When is it time to have surgery?

If you pay attention to anything I say at all or know me personally, you know I’m pretty anti-surgery. And with good reason, surgeons are too quick to do operate and many of them have no regard for the patient. If surgery doesn’t help you, they don’t care. They "did their job".

When you look at the research, a lot (definitely not all) of the outcomes of common aches and pains have the same results 1 and 2 years post surgery when compared to conservative care or sometimes nothing at all. So why have the surgery? That’s my point!!

But there are 100% times surgery is warranted or needed. When is this and how do you, the patient, make the right call?

First we need to look at what you are dealing with. In some instances such as trauma, acute neurological issues or worsening neurological issues, or red flag symptoms, immediate surgery is ideal, even required. Outcomes support faster surgery. However, most people do not fall into that category. Most people I am talking to are people with nagging low back pain, with that cranky knee or troublesome shoulder. Much of the time, people have non-specific pain- a structures hurts but not due to 1 specific thing.

• Just because it is on the MRI, doesn’t mean it is the root or cause of your problem. Many surgeons use this to their advantage and state “X” is torn so you need surgery. But there are plenty of tears that do not cause pain or they heal on their own. The imaging has to match how you present clinically. If the surgeon does not listen to your symptoms and assess how you move, then they DON’T KNOW what is causing your pain. Many structures, such as the meniscus, tear gradually with age. Symptomatic meniscus tears present a certain way. And nearly all people over the age of 45 will show a tear on an MRI...even people WITHOUT any pain. If your symptoms present like a meniscus tear, MRI confirms it...then proceed with appropriate treatment. (Hint: that’s not a menisectomy).

• Have a good go with conservative care: chiropractic, physical therapy, or exercise! You have to change your lifestyle and work on the underlying issues: this includes sleep habits, eating better, and managing stress. If you try physical therapy and don’t have good success then, it may be time for surgery. However, it is still a win: your body will be better prepared to overcome the surgery by having had PT first. Rest and medication is not conservative care!!! That’s symptom modification. They do nothing for the actual issue. So if you doctor issues some meds and says rest, come back in a month if it is still bothering, that does NOT mean surgery is the next step. Physical therapy can help many areas of pain. Can it heal tears? No. Your body can sometimes. But does a tear automatically equal surgery? No. How is your pain and function? That’s the question to be answered. On a side note: If you weren’t consistent with your PT, you can’t say it didn’t work. Physical therapy and rehab should not be things done solely to you but should educate you on how to manage. PTs are giving directions, not driving the car.

• Be patient. Unless it is an emergent need such as neurological issues where time is of the essence, realize that the body can heal itself….but in time. Surgery may “fix” the tear quickly but the healing times remain the same or longer. Trust the process of healing and know that 12-16 weeks of diligently working on it and teaching your body to adapt is crucial.

The following table has average timelines and expectations on healing.

Now, let me be clear, I am not saying to not have surgery. I am saying there is 100% time and a place. I am saying challenge your surgeon: ask him questions, ask for conservative care first, do your own research on what the latest evidence says (not Wikipedia or webMD). Be prepared for what that means.

When no longer live in a time where someone else is an advocate for you, not even me. Be an advocate for yourself and challenge the norms! Surgery can be the answer but be prepared for the outcomes and make sure you understand the disadvantages that come along with it.

I am of course biased (everyone is), but will try to give you what the research says. Give Body Fix 180 a call!