01 Aug Rehabilitate over Operate

“Look, try the physio for a few months and if they don’t sort it, come back and we will”.

Knee Rehabilitation

Let’s use one of the most well-known operations for easy of analysis, the arthroscopy of an arthritic knee. Arthroscopic surgery is commonly used for knee pain when the medical and drug route doesn’t work. In the US alone, close to 1,000,000 operations are performed annually at a cost to the person if not medically insured of €5,000 per operation. At this rate surgery must be a smoking gun, a sure think, a banker, right? Studies have shown a 50% report of relief in pain. And better again, surgeons and consultants themselves state the method by which the operation exactly provides pain relief is ‘unclear’. In fact, some people believe the traumatic effect of cutting in to the knee joint might in the long term, increase the rate of degradation. In addition, people believe that it is the ‘re set’ and new found enthusiasm for movement, exercise and improvement that modulates pain.

Study

180 willing and knowing participants of study were divided into three groups and to one of three surgical interventions under the same surgeon:

• Debridement
• Lavage
• Placebo (full operation logistics and physical entry but with no internal procedure)

Patients were assessed on pain scale and functional tests: walking, bending, timed tests, stair climbing etc. They were also asked to state which operation the felt they had.

Findings:

• 2% of intervention groups believed they had placebo.
• ‘At no point did either of the intervention groups have greater pain relief than placebo’
• ‘Walking and stair climbing’ were worse in debridement than placebo group at one year. Worse.

Perception is key

If we can alter the way people perceive their problem, we can change the way they analyze it, use it, exercise it, function and move. The key to it all, in my opinion, is the core to all interventions should be gradual exposure to movement they enjoy.

Movement is best

I am not saying surgery doesn’t have a place, my issue is with the ‘try that and if they can’t don’t worry, we will sort it’ stuff. In addition, there are not enough good surgeons who refer to therapists to support and optimize their return to their goals, function and life. I also have people every week who both didn’t improve after surgery and say ‘oh, they didn’t tell me to come for physiotherapy’. We can do better. Food for thought.