People often look at surgery and physical therapy (PT) as mutually exclusive. But that’s not always the case. In fact, these days we’re seeing these two departments collaborate more often than before.
That’s because there’s significant research supporting the benefits of PT before and after surgery.
Some people consider surgery as the silver bullet that can rid them of their pain. And so don’t pay much attention to physical therapy.
We’ve seen it happen many times with our patients.
Even if patients have mobility issues – that may or may not be related to the issues they’re seeking surgery for – they tend to ignore it until after surgery. We’re here to show you why that’s not the best approach to a healthy life.
If your surgeon has recommended PT for you before scheduling your surgery and you’re wondering why that is, then this article will answer that for you.
Here, we’ll discuss the top two reasons why exploring PT before surgery is highly beneficial. We’ll also cover some common conditions for which physical therapy might be better than surgery.
Reasons to Explore PT Before Surgery – Supported by Research
PT is not always better than surgery and vice versa. But you can definitely benefit from some physical therapy before going under the knife.
There is high-quality scientific evidence that preoperative exercise is safe for most surgical patients, including and not limited to cardiac surgeries and joint replacement surgeries.[i]
Here are the top two reasons why you should explore PT before surgery.
PT Can Improve Your Post-Surgical Outcomes
PT before surgery is known as pre-rehabilitation or prehab.[1] Research shows us that prehab reduces the duration and intensity of rehabilitation after surgery.
Patients who take PT pre-surgery tend to recover faster, have long term benefits, reduce hospital stays and improve in all areas as well as the area for which they underwent surgery.[ii]
For example, the PT prehab treatment for a patient who has a hip surgery scheduled might include working on the stamina, lower limb musculature, breathing exercises and increasing lung capacity.
This holistic approach of physical therapists helps you improve your post-surgical outcomes. It not only treats the condition on hand but improves the quality of life and works on overall wellness.
Justina A. Gawel et al. (2013) did a systematic review on studies on PT before total hip or knee replacement surgeries. They found that patients that had PT before surgery had reduced likelihood of admission to a rehab facility after being discharged from the hospital, reduced pain and improved satisfaction. However, the effect of PT on functional outcomes still remains unclear.[iii]
A systemic review by Hulzebos et al. (2012) showed that preoperative physical therapy for patients scheduled for elective cardiac surgery has tremendous benefits. It reduced the risk of pneumonia and postoperative atelectasis (collapse of some areas of the lung).
The duration of postoperative hospital stay was also significantly less in the patients that had PT before surgery. One of the studies in the review also reported improved functional outcomes in the form of a better score of a six-minute walk test for patients that had PT.
Physical Therapy an Eliminate the Need for Surgery
In certain cases, PT can help you avoid surgery completely. Your surgeon and physical therapist are the health care professionals that can best guide you in this regard.
PT is non-invasive so it usually carries less risk than surgery. And for those of you paying out of pocket, it can be cheaper as well. So you should explore PT if the surgery is not necessary. You might be surprised at how much improvement you can make with the proper therapies and exercises.
A randomized trial by Jeffrey N. Katz et al. (2016) showed that the group that had surgery with or without preventive PT had almost the same level of pain reductions as the group that had only had PT for their meniscal tear and osteoarthritis.
Another randomized control trial showed that manual therapy, clinical exercises and a home exercise program may reduce or delay the need for knee surgery in patients.[iv]
A 2018 RCT compared the effects of surgery and physical therapy for treating Femoroacetabular Impingement Syndrome. They did a 2-year follow up on the patients and found that there was no difference in the outcomes between the two groups. That goes to show that PT can have quite similar effects on this condition as surgery.
Common Conditions Physical Therapy Can Treat Instead of Surgery
In the research cited above, we’ve mentioned several musculoskeletal conditions that physical therapists can help with. Here are five more commonly occurring conditions that can –not always – be treated by physical therapy instead of surgery.
1. Meniscal Tears
Meniscal tear repair surgery is not always the most effective way to treat this condition.
A randomized control trial by Victor A. van de Graaf, et al (2018) found that physical therapy can be considered as an alternative for surgery in patients with a non-obstructive meniscal tear.
