DO I REALLY NEED THAT OPERATION?
Have you been struggling with a painful injury or problem and been told that you need surgery? The latest evidence shows that many surgeries can be safely avoided.
Have you explored all the options?
Results from X-rays, CT scans and MRIs can be misleading
The latest research is showing that exercise-based “pre hab” with a Physiotherapist can determine whether a specific exercise program can actually have a better outcome.
IS SURGERY THE ANSWER?
In the last decade there has been major research showing that many surgeries can be safely avoided. These “elective surgeries ”, which are not urgent, can in fact achieve better outcomes with conservative management along with significant cost savings, reduced risks of post operative complications, infections and disability through well structured treatment programs designed by specifically trained physiotherapists.
HIP AND KNEE REPLACEMENTS
Hip and knee pain are common and you may have heard that joint replacement surgery is the answer.
“Wear and tear” is a normal part of ageing, but there are many other causes of joint pain. A joint may ”look bad” on a scan but it cannot confirm where the pain comes from.
Accurate Assessment is Essential
The causes of ongoing pain differ but co-existing pathologies from nerves in the lumbar spine are common. Injuries in the lower limb can cause faulty movement which, treated properly, can resolve the problem and avoid surgery. If there is pain elsewhere in the leg it is critical that the lumbar spine is properly cleared by a physiotherapist.
Joint replacement, despite successes, can also lead to serious complications such as pulmonary embolism, heart attack, vascular injuries, nerve injuries, fractures and dislocations or fatality. (Pulido L et al 2008).
Studies have also shown that persistent pain is common after replacement, affecting up to 50% of patients. (Wylde et al 2010). Longer term studies show similar with 49% still unable to walk unassisted at 12 months.
CONSIDERING SPINAL SURGERY?
Then consider this…..
Your spine is made up of a number of different structures including vertebrae, discs, the facet joints, the spinal cord and exiting nerves, ligaments, muscles, blood vessels, and other connective tissues. Any of these structures can be injured or damaged, however it doesn’t always indicate pain. Discs may be described as slipped, bulging, prolapsed or degenerative. Facet Joints; arthritic or degenerative. Sciatica is pain felt down the back/side of the leg, referred from a “pinched nerve” in the low back. However research on pain free people often shows damage on scans that doesn’t correlate with pain. Disc protrusions are very common in pain free individuals. (Brinjikji, W. et al. 2015)
What is important is not how your spine looks on scans, but how it moves, and how well you can things that you want to do.
There are a variety of spinal surgeries but no guarantee that it will fix symptoms and improve function. There are also risks of infection, nerve damage, bleeding and loss of life. Therefore, it is important that surgical candidates are chosen carefully and have exhausted conservative methods first.
Types of Surgery
Discectomy and Microdiscectomy involves removal of herniated disc material that may be pressing on a nerve root or the spinal cord. While removal of the offending material should relieve pressure on the nerves and eliminate the pain, up to 65% of these reinjure within 3 yrs (Suri 2017)
A Spinal Fusion joins two or more vertebrae into one single structure using bone grafts, artificial rods and screws or plates. This is designed to stop motion, however as, the spine was designed to move, results of fusion are generally quite poor (Atkinson 2016).
Laminectomy, also known as decompression surgery, involves removing a portion of bone to create more space and relieve pressure on the spinal cord or nerves. If the disc is the problem, it will still be present and may now just herniate into the extra space.
- A major review of the research by van Tulder et al (2006) found there is no scientific evidence to support spinal surgery.
- Various spinal injections showed very poor effect and cannot be recommended. The clinical recommendations to come out of the review were that cognitive intervention (psychology) combined with select exercises are most beneficial for chronic back pain.
- Strong research shows there are often certain movement patterns and directions that will either aggravate or relieve your problem. Directional preference exercises will produce better outcomes for pain and function than joint mobilisation alone.(Dunsford et. al. 2011).
Clinical Pilates and Back Pain
DMA Clinical Pilates exercises are tailored to an individual’s specific preferred direction (directional bias) provide immediate improvements in performance and dynamic postural stability (Tulloch et al 2012).Once these patterns are identified, they can be used to develop a Clinical Pilates based exercise program to help you with your problem,without resorting to unnecessary surgery.
DMA Clinical Pilates and Physiotherapy and affiliated Clinical Pilates Network Physiotherapists are leaders in Clinical Pilates rehab and Prehab treatment programs.
SHOULDER SURGERY / ROTATOR CUFF
Pain or injury in the upper limb can be quite debilitating. Rotator Cuff degeneration or tears are often blamed for shoulder pain, yet many people are able to use their shoulders very well with “torn” rotator cuffs on scans.
