As part of the Australian government’s response to the COVID-19 pandemic, elective surgeries have been postponed. This means no knee replacements, no hip replacements, no knee reconstructions, no arthroscopies, no rotator cuff repairs and no ankle stabilisations! This is both a frustrating and stressful situation as you may have already been waiting months for your surgery. We know that this is the case for many and that it can feel as though your journey back to doing the things you love again has been put on hold.
My fear as a health professional is that patients may turn to pain medications as their solution, which risks other health concerns along with becoming dependent long term. The silver lining in this situation however is there are a lot of other strategies that can be used to manage your pain right now without the need for medications or surgery.
What is the best recommendation prior to surgery?
If you have been scheduled in for an orthopaedic surgery, you have most likely been suffering from pain or injury for a while. As a result, you may have developed compensatory movements like limping or avoiding painful movements/ exercise altogether. Immediately after an injury, these coping strategies can be beneficial, however if they have remain for months or years, our body will adapt. This means that our muscles become weaker, and our joints feel stiff – we simply don’t feel that we can move in the same way as we did before, and we certainly don’t feel as strong either.
In normal circumstances, the best thing you can be doing leading up to surgery is a tailored exercise program to regain what we may have lost. We call this pre-habilitation (rehabilitation pre-surgery) and it is aimed at increasing the strength of your muscles and range of motion in your joints. We know that the better condition you are in beforehand, the better your chance is of a successful outcome from surgery. This means both an improvement in the overall level of function you achieve and a reduction in the amount of time it takes to recover.
What if my scans have shown changes to my muscles or joints?
Getting a scan is quite common for musculoskeletal conditions, especially if you are considering a surgery. What is important to remember is that a finding on a scan is just part of the overall picture and not the determining factor to your prognosis.
Studies have shown for quite a while now that the area and severity of pain does not correlate well with what is displayed on imaging. For example, two patients of the same age and gender can have similar X-ray results of their knees, however one of them may be in agony and the other completely pain free. Furthermore, it is quite common for the same person to have similar findings on both shoulders, yet only have one that is painful. This is not to say we need to disregard scans every single time, but to reinforce that the findings on scans must also match with clinical findings and the history in which that pain has arisen and progressed over time.
The problem we find is that once a finding appears on a scan report, we assume that nothing can be done to eliminate it without surgical intervention. The images below show how common some of these findings are in pain free individuals for the knee and lumbar spine (lower back). The research suggests that often these changes are age related and not due to damage or trauma that needs to be fixed.
How does Physiotherapy compare to surgery?
Although your surgery may have been cancelled for now, what we can focus on with Physiotherapy is the pre-habilitation mentioned earlier. This pre-habilitation window will allow better pain management as well as improved preparation for surgery when they can resume post coronavirus.
The part of this that really excites me as a Physiotherapist is that many of our patients who complete a comprehensive pre-habilitation program begin to manage their symptoms better. As a result they can hold off having surgery by months or years and at times, or even cancel their surgery completely – what an outcome! Many studies have also shown this to be true, especially in surgeries of the shoulder, hip and knee. What they have highlighted specifically is that patients have achieved similar outcomes by attending physiotherapy when compared with surgery – that means the same function and decrease in pain, without all the risks and pain killers!
Sound too good to be true? Of course, as a Physiotherapist, I would recommend Physiotherapy…. But even surgeons agree that a conservative approach is always best to try before going down the surgical path. The latest research and recommendation from orthopaedic surgeons is to undertake a minimum of 12 weeks of pre-habilitation before any surgery. We often hear our clients report that the first two weeks are a challenge as they may be doing something that they have not done for a long time. By the end of their treatment and exercise programs however, they can see the clear benefit over going under the knife.
So, if you’ve had your elective orthopaedic surgery cancelled, fear not, we can still make the most of this opportunity together. Pre-habiltation can be achieved with or without equipment and is tailored to your level. Don’t hesitate to give this non-surgical option a chance with us, especially right now when there is no clear indication when surgeries will return.