Can I Avoid Surgery? How Physical Therapy Can Help Relieve Pain and Restore Function Without Surgery

by Proclinix, November 2, 2018

By Dr. Brittany O’Rourke, PT, DPT, CSCS

You were just diagnosed with a meniscus tear and told you may need surgery. You are worried about how many other things you have going on and how you don’t have time for surgery right now. So what now? Have you considered physical therapy? Recent research shows that physical therapy can be considered as an alternative to surgery for individuals with meniscus tears that are non-obstructive as well as degenerative full thickness rotator cuff tears and superior labral tears of shoulder (SLAP tears). These are a few of the many injuries that can be addressed with physical therapy alone to help relieve pain and restore function!

According to an article in the International Journal of Sports Physical Therapy, there is substantial evidence to support physical therapy as the first line of management, especially in individuals >60 years of age with chronic, degenerative full thickness rotator cuff tears.

Further evidence from an article about clinical outcomes of non-operative treatments states that non-operative treatments were extremely successful for the outcomes of middle-aged patients with symptomatic SLAP lesions, where surgical intervention was not required.

Other evidence from an article about knee injuries suggests that people who went through physical therapy with nonobstructive meniscal tears had better outcomes after a 24 – month follow up then patients that underwent an arthroscopic partial meniscectomy.

What does all this mean? You CAN avoid surgery by trying physical therapy!

How does PT work? For injuries in the knee including meniscus tears and osteoarthritis, it is important to reduce strain on the weight bearing surfaces of your knee. This can be done by improving strength of the muscles that support your knee and restoring full range of motion to increase available surface area and decrease pressure on the injured area. Impaired mechanics with walking, squatting, and going up and down stairs can increase strain on your knee and contribute to pain. Working on correcting muscle imbalances and retraining your muscles to move through the correct patterns can help decrease strain on the injured area. For example, if you are getting out of a low chair and your knees are collapsing inward because you lack the hip strength to control this and are unaware of correct mechanics, this can increase strain in multiple areas of your knee. It can increase joint compression on the outside of your knee, create abnormal tracking of your knee cap within its groove, increase strain along your IT band, and put important hip muscles at a disadvantageous muscle length making them weaker. In turn these imbalances can make functional activities more difficult and painful.

For injuries of the shoulder including SLAP tears and rotator cuff tears, it is important to decrease strain on the shoulder joint by correcting posture and biomechanics. This is done through addressing shoulder range of motion, strength of the muscles that control the shoulder and shoulder blade, mobility through the upper back and neck, and motor control. Many of us sit or stand with a slouched posture for prolonged periods of time. When in this position, the area in your shoulder joint gets smaller. Your rotator cuff tendons pass through this area and when you lift your arm with this smaller joint space, it increases the risk of pinching one of these tendons, otherwise known as “impingement”. Overtime, this can contribute to tendinitis and micro-tears. If you already have a tear, this repetitive impingement can contribute to continued inflammation affecting the shoulder’s ability to heal.

It always important to address the entire body even when treating a localized injury and a strong core is key. For example, it is recommended to include hip range of motion, hip strength, and core exercises in shoulder rehabilitation programs especially in the throwing athlete. Unfortunately, surgery won’t make your core stronger, but physical therapy CAN help with this.

Surgery is necessary with many injuries, but there are many cases in which you may be able to avoid or postpone it by training your body to work with optimal mechanics. Even if you still need surgery, despite trying PT, you are now stronger and better educated about proper posture and biomechanics. This can help you in the long run by making your post-op rehab easier and by reducing the risk of another injury.