Weighing up conservative versus surgical approach to therapy for musculo-skeletal injuries
It is most likely not a question of ‘if’ but ‘when’ we will experience a musculoskeletal injury in our lifetime. Sometimes it is quite clear to us whether we need physiotherapy or surgery, such as a mild ankle sprain versus a complete anterior cruciate ligament (ACL) rupture. However, often times it isn’t so clear cut.
What is Orthopaedic Surgery
Orthopaedic surgery is performed by a medical specialist trained to deal with problems that develop in the bones, joint and ligaments, and sometimes in the nervous system. The goal of treatment is to relieve pain and restore function.
What do we mean by ‘Conservative Management’ (involving physiotherapy)?
Physiotherapy is a clinical health science which involves assessing, diagnosing and treating through physical means to minimise pain and restore function. A physiotherapist will assess the stability of your joints (and/or stiffness), your flexibility and look at the way you move. They will then give you exercises to improve the way you move, to offload painful joints, mobilise stiff/painful joints, improve your stability with exercise prescription and give you tips for pain relief.
When both approaches aim to minimise pain and restore function it becomes quite difficult to determine which approach is best for you.
Is Surgery a ‘Quick Fix’?
In some cases, the ‘quick surgical fix’ is not always the best way to go, and certainly not always the quickest. Post-surgery there is often a long recovery process involving physiotherapy to restrengthen muscles, facilitate motor relearning (your brain will have to ‘relearn’ how and when to activate certain muscles), and fix any compensation strategies your body has adopted as a result of your injury. Multiple studies now indicate that physiotherapy can have equal or more effective outcomes than surgery without the risks or the costs.
The cortisone injection debate: Pros and Cons
Imagine you are two weeks out from the local triathlon festival and your shoulder has progressively worsened. You hear of a ‘miracle treatment’ called the corticosteroid injection (or ‘cortisone shot’) and naturally you are drawn towards the proclaimed fast and effective results. However, there is a saying ‘if it seems too good to be true, it probably is’. This saying can in many ways apply to the uneducated and inappropriate administration of the corticosteroid injection for many musculoskeletal conditions. While this medicine has been widely used to treat inflammatory pain since the 1950s, it is worthwhile being familiar with the pros and cons of corticosteroid injections to help dictate your decision.
What is a corticosteroid/cortisone injection?
Corticosteroids are medicines that mimic your body’s natural corticosteroid hormones (cortisone and hydrocortisone) produced by the adrenal glands above your kidneys. They are not the same as anabolic steroids sometimes misused by athletes and body builders, and they don’t increase your muscle strength.
Corticosteroids that are used appropriately can help a variety of conditions such as arthritis and common sports-related injuries, including:
- Tennis elbow
- Golfers elbow
- Bursitis of the hip, knee or shoulder
- Frozen shoulder
- Plantar fasciitis
- Carpal tunnel syndrome
- Herniated disc
- Rotator cuff injury
In some cases, they can reduce inflammation, relieve pain, and improve function for up to several weeks or even months. When cortisone injections work, they work really well. Still sounds like a miracle right? However, many studies have drawn attention to the common side effects, and the detrimental and failed outcomes that can result from cortisone shots.
Studies have found that people who had corticosteroid injections for tennis elbow had significantly less pain in the short term than those who had no treatment. However, they had much lower rate of full recovery six to 12 months down the track and a significantly higher rate of relapse. It is because of these statistics that many health professionals are concerned that reducing inflammation might mask serious injury. Studies have shown that high concentrations of cortisone or repetitive use can lead to tissue damage, which can lead to softening of cartilage in joints and/or weakening of tendons.