Rehabilitation deserves more respect

  • Sunday 09 November 2014

I've written previous blogs lamenting what I think is an excessive emphasis on surgery for a lot of common musculoskeletal conditions. While surgery has an important role in some cases, I think we are too quick to resort to a surgical cure for many problems that will do as well (if not better) with a conservative rehabilitation program. This is best exemplified in anterior knee pain (where I think surgery has almost no role) but it could also pertain to other conditions such as tendinopathy, tennis elbow, rotator cuff disease of the shoulder, and plantar fasciitis ('heel spur'). As a Sports Medicine consultant, I see many conditions that don't require surgery.

If it isn't bad enough that people are having surgery unnecessarily, I'm astounded by the lack of respect for post-operative rehabilitation.

I was casually speaking to a recently qualified surgical colleague the other day. We were discussing surgical treatment of a common shoulder condition called impingement. Impingement of the shoulder presents as pain in the front of the shoulder due to 'impingement' or pinching of the rotator cuff tendon of the shoulder against the undersurface of one of the shoulder bones. While initial treatment should always be conservative, I acknowledge that subacromial decompression is a good option for cases that fail a rehabilitation program and one or two cortisone injections.

However, the discussion got a little more interesting when we spoke about post-operative care. The surgeon said that his hospital had ceased all post-operative physiotherapy after decompression surgery because (quoting him directly) "physiotherapists make our patients worse". Well what do you tell patients who have had the procedure but want to return to sport such as tennis, squash or weight lifiting? I wasn't sure he knew the answer. (And just for the record, I know orthopaedic consultants who understand the importance of a good post-operative rehabilitation program).

I would argue that good outcomes following surgery arise in part due to excellent post-operative rehabilitation. Surgery may correct the structural problem, but it's the post-operative rehabilitation that gets people back to full function. This point of view could pertain to many areas of surgery but especially to hip and knee arthroscopy and tendon surgery. Rehabilitation deserves more respect. I just wish some of my surgical colleagues would think the same.

Tags: surgerycortisone injectionsrehabilitations

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