Physical Therapy Versus Surgery
October is National Physical Therapy Month, so the American Physical Therapy Association (APTA) is launching a new campaign, “#ChoosePT,” to celebrate. Essentially, “#ChoosePT” is all about informing the public that physical therapy is an excellent alternative to the more commonly known methods for treating pain, such as opioid use and surgery. Although surgery is frequently a preferred treatment for patients eager to return to their preinjury lifestyle, recent research has proven that physical therapy is just as valuable a resource.
Picture this: a student-athlete is playing in the first game of the season. Their teammate sends them the ball, and they are lined up perfectly to score. They plant their foot and take the shot, but then, out of nowhere, a defender takes them down. After a trip to the hospital, they’ve been diagnosed with a horrific Grade III ankle sprain, and are faced with the choice of a “quick” surgery or months of rehabilitation in physical therapy. And they’re not alone- 27,000 people in the United States alone sprain their ankle every day and many have to make this same choice.
Grade III sprain treatment is a fairly controversial topic among researchers, with some favoring physical therapy and others leaning towards surgery first. Yet research shows that patients who choose physical therapy return to work 2–4 times sooner than those who choose surgery. Furthermore, 75 percent of studies report a faster return to all other preinjury activity with those who choose physical therapy over surgery. Therapy is often more cost effective than surgery, and is also more likely to help prevent further ankle sprains in the future. While the research process is always ongoing, the general consensus has been that physical therapy works as well, if not better, than surgery.
This is not just the case for ankle sprains. A 2013 New England Journal of Medicine study proved that for people experiencing osteoarthritis and/or meniscal tears, physical therapy is equally as effective as surgery. The study focused on 351 patients aged 45 years or older with these injuries, with some receiving just physical therapy and others receiving surgery first. After 6–12 months, all patients who did not choose surgery had the same or less pain and the same or more functional improvement than those who chose surgery.
Despite this fact, many patients do not want to put the time and work into physical therapy, and think surgery will be a fast cure. But again, in the words of APTA President Paul Rockar, “Surgery may not always be the best first course of action,” as surgery comes with many risks and often unforeseen costs by the patient eager to return to their preinjury lifestyle. Given this information, it is important to spread the word about the common benefits of physical therapy. It is potentially the best course of action for people experiencing an injury, though they may not realize it when under the stress of an injury.
Of course, there will be times when surgery is the best option to handle an injury. In these circumstances especially, patients, physicians, physical therapists and/or surgeons must all work together to determine what is right for the patient, both immediately and long-term. At the same time, it is also important for patients to be their own advocate, and to speak up and inquire about physical therapy as an alternative.
All 50 U.S. states and the District of Columbia have passed direct access, meaning a patient can visit a physical therapist without a referral or prescription from a physician. In Massachusetts, there are no limitations for what treatment a physical therapist can provide on the first visit without referral; so on the first visit, the therapist can help to determine if physical therapy is the best option or if outside referral and/or surgery is the better option. Given all the studies and research available on the validity of physical therapy as an alternative to surgery, don’t be afraid to “#ChoosePT.”
