"Life is a matter of choices, and every choice you make makes you." — John C. Maxwell

Do You Really Need Surgery? Exploring Conservative Treatment Options

Surgery often seems like the go-to solution for injuries and chronic pain, but is it always necessary? Many people assume that if a body part is injured, surgery is the only path to recovery. As a physical therapist, I find this a bit insulting. However, research suggests that conservative treatments—such as physical therapy, strength training, and lifestyle modifications—can be just as effective, if not more so, in many cases. Before jumping into an operating room, it's essential to explore all options and understand the potential benefits of non-surgical approaches.

Here's all the body parts you may not need surgery on.

When Surgery May Not Be Necessary

1. Knee Injuries (ACL Tears, Meniscus Tears, Osteoarthritis)

   • A 2013 study published in the New England Journal of Medicine found that physical therapy alone was as effective as surgery for some meniscus tears in middle-aged patients. This is significant because meniscus tears are one of the most common knee injuries, and unnecessary surgeries can lead to prolonged downtime and avoidable risks. Meniscus lesions are also very common, and can be present along with arthritic changes in knees that hurt and ones that don't. The outcomes with meniscus injuries are similar as well, whether you get surgery or not, you get better. But one path has fewer risks.

   • ACL tears, particularly in non-elite athletes or individuals who do not engage in high-intensity sports, can often be managed with physical therapy and bracing. Studies have shown that conservative rehab programs focusing on quadriceps and hamstring strength, proprioception, and neuromuscular control can provide similar functional outcomes to surgical reconstruction in certain populations.

   • Osteoarthritis patients can significantly reduce pain and improve function through weight loss, exercise, and injections rather than opting for a knee replacement. Many studies indicate that movement is medicine, and structured physical activity can be just as effective as surgery in managing osteoarthritic symptoms.

2. Rotator Cuff Tears

   • Research in The Journal of Shoulder and Elbow Surgery indicates that many rotator cuff tears can be treated successfully with physical therapy. A structured rehab program focusing on scapular stability, rotator cuff strengthening, and posture correction often yields excellent results.

   • Strengthening the surrounding muscles and improving mobility can restore function without the need for surgical intervention. In some cases, small tears that do not cause significant functional limitations may not require surgery at all, especially in older individuals who can function well without full anatomical integrity of the tendon. This is supported by the fact that most people with small rotator cuff tears in a painful shoulder usually has small rotator cuff tears in nonpainful shoulders. Think about that. MRI results from BOTH shoulders show similar tears, even in ones that hurt.

3. Herniated Discs and Low Back Pain

   • A study in Spine Journal revealed that most herniated discs improve with conservative treatment, such as physical therapy, core strengthening, and pain management strategies. In fact, studies have shown that over 90% of people with disc herniations experience significant improvement within six months without surgery.

   • Surgery may provide faster relief but does not necessarily offer better long-term outcomes compared to structured rehabilitation. There are so many studies of so many treatment plans that are helpful for back pain, from the most intense "core stability" program to a simple walking routine to improve cardio and heart rate. Many different treatments have shown to be useful for low back pain, and that's before surgery.

4. Tendon Injuries (Achilles Tendon, Tennis Elbow, Plantar Fasciitis)

   • Achilles tendon ruptures can heal effectively with non-surgical management, including immobilization and progressive rehabilitation. Some studies suggest that functional rehab approaches can lead to comparable or even superior outcomes compared to surgical repair.

   • Tennis elbow (lateral epicondylitis) and plantar fasciitis often resolve with conservative treatments like eccentric strengthening exercises, stretching, and shockwave therapy. Platelet-rich plasma (PRP) injections and dry needling are also promising non-surgical options. You could also do nothing for tennis elbow and it would get better.

Benefits of Conservative Treatment Over Surgery

• Lower Risk: Surgery comes with inherent risks, including infections, complications from anesthesia, and prolonged recovery time. Avoiding these risks through conservative management can be a safer approach.

• Faster Recovery: Many conservative treatments allow you to continue moving and maintaining function while recovering. Gradual loading strategies in physical therapy help tissue adapt over time without complete immobilization.

• Cost-Effective: Avoiding surgery can save thousands of dollars in medical expenses and lost work time. Insurance coverage may favor non-surgical approaches before approving more invasive procedures.

• Better Long-Term Outcomes: Strengthening muscles, improving mobility, and correcting movement patterns can prevent future injuries and chronic pain. Many surgical procedures do not address the root cause of an issue, leading to recurrent problems.

• Less Scar Tissue and Stiffness: Surgical procedures often introduce scar tissue, which can limit mobility and function. Conservative treatments emphasize restoring mobility and strength naturally.

When Surgery May Be Necessary

There are certainly cases where surgery is the best or only option, such as:

• Complete ligament or tendon ruptures in high-demand athletes who require full joint stability.

• Severe fractures or dislocations that require stabilization with hardware.

• Conditions that do not improve with conservative treatment after a dedicated trial period (e.g., six months of structured rehab without improvement).

• Structural issues that significantly impair function and cannot be corrected with rehabilitation, such as severe spinal stenosis causing nerve compression symptoms.

How to Decide If Surgery Is Right for You

• Seek Multiple Opinions: Consult with orthopedic specialists, physical therapists, and sports medicine doctors to get a well-rounded view of your options.

• Try Conservative Treatment First: In most non-emergency situations, attempting physical therapy and other non-surgical treatments for at least 3-6 months before considering surgery is a wise approach.

• Consider Your Lifestyle and Goals: If you’re an athlete who requires high joint stability, surgery may be a better option. However, if you’re looking for pain relief and functional improvement without extensive downtime, conservative care might be best.

• Understand the Risks and Benefits: Every surgery comes with potential risks, including failed procedures or complications. Be sure to weigh the long-term impact against the potential benefits.

Final Thoughts

Surgery isn’t always the answer. With the right approach, many people can recover and return to their activities without going under the knife. Conservative treatments have been shown to be highly effective for numerous musculoskeletal conditions, often providing equal or superior results to surgical intervention. The key is to explore your options, prioritize long-term health, and make an informed decision about what’s best for you.

So before committing to surgery, take a step back, do your research, and give conservative treatment a fair chance. You may find that you can heal, strengthen, and return to full function without ever stepping into an operating room.

Surgery isn't always the answer. If you're looking for answers and feeling stuck, don't wait. I can help. Book your call now: https://roadtodawnwellness.com/book-page-7052