Both the groups (patients who underwent surgery vs. patients the didn’t) in their study had similar improvements in function in the two-year follow-up.
The trial also concluded that the surgical group had more adverse effects after the surgery. These included repeat surgery and more outpatient visits due to pain.
2. Osteoarthritis (OA)
Joint replacement surgery is a commonly performed procedure in end-stage osteoarthritis. But a preventive PT program can eliminate the need for this surgery in OA patients.
Multiple studies have concluded that there is no significant difference between the preventive PT and surgical groups.[v] Some trials have also compared surgical groups with sham and found no statistically significant functional improvement or pain relief in either of the groups.[vi] [vii]
This goes to show that prehab for osteoarthritis is just as, if not more, effective for treating the condition as surgery.
3. Pelvic Organ Prolapse (POP)
Pelvic organ prolapse affects 50% of women globally. It results from a weakness of the pelvic support muscles which could be due to ageing, childbirth, straining with constipation or genetics.[viii]
Surgery is performed in 6-18% of the cases while the rest of them are treated with exercise and pelvic muscle strengthening programs. Physical therapists use guided pelvic floor muscle training and Kegel exercises to treat POP.
Several studies and trials have found that Pelvic floor physical therapy (PFPT) is highly effective in treating POP.[ix] It can even reduce the symptoms and improve the quality of life of patients.
4. Degenerative Disk Disease (DDD)
40% of people above 40 years of age have DDD.[x] Surgery is an option when there is severe pain that drastically decreases the functional performance and the quality of the life of the patient. Otherwise, a prehab program designed by a physical therapist is effective in managing symptoms.
A 2014 long-term study found that there was no significant difference in pain, health status, satisfaction, or disability between patients that had surgery and those who had conservative management for degenerative disk disease.[xi]
5. Small to Medium Rotator Cuff Tears
The prevalence of rotator cuff tears in the non-athletic population is about 25% in people in their sixties. Surgery is used for repairing rotator cuff tears. But the most significant issue with that is recurrent tears, especially in the older population.
That’s why PT is an effective approach to treat rotator cuff tears.[xii] This approach improves functional deficits and muscle weakness thus generating better long-term effects.
Benefits of Doing PT Before Surgery – The Takeaway
Physical therapy is recommended for patients scheduled for surgery. It can improve your post-surgical outcomes and decrease pain and reduce hospital stay. Some surgeons refer you to a PT when you schedule surgery. If yours didn’t, then you should either ask about Prehab from your surgeon or get a consultation with a physical therapist on your own to explore other options.
In some conditions, PT can help you avoid surgery altogether. It depends on your case, medical history, lifestyle and other factors. Your physical therapist can help you make that decision after reviewing your case and talking to your surgeon.
In either case, there is sufficient scientific literature supporting prehab. So if you have surgery coming up or a painful condition that might require surgical intervention down the line, be sure to explore PT first.
[i] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4072442/
[ii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116720/
[iii] https://www.researchgate.net/publication/286074147_Does_pre-operative_physical_therapy_improve_post-surgical_outcomes_of_patients_undergoing_a_total_knee_andor_total_hip_arthroplasty_A_systematic_review
[iv] https://www.acpjournals.org/doi/full/10.7326/0003-4819-132-3-200002010-00002
[v] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690119/
[vi] https://pubmed.ncbi.nlm.nih.gov/18784099/
[vii] https://pubmed.ncbi.nlm.nih.gov/12110735/
[viii] https://pubmed.ncbi.nlm.nih.gov/24142054/#:~:text=Results%3A%20Pelvic%20organ%20prolapse%20(POP,widely%20from%206%20to%2018%25.
[ix] https://pubmed.ncbi.nlm.nih.gov/24290404/
[x] https://pubmed.ncbi.nlm.nih.gov/23074480/#:~:text=The%20prevalence%20of%20DDD%20is,aged%2080%20years%20or%20older.
[xi] https://pubmed.ncbi.nlm.nih.gov/24047821/
[xii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827371/
