In some cases, surgery is the only option, especially in the case of a traumatic, acute injury that may indicate a full ligament or tendon rupture. “Say you’re skiing, fall and hear or feel a pop in your knee, that’s probably going to be a case for surgery,” said Dr Johnson. “There are times when you need a doctor to jump in and operate immediately.”
In other cases, a less invasive approach with physical therapy can lead to equal, if not better, outcomes. Take the case of meniscus tears — knee injuries that are considered minor and incredibly common. Evidence increasingly suggests that surgically repairing a torn meniscus offers no more benefit than physical therapy to help strengthen the surrounding tissues and support healing.
Additionally, the surgery may lead to faster onset of osteoarthritis, as well as increase the risk of other conditions that come with an operating room, like staph infections. In 2017, an international panel recommended against the procedure and in favour of physical therapy and other conservative interventions, like activity modifications and lifestyle changes.
Dr Matusz sees a few dozen patients on the average day and sends the majority to physical therapy, rather than the operating room. He said this represents a change in his approach over the 18 years he has been practising.
“People find it startling because I’m a surgeon,” he said. “But most patients my partners and I see don’t need a surgical intervention. They need PT.”
HOW TO DECIDE WHICH APPROACH IS RIGHT FOR YOU
If you have a lingering or acute injury, find the right specialist for your condition and body part, and then gather all the relevant information and potential options. With your clinician, determine things like whether the joint was damaged from a traumatic event, or if the issue stems from more chronic issues, like strength imbalances or age-related changes that were exacerbated by a spike in physical activity.
If you’re considering surgery, go in with questions for your doctor: “Make sure they understand your goals, life demands and activities,” Dr Johnson said. “Learn whether you have an isolated injury, like a small tear to your ACL, or multiple, such as a couple of ligaments or your meniscus, too. In those cases, surgery might be best.”
Before greenlighting surgery, you and your doctor should also take into consideration your age and activity level. A 20-year-old Division 1 soccer player with an ACL tear might want a repair, for instance, so that they can return to the playing field at or near 100 per cent. A 50-year-old runner, on the other hand, can likely avoid it, regaining enough stability through PT to allow them to return to their sport, since it is less demanding on the knee.
Not all types of injury are created equal, said Dr Allison Fillar, an orthopedic surgeon at MedStar Health in Baltimore. Take a meniscus “buckle tear” or a full-on ACL rupture. In those cases, surgery is required. But with other meniscus tears PT alone can work, she said.
If you are leaning toward PT, you should request a full battery of medical tests from your physician or physical therapist, including functional assessments of the damaged joint and strength tests, Dr Johnson said. These might also include performance tests involving movements like jumps, calf raises, squats, push-ups and more.
If you decide to pursue physical therapy, different clinicians will have varied approaches. “What works for one patient might not work for another,” Dr Matusz said. “Sometimes I’ll even have a patient switch PTs if they’re not getting the results they want before we take the step of surgery.”
From where Dr Matusz stands, even if you end up in the operating room, if you’ve first tried physical therapy, you’re ahead of the game by having given it a chance to work. “By the time you get to surgery, whether for the spine or something else, it should be your last resort,” he said.
By Amanda Loudin © 2023 The New York Times
This article originally appeared in The New York Times.
For all the latest Sports News Click Here
