When you’re in pain from an injury, you may question if surgery is the only answer. Surgery can be an impactful remedy, offering a definitive solution to certain health conditions. However, it might not always be the best first step, or even necessary at all. A physical therapist’s assessment can help determine the right path.
“So many people think physical therapy is massage, stretching, heat and ice—but it is so much more,” says Cassie Casatelli PT, DPT, OCS, a physical therapist and orthopedic specialist at Memorial Hermann | Rockets Sports Medicine Institute – Memorial City. “We can make a huge difference in people's lives and help them avoid unnecessary surgery, such as back surgery that they may not need.”
Casatelli, who’s trained in orthopedic therapy, helps to weigh your treatment options.
Physical Therapy Exam and Treatment
When: If you experience mild or minor injury, pain, swelling or arthritis, alert your health care provider, who may suggest that you see a physical therapist rather than a surgeon, Casatelli says.
If your insurance allows, you can go to a physical therapist without seeing another health care provider first.
“This can avoid delays in care and gets people the help they need when they need it," she says. “Physical therapists can help strengthen around the joint to improve function and improve quality of life. Generally, conservative treatment is used first, such as corticosteroid injections and physical therapy.”
Why: The physical therapist can assess you and may suggest:
- Guided exercises
- Joint Mobilizations
- Muscle stretching
- Pain Relief recommendations
- Tailored Home exercise program
Recovery Timeline: Acute injuries tend to heal within four to12 weeks, though some may take longer.
Your physical therapist will consistently monitor your progress throughout your plan of care. "If your pain or function is not progressing as expected, your physical therapist might direct you to your primary care physician or an orthopedic surgeon," Casatelli says. "Physical therapists have contacts for the providers you might need."
Surgery
When: If your life or future ability to use your limbs becomes threatened by trauma or through natural causes, you may have no choice but to have surgery performed by an orthopedic surgeon or neurosurgeon.
Why: Surgery may fix bone deformities, free trapped nerves, restore blood circulation and stabilize fractures. “If you experience neurological weakness and related symptoms that will require surgery then we do not want to delay it,” she says.
But “for arthritis or back pain, usually surgery is a last resort after conservative treatments fail to help,” Casatelli says. “Advanced arthritis that disrupts basic activities of daily living will more likely benefit from total joint replacement surgery.”
After your operation and, perhaps even before, physical therapy is essential to regain full use of your injured area. You may require the services of a sports therapist or general orthopedic therapy.
If you know in advance that you’ll have surgery, such as a knee or hip replacement, you should talk to a physical therapist. “Then you can do prehab—that is, strengthen the areas surrounding the joint—to get as strong as possible before your surgery,” she says.
Physical therapy is vital to ease pain and reduce swelling. It also helps to restore function, strength and range of motion. “We want to get you back to where you were, with full function,” Casatelli says.
Home therapies such as stretching, strengthening, icing and heating may be needed both before and after your surgery. Your physician and physical therapist can guide you.
You’ll heal faster and more fully if you follow directions for how to conduct rehab exercises, and how often to do them. “Physical therapy is 50-50 between you and the therapist,” Casatelli says. “If the therapist is doing their job, but you are not, you may see results more slowly—or not fully.”
Recovery Timeline: The severity of the injury and resulting surgery will determine how long you’ll need to heal, as will your age and prior activity level. Your surgeon and physical therapist usually can estimate a window of time needed for your adequate recovery.
Be patient and don’t rush your recovery by disobeying doctors’ orders. You could slow your healing or reinjure yourself, which could lead to more surgery.
Your Potential Homework
Stretching and strengthening on your own can be invaluable, Casatelli says. Your therapist will recommend things you can do on your own to promote healing. Using ice or heat also may be suggested, but “most likely that will be a small element in your recovery,” Casatelli says.