Shoulder impingement syndrome accounts for 70% of all shoulder problems (Mitchell et. al 2005). Common contributing factors include tendons of the rotator cuff or irritation of bursae (“bursitis”). While surgery to remove bone lipping, bursa, and/or releasing ligaments was common there was a ten-fold increase from 2500 surgeries a year to 21,000 a year over 10 years in England alone. (Judge et al 2014)
Corticosteroid injections (CSI) may provide short-term relief.
- However there is also mounting concerns regarding damaging effects of CSIs on tendon health (Dean 2014).
- A quality review of the published research showed physiotherapy just as effective (Camarinos 2009).
- In fact, surgery was no better than physiotherapy treatment involving education, advice and exercise (Camarinos 2009, Babatunde 2017).
- A recent study on exercise treatment for shoulder pain showed Clinical Pilates to be more effective than general exercise in helping to reduce pain and disability (Atiglan 2017).
- Ongoing, shoulder pain can often be related to the nerves from the neck travelling into the shoulder & arm. A thorough assessment of a shoulder problem MUST include the neck, especially if there is pain in the arm (“sciatica” of the arm) (Slaven and Mathers 2010).
Clinical Pilates and Shoulder Pain
When irreversible shoulder surgery is being considered, it is critical to complete a comprehensive assessment as the source of the problem may not be located in the shoulder at all. Shoulder surgery will not fix a neck problem so many shoulder surgeries can fail. Physiotherapy assessment and a trial of conservative treatment that includes specific individualised exercise therapy must be undertaken to avoid making a costly mistake.
Physiotherapists trained in Clinical Pilates select or de-select exercises based on a direction-sensitive clinical assessment, rather than exercises in all directions. This approach is especially suitable for specific, individualized therapeutic exercise treatment, not simply a generic exercise program.
DMA Clinical Pilates and Physiotherapy has trained over 10,000 physiotherapists world-wide in pilates-based functional restoration methods, and continues to grow in its sucess. DMA Clinical Pilates and Physiotherapy and affiliated Clinical Pilates Network (CPN) Physiotherapists are leaders in Clinical Pilates Rehab and Prehab treatment programs
JOINT ARTHROSCOPY / KEYHOLE SURGERY
Joint arthroscopy or keyhole surgery allows internal examination of a joint using a small fibreoptic camera (the arthroscope).
Knee arthroscopy is one of the most commonly performed surgeries.
- While arthroscopy is common for knee meniscus injuries it is no longer supported by any research. (Järvinen et al 2016).
- The British Medical Journal Rapid Recommendations group makes a strong recommendation against arthroscopy for osteoarthritis as there is no lasting benefit with less than 15% of people having a small short-term benefit only (Siemieniuk 2017 ).
- Two major trials of arthroscopic surgery for osteoarthritis of the knee found no benefit for these surgeries (Kirkley et al 2008-09, Moseley et al 2002) There are now some 20 major studies coming to the same conclusion (Bohensky 2012).
- Many medical insurgence providers are now reluctant to cover this procedure.
Hip arthroscopy has also been popular but is now withdrawn from benefits for the same reasons. Sadly this is still widely used for conditions such as osteoarthritis, labral tears, femoroacetabular impingement and osteochondritis dissecans.(MBS see Hip Surgery items)
The Australian Rheumatology Association is urging doctors to pay attention to the overwhelming research and avoid arthroscopic surgery, discussing alternatives such as exercise therapy to address the problem instead (Han E 2018)
Physiotherapists are fully trained and qualified to assess the problem of a painful joint, and provide high quality, exercise based treatment programs to assist with return to function.
DMA Clinical Pilates and Physiotherapy has trained over 10,000 physiotherapists world-wide in directional-classification and pilates-based functional restoration methods, and are leaders in Clinical Pilates rehab and Prehab treatment programs.
Article compiled by Physiotherapists from DMA Clinical Pilates and Physiotherapy, 1 Yarra Street, South Yarra 3141, ph 98274511.
DMA Clinical Pilates and Physiotherapy and affiliated Clinical Pilates Network (CPN) Physiotherapists are leaders in Clinical Pilates rehab and Prehab treatment programs
HEALTH REFORM AND PHYSIOTHERAPY
Ongoing modernisation of our health care system means will stronger primary care programs. Exercise-based Physiotherapy will play a key role in selecting the most appropriate patients for surgery (read more)
DMA Clinical Pilates & Physiotherapy and affiliated Clinical Pilates Network (CPN) Physiotherapists are leaders in Clinical Pilates Rehab and Prehab treatment programs. (Clinical Pilates Network)
Article compiled by Physiotherapists Treena Lord, Andrew Brand, John Buchanan, Maya Panisset, Eric Coleman, Ilana Raitman and Craig Phillips from DMA Clinical Pilates and Physiotherapy, 1 Yarra Street, South Yarra 3141, ph 98274511.