It’s been three months, and no change. You go for your regular runs after work. You know, the same ones that help you deal with work, life, and stress. And no matter where you run, whether it’s Trinity Bellwood, Harbourfront, or High Park, the pain doesn’t seem to go away. You pay a visit to your family doctor, and after further inspection, X-rays, he comes and offers surgery as a solution. The pain is annoying, but you never fathomed SURGERY!! However, now that it’s on the table, should you do it? More importantly, is there an alternative?
This may sound VERY biased, but have tried physiotherapy? I know it’s not surprising that someone in physiotherapy is promoting physiotherapy but before you stop reading, let me tell you what the science is saying, because I promise you, it is eye opening.
A group of scientists looked at individuals with knee osteoarthritis and partial meniscus tears. Osteoarthritis is common among weight-bearing joints and joints that are overused as a result of wear and tear across decades. The meniscus in the knees acts as shock absorbers, among other things, and can be damaged by forceful twisting of the knee. However, parts of the meniscus have poor blood supply which means recovery potential is low. As a result, these candidates were separated in two groups, one group that underwent surgery for the meniscus and a physiotherapy program and the other group solely took part in a physiotherapy program. What they found was that the improvement seen among candidates in both groups after 6 months and 12 months with regards to their pain and function was the same (Katz et al., 2013). In other words, physiotherapy was just as effective as surgery. Moreover, this study raised questions on whether surgery was beneficial for recovery or whether it was a placebo. In other words, did the shear expectation of getting better after surgery dictate the recovery of these individuals?
Astonishingly, it seems to be the case. Individuals with knee osteoarthritis and meniscus tears were separated into a group where surgery was to be performed followed by an exercise program and another group where sham surgery was performed with an exercise program as well. Sham surgery is meant to simulate actual surgery without performing the surgery itself. This way, candidates could not be sure if they were in the surgery group or the sham surgery group. The results showed that surgery was not more effective than sham surgery with regards to recovery (Sihvonen et al., 2013). Moreover, this highlights the amazing beast that is the human mind. Just the shear belief and expectation of getting better from surgery or a treatment can heavily influence an individual’s recovery.
Overall, this blog is not meant to dissuade you on all things orthopedic surgery. In fact, for full tears of muscles, tendons, and certain bone fractures, it may be necessary. Rather, it is to empower you in your decision making. If you feel like surgery is too invasive, I encourage you to seek out physiotherapy as a great alternative which can be just as effective, less costly, and with less chances of complications. But whether you go with surgery or physiotherapy, I implore you to have a positive outlook on your recovery as this can make or break your recovery regardless of which road you decide to take.
Key takeaways:
- Physical therapy is just as effective as certain orthopedic surgeries in improving physical function and reducing pain
- Some knee procedures are not more effective than sham surgery
- Belief and expectation of recovery is powerful regardless of treatment
By: Nirushan Guruparan- Physiotherapy Resident
Citations:
- Katz, J. N., Brophy, R. H., Chaisson, C. E., De Chaves, L., Cole, B. J., Dahm, D. L., … & Levy, B. A. (2013). Surgery versus physical therapy for a meniscal tear and osteoarthritis. New England Journal of Medicine, 368(18), 1675-1684.
- Magee, D. J. (2013). Orthopedic physical assessment. Elsevier Health Sciences.
- Sihvonen, R., Paavola, M., Malmivaara, A., Itälä, A., Joukainen, A., Nurmi, H., … & Järvinen, T. L. (2013). Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. New England Journal of Medicine, 369(26), 2515-2524.