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Featured Article: Physiotherapy versus Surgery: Selecting the Best Treatment For Knee and Back Pain
When it comes to treating chronic knee and back pain, too often surgery is at the top of the doctor’s list of recommendations. While many people do benefit from early surgery, there are other equally effective options that are less expensive and less invasive. When used early in the course of treatment, Physiotherapy can relieve pain and restore function, either postponing or even preventing surgery.
Knee Pain
Much of the time, knee pain is caused by increased stress on the joint. This can be the result of abnormal movement patterns or simply a part of aging. As a person gets older, their knees tolerate stressful movements or activities less and less. As a result, activities that may not have caused problems in the past, like sports or kneeling in the garden, may now be quite painful.
Most of the knee pain in older adults is diagnosed as osteoarthritis. Osteoarthritis occurs when cartilage, the protective tissue cushioning the knee joint, deteriorates. Usually in the US and Canada, the preferred treatment option for knee osteoarthritis is arthroscopic surgery. Arthroscopic surgery uses a variety of techniques to remove debris and particles from the knee joint, as well as to smooth the joint surface. This helps reduce inflammation in the joint and eliminate anything that might interfere with joint movement.
Although arthroscopy is the most common knee surgery performed in the US and Canada, there is little published evidence that proves its long-term effectiveness. The results of a large randomized clinical trial published in 2002 showed that surgery had no benefit in patients with moderate-to-severe osteoarthritis of the knee. However many doctors questioned the validity of the findings and continue to rely on arthroscopic surgery. A more recent clinical trial may change that, though.
In this study, 178 patients over the age of 60 with moderate-to-severe osteoarthritis were recruited to participate. Half of these patients had arthroscopic surgery plus medical and Physiotherapy. The other half only had medical and Physiotherapy. After two years, the researchers found that arthritis severity was about the same in both groups, making them conclude that surgery provided no additional benefit to medical and Physiotherapy alone. This could be because although arthroscopy addresses the functional issues associated with osteoarthritis pain, it does not address the underlying muscular or dynamic factors – factors targeted by Physiotherapy.
A Physiotherapy plan of care is specifically designed for each individual patient’s needs after a thorough evaluation by a licensed Physiotherapist. However, in general, Physiotherapy sessions for knee osteoarthritis may include exercises that help improve motion, like swimming or flexibility training, and strength training.
Back Pain
At least 75 to 85% of adults will suffer from lower back pain sometime during their life. This pain could be due to a herniated disc, stenosis, or bad habits like slouching. No matter what the cause, though, the American College of Physicians and the American Pain Society both recommend Physiotherapy as treatment.
A variety of clinical studies have shown that exercise and Physiotherapy decreases pain and improves function in patients with chronic or acute lower back pain. But how does this relief compare to surgery?
A study published in 2007 focused on a group of 283 patients who had suffered from sciatic pain for at least six weeks. Sciatica is caused by a herniated, slipped, or protruding disc pinching the sciatic nerve and sending pain through the back and leg. Half of the patients in the study were scheduled for surgery, while the other half used stretching and back-strengthening exercises. After one year, 95% of people in both groups told the researchers that their symptoms had significantly improved – meaning surgery was no better at treating sciatic pain than Physiotherapy.
Like Physiotherapy for knee pain, Physiotherapy for back pain is tailored specifically to each individual after a detailed evaluation. In general, though, a Physiotherapist will recommend exercises to strengthen core muscle groups, including the abs and lumbar region, as well as stretching exercises.
All too often, people think that surgery is the only way to get rid of the pain they are experiencing. This is not the case, though. Recent studies have shown that Physiotherapy in many cases is as effective as surgery in relieving pain and improving function long term. It is also safer, with fewer side effects. If you are suffering from knee or back pain, the professional Physiotherapists at Peak Physical Therapy would be happy to talk to you. They are trained to create individualized Physiotherapy programs that will fit your needs and help you begin to enjoy life pain free. However, in the event that surgery has been determined to be the best option to manage your knee or back condition a Physiotherapist is an integral part of your rehabilitation as much as the surgery and that it is important for you to ask your surgeon what the earliest point in time post-operatively that you would be able to commence attending Physiotherapy. Also ask the surgeon to write out briefly or provide the operative report so that your physiotherapist can more effectively develop a rehabilitative program and educate you exactly about the surgery; as all too often surgeon's are very busy and are unable to explain in layman's terms what actually occurred during the surgery to the point that people are able to understand; your Physiotherapist will be able to do this for you.
References:
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