Quite literally the million, or even billion, dollar question. When should you have surgery and when should you avoid it like the plague? Physiotherapists and surgeons frequently work together to help people recover from their injuries. But at the heart of this relationship is a conflict. One group of professionals are doing everything they can to stop you needing surgery. The other group are experts in providing that surgery.
In this article we discuss what we think you need to consider before going under the knife. Considerations like: Have you explored all viable alternative treatments? Is your condition one that responds well to surgery? How much do your symptoms affect your life? Are you the kind of person that responds well to surgery? If you’re considering an operation or want to avoid one in the future then read on…
Physio vs Surgery: Who Is This Article For?
Some things quite obviously need surgery. Chances are if you’ve got a broken bone sticking out through your skin you’re unlikely to be reading this article. More likely you’re being rushed in for some much needed surgery. This article is not about this kind of condition.
It’s more about those injuries that haven’t really come from anywhere but just won’t go away and could be causing you quite a lot of pain. A knee pain that came from nowhere. A shoulder that just won’t move like it used to. The low back pain that simply won’t go away.
Maybe you’ve had a scan or perhaps you’re thinking about getting one to try and understand just why you’re getting the pain. Almost hoping to find something on the scan that will explain why you have all this pain.
If you’ve had a scan what did it find? Chances are it found something in Latin and pretty scary sounding. But is your prognosis as bad as you fear? Is what was found for sure the cause of your pain? Or was it more ‘general wear and tear’ or a minor finding like a small disk bulge or mild cartilage degeneration in a joint. I say small finding as many findings traditionally thought to be the cause of much pain have been found in lots of people with no symptoms as this excellent paper here explains.
This article is also aimed at those who have a condition that is traditionally operated on. Cruciate ligament rupture for example. Severe disc bulges. Joint replacements. Generally fixing things in place with screws. Is fixing one bit to another bit with metal really going to make things better? Is there any alternative?
What this article isn’t is questioning surgery when surgery is clearly needed. There are many conditions that absolutely need surgery and that is the best way forward. Here we talk about conditions that perhaps you didn’t know there was an alternative to surgery. This is all based on the latest research and backed up by what we see clinically day in and day out.
We’ll talk you through here the questions we feel you should be asking to determine whether surgery is the right choice for you? Our follow up article will then talk you through in more detail 6 of the most common surgeries which research suggests you may well fare better with physiotherapy alone.
How Severe Are You Symptoms?
If your symptoms are significantly affecting the quality of your life from day to day then that will more likely lean you towards surgery. The inherent risks involved with surgery are very much worth the potential benefit you may receive. If your symptoms aren’t too bad or it’s being done as a precautionary measure I would question the necessity of surgery.
Are you considering surgery for fear of how bad it might get? In which case two things. Firstly, you will still be able to take the surgical option if you’re desperate at a later date. Secondly, have you considered your fear might be adding to your pain? Fear of making things worse is the biggest single determinant in the amount of pain you feel. If your brain fears you might be doing damage it will give you the sensations to go along with that view.
As summed up by the International Association for the Study Of Pain in their definition of pain:
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
We talk more about the intricacies and subtleties of pain in our previous article: Just What Is Pain and How Do I Reduce It?
What Is Your Expected Recovery From Surgery?
Some surgeries have a really quick turnaround time and recovery. Generally the surgeries where they don’t ‘rummage around’ too much have a quicker recovery. Surgeries where they open you up extensively or hack bits off and re-attach things elsewhere generally have much longer recoveries. I appreciate I’m not a surgeon and that is a gross over simplification of what goes on but it’s a decent rule of thumb.
If you have been recommended surgery find out what the expected recuperation time is. Is that acceptable to you? How much will the potential benefits improve your life? How long have you been out of action already? Can you afford to be laid up for a long period again? What is the prognosis for the operation you are considering? Are there any potential complications? What is the surgeon’s success rate?
It’s also worth doing your research. The research keeps us professionals on our toes all the time. To give an example meniscus cartilage issues in knees has for sometime been one of those conditions where surgery is thought to be the best way to go. Generally we attempt physiotherapy recovery and it that doesn’t work then it usually suggests surgery is required.
But here’s a link to an interesting video that questions whether we should have operations on knees for meniscus (cartilage) injuries and osteoarthritis (other type of cartilage). And here’s an excellent summary of the same topic. It has to be said that these are for degenerative conditions. That is, the ones I keep mentioning that come on gradually.
Have You Tried All Other Possible Options Treatment?
Maybe you’ve already tried some conventional physio? Did you do all of the exercises as you were asked? Research suggest between 50-75% of people don’t!
Have you tried alternative forms of physiotherapy like ours for example? We find that when we realign people physically and emotionally magic things start happening. Have you considering focusing on the psychological side of your condition? What’s going on in life? How stressed are you right now? How stressful has your life been? Have you addressed these factors to reduce your sensitisation?
Stress and trauma stay locked in the body physically until released. Either by moving on emotionally or finding a way to release it. Our hands on treatment being one way. Yoga being another. Being more aware of how you move is another again. We find that most of our clients benefit from being made aware of how they move or how they react before they are able to choose a better way.
Obviously if your leg is flapping about in the wind after you’ve just been run over by a car you may consider psychology fairly irrelevant at that moment. And in that moment it is. But how did you get run over by the car? Were you in any way to blame? Were you absolutely concentrating on what you were doing or was your mind wandering onto something that felt more important?
