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 best physiotherapy treatment involves optimising each stage of the healing process, correcting the way you move, graduated strengthening, and correction of compensatory strategies. A physiotherapist will also retrain the order that your muscles contract when you’re doing day to day activities to ensure your joints are stable and your movements aren’t causing you pain. This will also prevent injuries and pain further down the track. Ultimately whether or not you go under the knife is determined by the severity of the injury, the physical demands on the person and the outcome of physiotherapy management (if conservative management has been attempted first). Physiotherapy is often a crucial part of a successful post-operative outcome.
On the other hand, there are many cases where surgery could be the only effective treatment approach.
So what Questions should I ask my Surgeon when deciding if surgery is the best option?
- Why is this procedure being recommended? Are there alternatives?
- Could physiotherapy (conservative management) be beneficial for me instead?
- Could you please compare conservative versus surgical outcomes for me?
- What are the benefits of this procedure in terms of pain relief and functioning/mobility?
- How long will the benefit last?
- What are the risks involved?
- What is the success rate for this procedure?
- What is the procedure called and how is it done?
- Will this surgery solve the problem? Will any more surgery be required in the future?
- What will happen if I don’t have surgery now?
- If I want a second opinion, whom can I consult?
- How long will the recovery take? What are my limitations during recovery? Will I need assistance at home? Will I need physiotherapy?
- Are there any materials about this surgery that I can review?
- What are the costs of this operation?
Having these questions ready at your next consultation will make it easier for you to make a well-informed decision. Your specialist should explain the benefits and risks of your options and ultimately facilitate your decision-making process.
If conservative management is suitable for you, a physiotherapist can help you achieve your goals and decrease your pain without having to undergo a painful and expensive surgical procedure. If surgery is the best choice for you, a physiotherapist can help maximise the outcomes of your surgical procedure after your operation and get you back to the activities you love faster.
If you would like expert advice in weighing up treatment options for you, visit any of our Physiotherapists for valuable advice today.
Contact our friendly staff on 47240768
Brianna O’Toole Physiotherapist