Before agreeing to surgery for a muscle, joint or ligament problem, ask your surgeon why it is recommended, what the alternatives are (including physiotherapy), what the risks, costs and recovery involve, and what is likely to happen if you wait. For some injuries physiotherapy is a reasonable first option, while for others surgery is the better choice.
Having surgery can seem like a scary concept, especially when thinking about the procedure itself. There are lots of things to weigh up in deciding to have your injury treated surgically. But is surgery going to be the best option for you and what questions should you be asking?
Weighing up conservative vs surgical treatment for musculoskeletal 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 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, joints and ligaments, and sometimes in the nervous system. The goal of treatment is to reduce pain and improve 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 reduce pain and improve 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 reduce pain and improve 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 change any compensation strategies your body has adopted as a result of your injury. For some conditions, studies have found that a structured exercise and physiotherapy program can give results similar to surgery, so it is worth asking whether this is an option for you.
Good physiotherapy treatment involves supporting 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 help your joints feel stable and your movements more comfortable. This can also help reduce the risk of injury 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 work towards your goals and reduce your pain without surgery. If surgery is the best choice for you, a physiotherapist can help you get the most out of your recovery after your operation and get back to the activities you love.