If your accident was a long time ago – let’s say anything over a year – a lot of any residual pain you may feel may well be stored trauma from the original accident. At which point any further operations are unlikely to help.
From a physical perspective what techniques and approaches have you tried to get your injury better? There are countless techniques and approaches within the world of physiotherapy. As a practice we use Muscle Activation, Fascial Alignment, Relaxation Techniques, Corrective Exercises and Stretching, Joint Mobilisation and Sports Massage. If none of those work for you there are lots more practices out there that have a whole range of other options. Try them too!
How Old Are You?
The older you are the longer it takes to heal. Sorry. Don’t shoot the messenger. It’s just the way it is. The good news is that no matter how old we are we can still heal. Factor your age into your decision making process. Now being young at heart always helps (as we discuss in our article: How To Grow Old Disgracefully). This will literally make your recovery better. This is part of a bigger consideration…
What Kind Of Person Are You?
As we alluded to above. If you’re a happy go lucky young at heart type, your response to surgery will be better. If you are more anxious or fearful then you’re the kind of person who might fare a bit worse in terms of recovery. It’s always best to be in the best possible mental state before you have any surgery and discuss any concerns and fears you may have beforehand with your surgeon and / or physiotherapist.
Physiotherapists often talk about prehabilitation. Getting your body in as good a shape as possible before surgery. Make those muscles what will be affected by the surgery strong before they get weaker as a result of recovery from surgery. There is research to suggest that even if you can’t move your leg if your visualise yourself doing strength exercises it will take you less time to get your strength back!
I would say it’s also worth prehabilitating your mind too to get you in the best possible shape before surgery. You may even feel less pain when you do such a thing. How you do that is down to you.
We find that many people get an emotional release from the physical work we do. Helping people to move on emotionally leaving old stress or trauma behind. You may need something a bit more in depth than that like counselling or psychotherapy. Or you may just need nudging in the right direction so you lead a less stressful life, become less sensitive, and therefore feel less pain. Easy to write, more challenging to do.
What Do You Want To Get From Your Body?
Do you need your body to compete at the highest levels of sport? Do you just want to be able to do some recreational exercise? Does the sport you do put you at risk of re-injury? Or will you be able to cope without an operation? Can you modify what you do to reduce the necessity of an operation? If you do change what you do how does that make you feel about your quality of life?
The best example here is the discussion as to whether to have a cruciate ligament reconstruction. If you rupture your cruciate ligament skiing but you’re happy so long as you can run and happy to give up skiing then you’ll more likely be ok without a reconstruction which has an extended rehabilitation period. Whereas if you’re desperate to get out skiing every year again you might be better going through reconstruction surgery.
What Are Your Beliefs?
Whatever you believe you’ll probably be right! If you completely believe in surgery and believe that it will cure all your ills then probably it will. If you’re anxious about surgery and you have doubt about your ability to heal then that will increase the likelihood of your operation remaining sensitive for longer.
My personal belief here is based very specifically on conditions that come on gradually. The kind of things that don’t have a spectacular start point. These are conditions, without wanting to sound too harsh, that we have brought on ourselves. It stands to reason that we have ability to unwind these conditions if it was ourselves who got us there in the first place. If we unwind ourselves and unwind our beliefs we can make ourselves better.
I appreciate the bold statement ‘whatever you believe you’ll probably be right’ may be a bit ‘fluffy’ for some. But there is an increasing body of evidence to back up this statement. Bruce Lipton is at the forefront of this work. I would recommend his seminal book – The Biology Of Belief – to anyone interested. Ideal for the believers in such concepts and those who are still slightly sceptical but willing to keep an open mind and give it a go. Anyone completely closed to off to such ideas probably hasn’t made it this far down the article!
I’ve already hit my maximum amount of words for an article so I’m going to leave it like the end of The Empire Strike Back as a massive cliff hanger. Don’t worry you won’t have to wait 3 years to find out what happens. In fact a review of this article 4 year after it was written means you to click straight to it right now just here. Enjoy!
Conclusion: Physiotherapy vs Surgery
I hope this article has achieved my goal in introducing you to the underlying principles you need to consider when electing for surgery or physiotherapy. It’s hugely important that you get conditions checked out in all ways possible. Get as many experts with as much experience as possible to give you all the information they have and then choose the way forward which feels best for you.
I think traditionally surgery has been performed too frequently. However, times are changing. In my 19 years in the trade I have seen attitudes change and a much more balanced view being taken by conventional medicine as to whether to operate or not.
That said, I still feel more operations are being done than need to be. However, I speak from an area of expertise that isn’t available to conventional medicine. I am also very aware that my experience has been skewed by people who haven’t fared too well from surgery. If their surgery was a complete success why would they pay me money?
My opinion with regard conditions that don’t have a specific start point is much stronger. In my experience these conditions come about from an increase load in the area of pain. This increase load is rarely the fault of the bit that hurts – although it is important to screen for the occasional rare condition.
If we intervene with surgery in these areas that have increase load it only ‘blocks’ the mechanics at this pain point. Even if surgery is successful at reducing or eliminating pain in these areas then the mechanical limitation can just materialise as symptoms elsewhere.
For this reason I encourage anyone considering surgery to try all available options before going under the knife. Of course I’d love that alternative option to be our clinic! But really, anything that takes you fancy or feels a good fit for you. You can try chanting or crystal healing and go as alternative as you want, but please, do try.
If you’d like to speak to us about whether our physiotherapy and sports therapy might be able to help you please fill out the form here to request a call back.