Physical therapy may be an effective alternative to surgery in relieving joint and back pain.
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Exercising may be the last thing you want to do when you have a sore knee or aching back, but it might be the first thing you should do. Physical therapy has long been recommended following surgery. But for some, trying physical therapy before opting for surgery may be the better choice.
“You may be able to spare yourself the expense, pain, and recovery time of surgery,” says physical therapist Karen Weber, clinical supervisor at Harvard-affiliated Spaulding Rehabilitation Outpatient Centers in Braintree and Quincy, Mass.
There is growing evidence supporting that idea. In the past few years, studies have indicated that physical therapy is just as effective as surgery for relieving pain and restoring function for people with arthritis in their knees or backs.
Physical therapy or surgery for arthritic knees?
Recent studies have indicated that arthroscopy, in which torn cartilage is repaired through a keyhole incision, isn’t very effective for people with mild to moderate knee osteoarthritis. A 2013 report from a study of 351 women and men with arthritis — half of whom were randomly assigned to receive arthroscopic surgery followed by physical therapy and half of whom received physical therapy alone — found little difference in knee function between the two groups a year later.
In 2017, the journal BMJ assembled an international panel of experts to analyze data from 13 studies of arthroscopic surgery for meniscus tears (damage to the tissue cushioning the kneecap), a common consequence of arthritis. Although most of the reports acknowledged that arthroscopy may be helpful for some people, the panel strongly recommended against arthroscopy for almost all patients with degenerative knee disease. Complete knee replacement is still an effective option for those with severe knee arthritis that hasn’t improved with physical therapy.
Physical therapy or surgery for spinal stenosis?
An operation known as decompression or laminectomy, in which tissue that is pressing on nerves is removed, is often performed to relieve lower back pain from spinal stenosis (a narrowing of the open spaces of the spine caused by degeneration of the discs between the vertebrae, thickened ligaments connecting the vertebrae, or arthritic changes to the backbone). A study reported in 2015 involved 169 women and men with spinal stenosis, half of whom had surgery and half of whom had physical therapy instead. Both groups experienced pain relief and improved function within a few months. They also had similar levels of pain and physical function two years later. An earlier study of 121 Norwegian women and men with spinal stenosis had yielded similar results. In that study, half the group was randomly assigned to have laminectomy followed by spinal fusion — a procedure in which two or three vertebrae are joined with screws to stabilize the lower spine — and the other half was assigned to physical therapy and cognitive behavioral therapy for pain control. Both groups reported similar levels of pain and function for years after treatment.
Consider physical therapy first
The first step is to seek medical advice for arthritis pain that is limiting your daily activities like walking, climbing stairs, driving, or even rising from a chair or tying your shoes. “If you limit your mobility, you’re likely to get weaker and set a downward spiral in motion, making it more difficult to recover,” Weber says.
It’s a good idea to explore the options for physical therapy before you decide to have surgery for arthritis in your knees, back, or any other joint. But if you are just beginning to develop pain, it may be difficult to determine whether you should tough it out or get medical help. “Everyone’s threshold is different,” Weber says.
It’s best to see your primary care provider for a referral to a physical therapist. Weber recommends against starting at a gym or exercise facility. While physical trainers are great at helping healthy people become stronger and more flexible, they are not trained to diagnose an injury or to prescribe the exercises to help you recover from it, she says.
And if you have joint or back surgery, always follow up with physical therapy. Research has shown that women are less likely to do so than men are.