Quite literally the million, or even billion, dollar question. When should you have surgery and when should you avoid it like the plague? Physiotherapists and surgeons frequently work together to help people recover from their injuries. But at the heart of this relationship is a conflict. One group of professionals are doing everything they can to stop you needing surgery. The other group are experts in providing that surgery.
In this month’s article we discuss what you need to consider before going under the knife. Have you explored all viable alternative treatments? Is your condition one that responds well to surgery? How much do your symptoms affect your life? Are you the kind of person that responds well to surgery? If you’re considering an operation or want to avoid one in the future then read on…
Who / What Is This Article For?
Some things quite obviously need surgery. Chances are if you’ve got a broken bone sticking out through your skin you’re unlikely to be reading this article. More likely you’re being rushed in for some much needed surgery. This article is not about this kind of condition.
It’s more about those injuries you’re starting to wonder if you’re going to need an operation. The knee problem that just won’t go away. The shoulder that just won’t move like it used to. The low back pain that simply won’t go away. Conditions that have come out of nowhere and you don’t know why. Maybe you’ve had a scan or maybe you’re thinking about getting one to try and understand just why you’re getting the pain. Almost hoping to find something on the scan that will be ‘the’ explanation of all of the issues you’ve been having.
This article is also aimed at those who have perhaps had a scan. You may have had something ‘found’ on the scan – what’s your prognosis? Was what was found definite and certainly in need of surgery? Or was it more ‘general wear and tear’ or something minor like a minor disk bulge or maybe mild or moderate cartilage degeneration in a joint.
Finally, this article is also aimed at those who have a condition that is traditionally operated on. Cruciate ligament rupture for example. Severe disc bulges. Joint replacements. And anything that involves fixing things in place with screws – can’t come up with a better catch all expression than that! Do you absolutely need surgery? Is there an alternative way?
What this article isn’t is questioning surgery when surgery is clearly needed. There are many conditions that absolutely need surgery and that is the best way forward. Here we talk about conditions that perhaps you didn’t know there was an alternative to surgery. This is all based on the latest research and backed up by what we see clinically day in and day out.
So we’ll first talk you through considerations about surgery. What are the questions you should be asking to determine whether surgery is right for you? Then at the end of the Blog we’ve picked an unlucky 13 of our ‘favourite’ conditions and go into a bit more detail about our experience in each of them. And maybe introduce you to a different perspective which will help you make better sense of your condition.
How Severe Are You Symptoms?
If your symptoms are significantly affecting the quality of your life from day to day then that will more likely lean you towards surgery. The inherent risks involved with surgery are very much worth the potential benefit you may receive from surgery. If your symptoms aren’t too bad or it’s being done as a precautionary measure I would question the necessity of surgery.
Are you considering surgery for fear of how bad it might get? In which case two things. Firstly, you will still be able to take the surgical option if you’re desperate at a later date. Secondly, have you considered your fear might be adding to your pain? Fear of making things worse is the biggest single determinant in the amount of pain you feel. If you brain fears you might be doing damage it will give you the sensations to go along with that view.
I appreciate this statement needs a lot of explaining. If you want further info please check out our previous Blog: Just What Is Pain and How Do I Reduce It?
What Is Your Expected Recovery From Surgery?
Some surgeries have a really quick turnaround time and recovery. Generally the surgeries where they don’t ‘rummage around’ too much have a quicker recovery. Surgeries where they open you up extensively or hack bits off and re-attach things elsewhere generally have much longer recoveries. I appreciate I’m not a surgeon and that is a gross over simplification of what goes on but it’s a decent rule of thumb.
If you have been recommended surgery find out what the expected recuperation time is. Is that acceptable to you? How much will the potential benefits improve your life? Weigh up how long the recovery time will be versus the proposed benefits. How long have you been out of action already? Can you afford to be laid up for a long period again? What is the prognosis for the operation you are considering? Are there any potential complications?
Have You Tired All Other Possible Options?
Maybe you’ve already tried some conventional physio? Did you do all of the exercises as you were asked? Research suggest between 50-75% of people don’t!
Have you tried alternative forms of physiotherapy like ours? We find that when we realign people physically and emotionally magic things start happening. Have you considering focusing on the psychological side of your condition? What’s going on in life? How stressed are you right now? How stressful has your life been? Have you addressed your baggage?
Stress and trauma stay locked in the body physically until released. Either by moving on emotionally or finding a way to release it. Our hands on treatment being one way. Yoga being another. Being more aware of how you move is another again. We find that most of our clients need to be made aware of how they move or how they react before they are able to choose a better way.
Obviously if your leg is flapping about in the wind after you’ve just been run over by a car you may consider psychology fairly irrelevant at that moment. And in that moment it is. But how did you get run over by the car? Were you in anyway to blame? Were you absolutely concentrating on what you were doing or was your mind wandering onto something that felt more important?
If your accident was a long time ago – lets say anything over a year – a lot of any residual pain you may feel may well be stored trauma from the original accident. At which point any further operations are unlikely to help.
Generally speaking the psychology of conditions is more important for conditions that come on gradually. I would guard against operations for such conditions.
