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Physical Therapy versus Surgery

Physical Therapist and Woman Scaled

Conservative Pain Management May Be Your Best Option

Recent studies in the British Medical Journal and the New England Journal of Medicine highlight physical therapy as being a viable option to surgery to improve pain symptoms related to sciatica and a myriad of knee injuries. Physicians encourage patients to consider conservative pain management first before undergoing surgery.

The benefits of surgery and physical therapy for treating sciatica are typically the same according to a study published in the British Medical Journal. Sciatica is the pain that spreads along the path of the sciatic nerve. The sciatic nerve branches from your lower back through your hips and buttocks, and down each leg.

In some cases, sciatica resolves quickly, but in others, it may linger. In the study, patients were split into two groups. A group that chose surgery and a group that opted for physical therapy. The group that underwent surgery had short-term relief, but by month six the improvement was the same as those who participated in physical therapy only.

Physicians advise that surgery is not the only option to reduce sciatica symptoms. In fact, Dr. Pens who’s identified in the British Medical Journal study, states, “Patients should be aware that surgery is not the only option to reduce the symptoms of sciatica. All aspects of conservative management should be exhausted before considering surgery as a treatment option.”  The study concludes that well-informed patients should consider other options besides surgery to relieve sciatica, since surgery’s early benefits are gone by month six.

The results of this study, and others, further suggest that expensive treatments for low back pain are not necessarily the best options. In fact, less expensive conservative options such as physical therapy may be preferred. These physical therapy treatments include hands-on physical therapy to mobilize the spine, and exercises designed to alleviate low back pain and/or address prevention of reoccurrences. Physical therapists should be consulted for these options.

Furthermore, Dr. Edward Laskowski, co-director of the Mayo Clinic Sports Medicine Center in Rochester, Minnesota, indicates many types of knee injuries tend to be treatable without surgery, including MCL, PCL, and cartilage tears. However, Laskowski says ACLs, once torn, don’t knit back together very well, so if you play aggressive, high-impact sports such as football, reconstruction may be the better option. Yet, he further states, “But even if you’re an avid swimmer or cyclist, you might do fine without surgery, since those sports don’t require as much ACL use”.  Therefore, physical therapists should be consulted and conservative pain management should be explored as a viable option to surgery when optimal to do so.

Additionally, the study from the New England Journal of Medicine (NEJM) showed that physical therapy is as effective as arthroscopic surgery for treating patients with knee injuries. The study looked at 351 patients aged 45 years or older who had various knee conditions and applied surgery and physical therapy to two different groups. At six months, both groups showed similar improvements but 70% of patients who underwent just physical therapy avoided having to undergo surgery.

Physical therapists have the ability to help patients suffering from sciatica and certain knee injuries. Physicians support conservative pain management before opting for surgery. Patients who undergo surgery don’t typically show any more improvement than physical therapy patients after six months. It is important to consult both physicians and physical therapists to determine the best options for pain relief.



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