgery before the 6-month study period was up, though they ended up with the same outcome as those who did not get the surgery right away.
Rachelle Buchbinder, PhD, a preventive medicine expert, states that the study’s results should change practice. Buchbinder concludes that therapy “is a reasonable first strategy, with surgery reserved for the minority who don’t have improvement.” In the accompanying editorial written by Buchbinder, she also writes, “Millions of people are being exposed to potential risks associated with a treatment that may or may not offer specific benefit, and the costs are substantial.”
Jeffrey Katz, MD, one the lead authors of the study, adds that both surgery and PT are good choices, but “It would be quite reasonable to try physical therapy first because the chances are quite good that you’ll do quite well.”
[Source: New England Journal of Medicine]