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Is that surgery necessary? Is it even effective?

Recent research is showing that surgery might not be needed as often as we think. A large review estimates that 10% to 20% of surgeries might be unnecessary and that in some specialties such as cardiology and orthopedics, that number might be higher. The reasons for so many unneeded surgeries being performed are varied, but the most common are that more conservative options aren’t tried first, or lack of knowledge by the operating physician. 

Physicians undergo long and rigorous training programs to become surgeons, but if they don’t work hard to keep learning, their knowledge often stops growing when they leave residency. Recent research is showing that certain common surgeries aren’t any better than a placebo. Two such examples are kyphoplasty – a procedure for spinal compression fractures, and partial meniscectomy – a procedure used to treat tears of the meniscus in the knee. If a surgeon hasn’t continued to learn, they won’t know that these surgeries often don’t offer any more benefit than a non-surgical treatment and will continue to perform them. 

Every surgery, even “minor” ones carry risks. These include complications from anesthesia, blood clots after surgery, delayed healing of the incision, infection, and unintended damage to nerves or other organs near the surgical site. Some of these risks cause discomfort for a period after surgery and go away, but others can result in permanent disability or even death. For some patients and conditions, surgery is a great treatment option, but with all the associated risks, when surgery can be avoided, it should be. 

For musculoskeletal problems like back and joint pain, sprains, and strains, seeing your PT before a surgeon can help keep you out of the operating room and get you back to life without surgery. Studies have shown that physical therapy is just as good if not better than surgery for a multitude of conditions and carries less risk. Some examples would include rotator cuff tears, meniscal tears, spinal stenosis, low back pain, and osteoarthritis. 

Physical therapy can’t fix every problem, and for some patients surgery is the best choice. However, research is showing that surgery isn’t a cure-all, and is sometimes just a very expensive and risky placebo. In most cases, starting with physical therapy is the right choice, and for many patients, PT is the only treatment necessary.

Data and commentary compiled from The Private Practice Section of the American Physical Therapy Association. 

What If We Told You That Not All Physical Therapy is Created Equal?

Setting: Orthopedic MD office.  You have just had an x-ray that came back clear (no breaks, hallelujah), medicine hasn’t helped the pain, and the MD enters the room:

MD:  Hi (insert your name here), everything looks clear on the x-ray and you still have pain so I think it might be time to try some therapy to see if we can get you better.

You: Ok, we can try

MD: Great.  I’m going to get you set up with the clinic across the hall.  I’ll send the referral over.  They use the same computer system and can talk to me anytime.

You: Alright.

*TIME OUT* Did you see what just happened?  I would guess most of you didn’t. What just happened is that the MD referred you to a clinic that they might have ownership,instead of suggest PT anywhere of your choosing.  Unsure how that matters?  A study1 assessed 3,771 patients with total knee replacements and the outcomes of therapy. Individuals that attended therapy at a clinic owned by physicians on average attended twice as many visits (approx. 8 more) and tended to receive less intense and specific treatment.  How does saving time and $320 sound? (based off $40/visit copay). Pretty good right?  Perhaps that referral isn’t based off care but based off self interest? I’m not saying but I’m just saying.

Bonus Riddle:  We’ve heard so many individuals voice their concern regarding visits to see their physician in which they actually see the PA. “I want to see the surgeon.” “I’m paying for the MD, not the PA.”  Common things I hear from patients in the clinic, as well as just in discussion with people.  It might be the most common thing after “is popping ok?”  So if it seems to be common thread that people want to see the MD and not the PA, why do people seem to constantly go along with therapy services in which they see commonly 5 different clinicians (PTs, PTAs, Athletic Trainers) in 6 visits?  Perhaps the thought is “that is just how it is” and the idea is that you just can’t do anything about it.

I’m here with great news! The grass is greener on the other side. While many clinics may have this scenario, there is something better.  At Greensboro Physical Therapy,we strive to bring you in with the same Doctor of Physical Therapy and keep you with them during your entire treatment.  We want to be your DPT for life!  We pride ourselves in getting to know you, your goals, your worries and more.  This you-centered focus allows us to get you where you need to be (apparently faster and better per research).

So if you’ve had that conveyor belt, bouncing around experience before and want something more, Greensboro Physical Therapy waits for you.   You have a choice, we hope you choose us.

