We explain why patients find themselves worse off after surgery

It often comes as a surprise to patients when we explain to them that surgery should always be a last resort. It can often seem the ultimate 'fix' to a problem, and some patients jump at the opportunity to jump under the knife.Our experts explain why they should hold back and reconsider.

Butchers cut meat, but don't feed the cows

Health professionals have their own areas of expertise. If a patient sees a GP they will be given pain killers to mask the problem. Likewise, if they see a surgeon they will often be offered an injection or surgery to 'fix' the problem.In the NHS, patients will often see their GP numerous times and given prescriptions before being referred on to an MSK/musculoskeletal/physiotherapy type service. Patients will then typically receive hands off, exercise based 'treatment', before being referred onto the surgeons because 'all options have been exhausted'.The problem is that everybody tends to focus on treating the 'symptom' rather than the underlying 'cause'. When pain developed gradually and for no apparent reason, the 'cause' is usually biomechanical and the answer lies elsewhere in the body.

Your pain is like an onion

Following pain or injury, the body will compensate and adapt. As the body moves differently, this overloads other tissues which are now taking on extra strain. This overload may be subtle, but the repeated overload is significant. The body will then adapt for this, and the cycle goes on.The result is that tissues being overloaded and painful, are the end result of weeks, months or years of adapting and compensating. The layers of problems need addressing sequentially for the injury to be resolved.

'Proper' physio can help

Without effective physiotherapy, patients are unable to identify and resolve the layers of problems associated with chronic pain.The physiotherapist should carry out a full thorough assessment of your biomechanics to identify what is the underlying issue.Hands on treatment is needed to effectively treat the biomechanical restrictions - stretches and exercises alone are often inadequate.

Why not surgery?

When a surgical incision is made into the patient, this initiates a cascade of problems - further adding layers to the 'onion'. The patient will recover from the surgery left with pain, cuts through the muscles, and muscle inhibition.This in turn affects the nervous system, and changes the muscle activation patterns. So on top of the layers of compensatory mechanisms from pre-surgery, there are now even more.Importantly, the site of the pain which has now been operated on may not have even been the underlying problem.Typical examples of these cases are:

Shoulder Impingement (sub-acromial decompression)

This is where the supraspinatus tendon becomes chronically inflammed as a result of restriction in the back and poor movement of the scapula.Invasive surgery to shave bone off to make more space for the supraspinatus tendon doesn't address the underlying issue, and adds move muscular compensation and abnormal scapula/shoulder movement to the problem.

Low Back Surgery

Persistent low back pain often leads to an MRI scan which shows disc bulges, and patient then offered injections and surgery. To get to the disc, the surgeon must cut through the tissues to reach the spine, then cut/remove bulges in discs. Patients then go on their merry way, without realising how weak their back now is.The disc bulges happen for a reason in the first place - weak muscles, poor postures, restrictions in other joints. This overloads the low back and the disc bulges under the excess pressure.It is worth noting that many of us live with asymptomatic disc bulges. A disc bulge does not automatically mean surgery is required. As the inflammation reduces, the disc bulge can reduce too.It is extremely rare that we see patients further down the line who are not worse off after their low back surgery. These patients always say they didn't have any physio/rehab after their surgery, and never addressed the issues they had for years prior to their surgery.

Knee Arthroscopy

Surgeons will sometimes offer to 'go in and have a look' or 'give the knee a wash out' when a patient continues to present with chronic knee pain. This knee pain is often a result of weakness in the hips, causing the knee to go into knee valgus and overloading the knee structures.Typically an MRI scan will show up clear, and the arthroscopy will debride a bit of 'wear and tear' on the meniscus. Again not addressing this muscular imbalances and hip issues.

Tennis/Golfer Elbow

Repetitive strain of the forearm muscles results in a chronic inflammation of the tendons - typically known as Tennis and Golfers elbow. This pain will have resulted in abnormal compensatory movements at the shoulder and scapula, often resulting in a protracted shoulder girdle.This sub-optimal position, results in increased tension in the forearm with gripping to compensate for the lack of shoulder stability now present. The result - a tennis/golfers elbow which doesn't resolve. Surgeons will inject and operate. Physio's will work on the patients back and shoulder girdle, then sequentially restoring normal function in the arm.

Exceptions

We do not deny that some patients do reach the stage where surgery is required, but they do this as a last resort and have exhausted all options beforehand.Our recommendation is that before committing to surgery, ensure all physiotherapy options have been exhausted from a reputable physiotherapist.

Got any thoughts or questions?

Please post any thoughts or experiences of your own below.If you feel you may benefit from our expertise in injury management and surgery prevention, please do not hesitate to contact us. Speak to us if you feel your upcoming surgery should be avoided.Additionally, if you have been unfortunate enough to have had a 'failed' surgery, then come and see our experts to address the underlying problem.Sports Physio UK – Website | Facebook | Twitter | Instagram | Book Online

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