From a physical perspective what techniques and approaches have you tried to get your injury better? There are countless techniques and approaches within the world of physiotherapy. As a practice we use Muscle Activation, Fascial Alignment, Relaxation Techniques, Joint Mobilisation and Sports Massage. If non of those work for you there are lots more practices out there that have a whole range of other options. Try them too!
How Old Are You?
The older you are the longer it takes to heal. Sorry. Don’t shoot the messenger. It’s just the way it is. Factor this into your decision making process. Now being young at heart always helps (as we discuss in our last Blog: How To Grow Old Disgracefully). This will literally make your recovery better. This is part of a bigger consideration…
What Kind Of Person Are You?
As we alluded to above. If you’re a happy go lucky young at heart type, your response to surgery will be better. If you are more anxious or fearful then you’re the kind of person who might fair a bit worse in terms of recovery. It’s always best to be in the best possible mental state before you have any surgery and discuss any concerns and fears you may have before hand with your surgeon and / or physiotherapist.
Physiotherapists often talk about prehabilitation. Getting your body in as good a shape as possible before surgery. Make those muscles what will be affected by the surgery strong before they get weaker as a result of recovery from surgery. There is research to suggest that even if you can’t move you leg if your visualise yourself doing strength exercises it will take you less time to get your strength back!
I would say it’s also worth prehabilitating your mind too to get you in the best possible shape before surgery. You may even (and I would expect you to) feel less pain when you do such a thing. How you do that is down to you. We find that many people get an emotional release from the physical work we do. Helping people to move on emotionally leaving old stress or trauma behind.
You may need something a bit more in depth than that like counselling or psychotherapy. Or you may just need nudging in the right direction so you lead a less stressful life, become less sensitive, and therefore feel less pain. It sounds so simple when I write it down like that!
What Do You Want To Get From Your Body?
Do you need your body to compete at the highest levels of sport? Do you just want to be able to do some recreational exercise? Does the sport you do put you at risk of re-injury? Or will you be able to cope without an operation? Can you modify what you do to reduce the necessity of an operation? If you do change what you do how does that make you feel about your quality of life?
The best example here is the discussion as to whether to have a cruciate ligament reconstruction. If you rupture your cruciate ligament skiing but most of the year you are a road runner. Your body should be able to adapt to life without a cruciate ligament and you will be able to carry on running.
What Are Your Beliefs?
Whatever you believe you’ll probably be right! If you completely believe in surgery and believe that it will cure all your ills then probably it will. If, like me, you believe surgery is always an absolute last option then maybe that doubt in your mind means you won’t respond as well to surgery.
My personal belief here is based very specifically on conditions that come on gradually. The kind of things that don’t have a spectacular start point. These are conditions, without wanting to sound too harsh, that we have brought on ourselves. It stands to reason that we have ability to unwind these conditions if it was ourselves who got us there in the first place. if we unwind ourselves and unwind our beliefs. Or quite simply change something about what we do and how we exist.
I appreciate the bold statement ‘whatever you believe you’ll probably be right’ may be a bit ‘fluffy’ for some. But there is an increasing body of evidence to back up this statement. Bruce Lipton is at the forefront of this work. I would recommend his seminal book – The Biology Of Belief – to to anyone interested. Ideal for the believers in such concepts and those who are still slightly skeptical but willing to keep and open mind and give it a go. Anyone completely closed to off to such ideas probably hasn’t made it this far down the article!
13 Conditions You Really Should Think Twice About Operating On
So we’ve got to the specifics and I’ve literally run out of words. I’ve already hit my maximum amount of words for a Blog. Clearly I’ve been waffling a lot. So I’m going to leave it like the end of The Empire Strike Back as a massive cliff hanger. Don’t worry you won’t have to wait 3 years to find out what happens. I’ll be publishing the juicy bits next month. If you’d like to make sure you get to read the second part of this Blog then please subscribe to our newsletter using the sign up box top right of this page.
Coming soon to a Brighton Sports Therapy Blog near you…
So we didn’t quite get to the specific conditions but I’ve achieved my goal in introducing you to the underlying principles you need to consider whether that’s now or into the future. I think traditionally surgery has been performed too frequently. The NHS funding by trust is based on how many operations are performed. However, times are changing. In my 15 years in the trade I have seen attitudes change and a much more balanced view being taken by conventional medicine as to whether to operate or not.
That said, I still feel more operations are being done than need to be. However, I speak from an area of expertise that isn’t available to conventional medicine. I am also very aware that my experience has been skewed by people who haven’t fared too well from surgery. If their surgery was a complete success why would they pay me money?
My opinion with regard conditions that don’t have a specific start point is much stronger. In my experience these conditions come about from an increase load in the area of pain. This increase load is rarely the fault of the bit that hurts. If we intervene with surgery in these areas it only ‘blocks’ the mechanics at this pain point. Even if surgery is successful at reducing or eliminating pain in these areas then the mechanical limitation will just materialise as symptoms elsewhere.
For this reason I encourage anyone considering surgery to try all available options before going under the knife. Of course I’d love that alternative option to be our clinic! But really, anything that takes you fancy or feels a right fit for you. You can try chanting or crystal healing and go as alternative as you want, but please, do try.
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This post first appeared on our Brighton site.