Can Physical Therapy Help Me Avoid Surgery?
If you suffer from shoulder, knee or low back pain, it depends on a few things.
“Physical therapists are experts in assessing a multitude of body systems, including the musculoskeletal and neurological systems. The scope of physical therapy (PT) is quite diverse and comprehensive, with the goal of restoring movement, function, and quality of life,” says Dr. Marlon Pereira, a dual board-certified orthopedic and sports specialist with the University of Miami Health System.
According to Dr. Pereira, some insurance companies even deny MRI tests until the patient tries PT. “This demonstrates growing awareness that PT can have significant value in improving a patient’s condition and quality of life and may yield cost savings over more expensive procedures.” Even if you ultimately need surgery, PT improves the strength and mobility of your body, which ensures a better postoperative outcome.
Physical therapy may help you avoid surgery for:
Rotator cuff tears
Small to medium size tears typically respond well to PT, though this depends on your age, medical history, and the tear’s location and severity. An orthopedic surgeon will discuss your treatment options or refer you to a physical therapist. If you have a large rotator cuff tear or diagnostic imaging reveals a possible retracted tendon, you are less likely to respond to therapy.
A 2016 review of medical literature noted that conservative treatment such as ongoing exercise rehabilitation for rotator cuff tears is effective in 73-80 percent of patients, especially older patients.
"Nearly everyone over 50 will have signs of degenerative arthritis in most joints. Fortunately, this can be managed with PT. Placing weight and movement through a joint helps provide nutrients to maintain joint cartilage health. Without weight and movement, the joint becomes more arthritic and falls apart at a much faster rate.”
Talk to your doctor if arthritis begins to affect your daily life, or if you develop any of the following:
- A severe deformity
- Excessive fluid in your knee joint that won't resolve
- Imaging reveals bone-on-bone contact
Unless the tear causes your knee to lock or catch, meniscal tears improve with physical therapy. However, the size, location, and severity of the tear can determine whether you need surgery. “Meniscal tears are quite complex. If they occur in the outer third (of the knee) where the blood supply is good, they can heal. If the tears involve other portions of the meniscus, such as the posterior horn or they are large radial or complex tears, they will probably need surgical intervention. Some people require exploratory surgery to determine the size and location of the tears.” Meet with a surgeon and get an MRI to see if your condition will benefit from PT.
In a 2013 study of 351 patients with meniscal tears and osteoarthritis, half received physical therapy while the other half underwent surgery. The researchers didn’t find any significant differences in those who received physical therapy alone and those who had surgery. However, 30 percent of the PT patients did end up having surgery within six months. A 2017 review stated that arthroscopic surgery for degenerative knee disease (including arthritis and meniscal tears) did not give lasting pain relief or improved function.
Based on their findings, the reviewers advised against arthroscopy for most patients with degenerative, or progressively getting worse, knee disease.
Spinal stenosis is a degenerative disease that causes narrowing of the space between the bones in your back, your vertebrae, which may create pressure on spinal nerves in the low back and/or on the spinal cord in the neck and upper back. It is usually managed with physical therapy to keep your spine flexible and strong. Your neurological symptoms also need to be monitored at the same time, especially if you’re older and have neck pain. “Once signs of nerve compression become evident, a surgical consultation is warranted, especially if it hinders your ability to perform daily tasks, especially standing, walking and fine motor activity.”
A 2013 study found no major difference in outcomes between patients who had surgery for degenerative disc disease and those who chose physical therapy instead.
Pursuing Physical Therapy
Finally, if you want to try physical therapy, ask your doctor. “There are so many variables that go into the process of recommending PT or surgery. It needs to be assessed on a case by case basis.” If you are referred, Dr. Pereira suggests discussing your condition, treatment options, and prognosis with your therapist. “If we can’t help or you need a surgeon, we can facilitate that process. Your therapist and doctor make a great team and will answer any questions you may have.”
Nancy Moreland is a contributing writer for UMiami Health News. She has written for several major health care systems and the Centers for Disease Control and Prevention. Her writing also appears in the Chicago Tribune.