The vast majority of musculoskeletal conditions and diagnoses are not life threatening or time sensitive and allow for conservative treatments, including Physical Therapy, to be utilized prior to surgery. In our Boulder Physical Therapy practice we commonly see outcomes consistent with the current research on the utilization of Physical Therapy instead of surgery for common injuries. In recent head to head research trials, Physical Therapy has been shown to be more effective or equally effective for many conditions including neck or back pain, rotator cuff tears, knee arthritis, and hip impingement. Specifically prior authors found 86% of research trials comparing surgery, placebo surgery, and conservative care did not find a clinically significant benefit of surgery (Harris et al. Pain. 2020). A recent summary of the evidence compared the benefits and harms of surgical vs. conservative interventions including Physical Therapy.
Skou and colleagues published their systematic review and meta analysis in the Journal of Orthopedic and Sports Physical Therapy (JOSPT. 2022). Authors included 100 randomized controlled trials on this topic including over 12,000 participants. Conditions including neck disc injuries, neck and arm pain, shoulder impingement, rotator cuff tears, elbow pain, carpal tunnel syndrome, low back pain, lumbar disc injuries, lumbar spinal stenosis, SI joint pain, hip impingement, knee meniscus tears, knee arthritis, ACL injury, achilles tendon injuries, and plantar heel pain. Authors reported in 9 out of 13, 11 out of 11, and 9 out of 9 conditions, with data on pain, function, and quality of life, there was no significant differences between surgery and conservative care including Physical Therapy. Authors concluded the available evidence does not currently support surgery over Physical Therapy for many musculoskeletal conditions. Based on this evidence, patients are encouraged to try Physical Therapy first prior to surgery for many of these injuries and conditions.
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