When you’re hit with an injury or chronic pain, the thought of a potential surgery can feel like a cloud looming overhead. Nobody looks forward to the recovery period that can pause life for a period of time, as well as the potential for complications.
One of the advantages of physical therapy that we always bring up to our patients is physical therapy’s potential to avoid surgeries altogether. Though nothing is a guarantee, it’s a story we hear over and over:
Physical therapy can prevent the need for surgery by strengthening muscles, stabilizing joints, and reducing pain to promote natural recovery. It enhances movement patterns and circulation, aiding in regaining function without operations. However, it’s not always enough; certain injuries still require surgical care.
In this article, we’ll discuss how physical therapy can help you potentially avoid surgeries, when it’s time to consider surgery as an option, and how to know the difference.
How Physical Therapy Works to Prevent Surgery
Though there are limits to what we can accomplish in physical therapy, it’s common for many physical therapy interventions to reverse conditions to the point that they no longer need surgery, or are no longer heading in the direction of a surgical procedure.
We do this by strengthening and stabilizing weak muscles or unstable joints, restoring lost mobility in injured areas, and correcting biomechanical patterns that may have been the root cause of the pain in the first place.
This non-invasive and more holistic approach to pain management allows us to rehabilitate areas that have sometimes been generating pain in a particular patient for weeks, months, or even years at a time.
The downside? Physical therapy isn’t a one-stop fix. In order for a physical therapy treatment plan to work, patients generally need to commit to at least 2-3 appointments per week for 2-3 months at a time, in tandem with a self-directed home exercise program provided by your therapist.
When Physical Therapy May Not Be Enough
While PT is highly effective for avoiding more invasive procedures, it’s not a universal solution. Some injuries or conditions require surgery due to their severity or nature. One of the things we always try to be cognizant of as therapists is to recognize when a patient is better off having a surgical intervention before returning to our services later.
Here are scenarios where surgery might be the better option:
- Severe Structural Damage: Complete tendon ruptures, large joint dislocations, or significant cartilage loss often require surgical repair to restore function. For instance, a fully torn ACL in the knee rarely heals without surgery, especially for active individuals.
- Progressive Neurological Symptoms: Conditions like severe spinal disc herniations causing numbness, weakness, or loss of bladder control may require urgent surgery to prevent permanent nerve damage.
- Failed Conservative Treatment: If PT and other non-surgical treatments (e.g., injections or medications) fail to improve symptoms after several months, surgery may be necessary. For example, chronic rotator cuff tears that don’t respond to PT may need arthroscopic repair.
- Acute Trauma: Fractures or major ligament tears from accidents often need surgical fixation to promote healing and alignment.
Consulting with a healthcare team, including a good physical therapist and orthopedic specialist, is essential to determine the best course of action. Imaging (e.g., MRI or X-rays) and clinical assessments can help clarify whether PT can suffice or if surgery is unavoidable.
How to Know the Difference
Deciding between PT and surgery involves a combination of medical evaluation, personal goals, and lifestyle considerations. Here are steps to help you navigate your treatment options:
- Get a Thorough Diagnosis: Work with your doctor or specialist to understand the extent of your injury or condition. Ask about the likelihood of PT resolving your issue versus the necessity of surgery.
- Commit to a PT Trial: For many conditions, trying physical therapy before surgery is recommended to assess its effectiveness. Track symptoms like pain, mobility, and function to gauge progress.
- Evaluate Your Lifestyle: Consider your activity level and goals. Athletes or highly active individuals may opt for surgery for faster recovery in cases like ligament tears, while others may prioritize PT to avoid surgical risks.
- Monitor Symptoms: If pain or dysfunction persists or worsens despite PT, discuss surgical options with your healthcare provider. Conversely, if PT significantly improves your condition, surgery may not be needed.
- Seek a Second Opinion: If you’re unsure about surgery, consult another specialist or therapist to confirm the recommendation. Different perspectives can clarify the best path forward.
When surgery might be the best option: Signs to look for
- Persistent or Worsening Pain Despite Consistent Effort: If you’ve been diligent with physical therapy—weeks or months of exercises, stretches, and sessions—and the pain persists or worsens, it could mean the damage is too severe for therapy alone. Pain that doesn’t improve might signal structural issues (like bone-on-bone arthritis) that physical therapy can help with pain management but not reverse.
- Mechanical Symptoms Like Locking or Catching: When a joint “locks up” or won’t move fully—like your knee sticking mid-step—it’s often a sign of something physically blocking normal motion. A loose cartilage flap from a severe meniscus tear or a torn labrum in the shoulder might require surgery to clear the block.
- Numbness, Tingling, or Weakness Spreading: Neurological symptoms—like your leg going numb, pins-and-needles down your arm, or muscles weakening despite therapy—could indicate nerve compression or damage that’s worsening. A herniated disc pressing on spinal nerves or a pinched nerve in the neck might need surgical decompression if therapy can’t relieve the pressure.
Pushing physical therapy past its limit can delay healing or worsen things—like allowing a tear to grow or a nerve to become permanently pinched. On the flip side, surgery isn’t always urgent; sometimes, physical therapy buys time or prepares you for a better outcome if surgery becomes necessary.
If you’re experiencing any of these symptoms or are concerned about a chronic condition, always contact a healthcare professional for a second opinion.
Getting the Right Care for You
Sometimes, the answer is both. Physical therapy vs surgery can be a daunting decision to make without weighing out all of the options on both sides. Physical therapists and surgeons often work hand in hand to ensure the best outcome.
We suggest starting with an assessment from a skilled physical therapist near you to help guide you in making the right decision. From there, they’ll offer professional recommendations on the next steps. They might want to observe how your body responds to exercises over time, or they may suggest it’s time to consult a surgeon for another opinion. Either way, having someone work closely with you ensures your needs are met and provides realistic answers to your concerns.
