Why is my Doctor recommending I try physical therapy before resorting to surgery?
Every case is different due to not only the nature of injuries and the variability in how they can be sustained but also in the history of each person. Genetics, lifestyle, hobbies, and past injuries play into each person’s state of health. In some cases, with high severity or unresponsive to conservative treatments, the initial recommendation may be surgical consult. A surgical consultation can even reveal options other than surgery such as injections, braces, assistive devices, or epidural. In situations where other treatments have not been attempted, the injury is acute, or diagnosis is unclear many primary physicians will suggest trying physical therapy. X-rays may be performed in the case that fracture, arthritis, or possible break could be suspected.
Many times, Magnetic resonance imaging is not the first imaging to be performed and may even be required by health insurance to be performed only after physical therapy or other conservative treatment has been attempted. Part of the reasoning for this is that MRI is a very expensive imaging tool, not only for running the machine but to have a professional reading of results. But be aware it is not just cost that limits the immediate jump to performing MRI. There is also the fact that for as expensive of imaging as MRI is, evidence and experience have shown that MRI can be inconclusive to diagnosis or even that after round of physical therapy/ proper expanse of time many issues can clear up on their own. When injuries are acute, they can be particularly painful but given time and rest the body works to heal itself and it may be found that symptoms greatly reduce or completely disappear. Cases can occur of MRI showing no abnormal results or even only mild inflammation despite symptoms and pain, but there is also the fact that an MRI can reveal conditions in the body that can be normal or asymptomatic such as a bulging disc or normal wear and tear of aging such as arthritis.
Despite not having a clear diagnosis such as imaging, physical therapy can still prove beneficial. A physical therapist upon initial evaluation will take measurements for range of motion and manual muscle testing to determine if someone has limitations that could contribute or be due to certain conditions. Additionally, Physical Therapists are trained to perform special tests that can be indicative of certain conditions. At your initial evaluation, your Physical Therapist will make a diagnosis and a plan of care in order to regain strength, mobility, and function.
Why would I do physical therapy following surgery?
Despite the great effort of surgeons and the treatments, they perform there is not always a guarantee of full recovery or complete dismissal of pain with surgery alone. Physical therapy can work to help the surgical recipient work through the pain and regain function. Additionally, many times surgery is performed with the goal that therapy will help maintain and progress strength/range of motion/function during the recovery phase. Some surgeries require precautions such as a brace or sling, limited active motion, or completely prohibited use of a limb. For example, following a rotator cuff repair a sling is worn roughly 6 weeks and active motion or use of the arm is not allowed, this is because the repair needs time to solidify. While the active range and use of the arm shouldn’t be performed, your physical therapist will move the arm for you in order to maintain the flexibility in the shoulder. This process is necessary so that the arm is not “locked up” upon the phase of recovery where active motion is being re-established. Another example of a common surgery that typically requires physical therapy following is a total knee replacement. Following a total knee replacement, there is quite a bit of swelling, pain, stiffness, and weakness; A physical therapist will help maintain and progress the range of motion of the knee, begin gentle strengthening, and over the course of recovery help the patient regain strength/function of the lower extremity. Working with a physical therapist can also include adjusting back to walking without an assistive device or lesser assistive devices such as from walker to cane or from a cane to unassisted walking.
Whether or not you choose to have surgery is between you and your physician. The best you can do for yourself is research your condition, keep an open mind to your Doctor’s recommendations, and give your best effort to any and all treatments suggested. If you do Physical therapy expect that you will not have instantaneous results. With Physical therapy, a home exercise program will be assigned for you to perform daily and it is important that this is performed. The home exercise program is the foundation of your recovery and if all you do is the activities within the clinic for therapy, you are ultimately limiting your own success. If you end up requiring surgery, research the surgery and learn about the process it will take to recover. Pain and the sometimes-arduous journey of recovery can make you feel isolated, but you must remember that you are not alone and that many people have gone through and will go through these same issues. There is always hope.
Content provided by Lauren Cahn, CPTA
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