Monday, April 5, 2021

When Can Physical Therapy Prevent Surgery?

by Sally Fansler, PT
While more than 1.5 million orthopedic surgeries are performed in the U.S. each year, current research is showing that surgery might not be needed as often as previously thought. According to a recent review an estimated 10% to 20% of surgeries might not be necessary and in some specialties - such orthopedics - that number could be higher. One of the most common reasons for unnecessary surgery is that conservative options simply are not tried first. For musculoskeletal problems like joint pain, sprains, and strains, seeing a physical therapist before a surgeon can help keep patients out of the operating room and get them back to their daily lives sooner. Studies have shown that physical therapy is just as good - if not better - than surgery for a multitude of conditions, and it carries far less risk. We've compiled some research here as to the benefits of seeking physical therapy first for common orthopedic problems. 

Rotator Cuff Tears 

The rotator cuff is a group of muscles and tendons that surround the shoulder joint and provide strength and stability. When one of the rotator cuff muscles is frayed or damaged, it is considered a partial tear, whereas a complete tear is more severe and can actually pull the tendon from the attachment on the bone. Tears happen over time from normal wear and tear, or they can happen traumatically with a fall or strain. 

Small- to medium-sized tears typically respond quite well to physical therapy. A 2016 review of medical literature noted that conservative PT treatment for rotator cuff tears is effective in 73-80% of patients. While this efficacy rate depends on the age and medical history of the patient, the location of the tear, and the severity of the tear, more often than not surgery can be avoided (though in the case of a massive rotator cuff tear or a retracted tendon, the positive response to physical therapy may be reduced).

Meniscal Tears 

One of the most common knee injuries, meniscal tears are typically caused by an activity that twists the knee, and often occur when underlying osteoarthritis is present. An estimated 460,000 patients in the United States get surgery each year to fix tears in this C-shaped piece of cartilage, which acts like a cushion for the knee joint. 

Researchers are currently studying the effectiveness of surgery versus physical therapy in those patients with meniscal tears and knee arthritis. In a study of 351 patients who were 45 years and older with meniscal tears and osteoarthritis, half received physical therapy while the other half underwent surgery. The research did not find any significant differences after 6 months in those who received physical therapy alone and those who had surgery. Additionally, a 2017 literature review found that arthroscopic surgery for degenerative knee disease (including arthritis and meniscal tears) did not give lasting pain relief or improved function. Often, physical therapy is the optimal place to start to address this common knee injury.

Low Back Pain 

One type of back pain, called spinal stenosis, is a degenerative disease that causes narrowing of the space in the spinal canal. This narrowing creates pressure on spinal nerves and can become increasingly painful. Spinal stenosis is sometimes treated with surgery, but physical therapy often works just as well and comes with fewer unwanted complications than surgery, according to a study published in Annals of Internal Medicine in 2015. 

 Degenerative disk disease is also a common cause of back pain and has been studied extensively. Disk patients are sometimes treated with a surgical spinal fusion. However, a 2013 study found no major difference in outcomes between patients who had surgery for degenerative disk disease and those who chose physical therapy instead. 

Physical therapy can't fix every problem, and for some patients, surgery really is the best choice. However, the research continues to demonstrate that surgery is not a cure-all, and in fact is sometimes a very expensive and risky placebo. In many cases, physical therapy is the place to start - and for some, it's the only treatment necessary. 

 

References: 

Peter Edwards, Allan Wang. "Exercise Rehabilitation in the Non-Operative Management of Rotator Cuff Tears: A Review of the Literature". Pubmed Central (PMC), 2021.

"Surgery Versus Physical Therapy For A Meniscal Tear And Osteoarthritis". Vol 369, no. 7, 2013, pp. 683-683. Massachusetts Medical Society, doi:10.1056/nejmx130035. 

Siemieniuk, Reed A C et al. "Arthroscopic Surgery For Degenerative Knee Arthritis And Meniscal Tears: A Clinical Practice Guideline". BMJ, 2017, p. j1982. BMJ, doi:10.1136/bmj.j1982. 

Kuhn, John E. et al. "Effectiveness Of Physical Therapy In Treating Atraumatic Full-Thickness Rotator Cuff Tears: A Multicenter Prospective Cohort Study". Journal Of Shoulder And Elbow Surgery, vol 22, no. 10, 2013, pp. 1371-1379. Elsevier BV, doi:10.1016/j.jse.2013.01.026. 

Barrer, Steven J. "Surgery Versus Nonsurgical Treatment Of Lumbar Spinal Stenosis". Annals Of Internal Medicine, vol 163, no. 5, 2015, p. 396. American College Of Physicians, doi:10.7326/l15-5129.

Friday, January 15, 2021

More Than Just a Pose: Yoga and Physical Therapy

by Amber Yavitz,
Front Office Coordinator
Over my past two years at Lakeshore Physical Therapy, many patients have asked me for yoga class recommendations based on which teacher is the most beginner-level friendly. I’ve been learning yoga since I was nine years old and am in the process of becoming a certified yoga instructor, but for someone who has had a previous injury or hasn’t had much experience with yoga, the practice can sound understandably intimidating. Yoga - Sanskrit for “union” - uses spiritual and physical meditation, breathing and exercise techniques to improve overall health. In fact, physical therapy often uses poses originating from yoga to help people with injuries to help them build muscular strength, balance, and flexibility.

One of the most foundational components of yoga is building an awareness of breath. Yoga instructors guide practitioners through breathing techniques, which are used to help flow through each pose and movement and aid in stabilization of a pose. While  most yoga poses and breathing techniques are used for the intention of relaxation and mindfulness, physical therapy also uses breathing techniques to teach postural awareness and emphasize controlled breathing.


If you’re new to yoga, don’t be intimidated by some of the more advanced poses you may have seen! Modifications and variations are given in most yoga classes, especially for people who are not as flexible or experienced, and your physical therapist can always work with you to modify poses that fit within your restrictions. Yoga is an ongoing practice to learn your body and improve movement, and regularly practicing yoga can help with body awareness and clearing one’s mind to center attention. If you have done physical therapy before, chances are you already know more than you think - below are some poses that you may have seen or done before!


Child’s Pose

Child’s pose is a rest pose that is used in yoga to calm and ground the practitioner. Its main benefit is increasing flexibility by creating a gentle stretch for the back and hips, which is a common goal for physical therapy programs for low back and hip pain. Deep breathing in this pose can relax the body, especially after more difficult yoga sequences or exercises.


Warrior One and Two

These standing poses help with balance and focus while opening the hips and chest. By utilizing longer holds, they can also help strengthen the shoulders, legs, and back. Note that the difference between these two poses is the arm position: in Warrior One arms are up, and in Warrior Two arms are opened wide to the side.


Warrior One
Warrior Two


Sphinx Pose

Sphinx pose is a softer back bend that can stabilize the shoulders and lengthen the abdomen. This is a beginner pose that can prepare the body for more advanced poses later in your practice. This allows the practitioner to keep the pressure off the back while still opening the chest. In physical therapy, Sphinx Pose can be a good way to work on gradual extension in the back until you are ready for an Upward Facing Dog pose.

 

Low Lunge

The Low Lunge is used in many yoga sequences and there are many variations for different comfort levels. This position stretches the hip flexors and quads, helping to  restore range of motion in the hips. Many people are very tight in their hips due to living a sedentary lifestyle and so may require modifications depending on how tight the muscles are.



If you are experiencing an injury, physical therapy and yoga together can work hand in hand to ensure optimal recovery. Once you have graduated from physical therapy, continuing yoga will help the body maintain strength gains, decrease stress, and prolong flexibility.