1 Use of Physical Therapy Following Total Knee Replacement Surgery: Implications of Orthopedic Surgeons’ Ownership of Physical Therapy Services Jean M. Mitchell Ph.D. James D. Reschovsky Ph.D. Elizabeth Anne Reicherter P.T., D.P.T., Ph.D.

Want to Start a New Activity? Have Movement Goals? Here’s How Greensboro Physical Therapy Can Help.

When companies that operate in big industries like financial services and pharmaceuticals want to update their business models, streamline their market approach or launch a new commercial product, they often turn to the expertise of consultants. These experts have vast knowledge to help companies solve problems and achieve their goals. Did you know there’s such an expert that can help you manage pain, reach your fitness goals and prepare to try a new activity safely?

Meet us, the Doctors of Physical Therapy, the DPTs (sounds like a new Marvel Netflix series of heroes).  Think of your DPT as a movement consultant, trained to help you build the strength, endurance and flexibility needed to attain your goals. A common misconception is that DPTs are only trained to help clients improve their performance in the sports and leisure activities that they already participate in. But wait, there’s more: DPTs can educate clients who are interested in pursuing activities that they’ve never tried before, too. Let’s say you’ve always been a casual bike rider but want to train to run a 5K road race, where do you start?

At Greensboro Physical Therapy, our DPTs have the right training  and background to help you reach new goals.  Here are three ways to maximize your rehab sessions:

1. Know what you’re aiming for. Having a clear idea of your goal or goals—before going to that first PT appointment—will ensure that you can communicate exactly what you’re looking to achieve. Take the time to jot down some ideas for the future as well as goals you’ve attained in the past so you can jump start the conversation with your DPT.

2. Listen to your limitations—and your DPT. Of equal importance to communicating your wants and needs is taking the time to listen closely to what we might say.  We work hard and trained specifically to assess your body’s signals and then use that information to identify injuries in the making and uncover weaknesses and limitations that could prevent you from reaching your goals.

3. Be prepared to take it one step at a time. Our DPTs will work with you to establish an appropriate timeline to achieving your goals. For example, it’s unlikely that you’ll be ready to keep up with your best friend and avid runner at the town 5K the following weekend. However, your DPT can help modify your approach so you can still participate, even if you aren’t ready to run the entire distance.

These three steps will help your DPT design a customized exercise program that suits all of your needs and gets you to the finish line quickly—and safely.

What’s The Deal With Knee Osteoarthritis? (And What Can You Do About It?)

Osteoarthritis (OA) is characterized by cell stress/degradation caused by trauma and maladaptive repair in joints.  Articular cartilage, which covers the bones in the knee joint, is avascular (has no blood supply), does not regenerate, and receives nutrients through diffusion via mechanical pressure (which means if you don’t move, it doesn’t get nutrients!). Pain actually occurs from the synovium, bone, and nerves, not from the cartilage itself. Bone becomes weight bearing as cartilage wears, with changes in pressure and loading resulting in pain.

Diagram showing OA

Did You Know?

  • 50% of population has a musculoskeletal disorder, with 25% reporting chronic pain in a joint. 
  • The knee is the most common lower extremity site for OA (27 million people have knee OA).
  • Primary factors for knee OA:  increased BMI, female, previous knee injury.  Other factors: high impact sports, altered joint mechanics, and jobs that require frequent kneeling.

Treatment Options

Arthroscopic surgery: “Just say no”.  Research has shown a placebo effect at best, with an increased chance of needing a total knee replacement down the line.

Injections: Research has shown relief for approx. 2 weeks typically, with no measurable increase in function noted long term.  

Consistent supervised/guided exercise plan and physical therapy are low risk options that show improvements at 2, 4, 6 and 12 months.

Why Choose Physical Therapy?

Clinical evaluation/screening with “booster sessions” performed by our Doctors of Physical Therapy have shown improved outcomes, progressed activity level and helps address impairments that limit your daily life. Yearly “checkups” are recommended, with more frequent sessions when pain is present. Supervised exercise, manual therapy, strength/endurance training, and light aerobics have been shown to decrease pain, increase function, improve strength/control, improve joint mechanics, improve quad strength, decrease inflammation, improve motion, and improve gait to help you achieve your maximum function.

What to do?  Give us a call at Greensboro Physical Therapy (336.274.5006) to set up your personalized evaluation to find out what may help you have less pain and trouble related to that diagnosis of “Uncle Arthur.”