Non-Surgical Treatment



By  Terry Kane, Registered Physiotherapist (Calgary, Alberta) 

Founder | Owner, |

Even with an abnormal MRI – surgery is not the first treatment option for back pain, ligament, meniscal and disc injuries, rotator cuff and Achilles tendon tears, repetitive strain injuries and osteoarthritis.   

Given the potential complications with any form of surgery, it is always considered the last treatment option and only undertaken in emergency situations or when all non-surgical treatment options have been exhausted and unsuccessful.

There is more and more published research every year that demonstrates safe and appropriate exercise is the single most effective non-surgical treatment method to improve joint mobility, muscular strength and functional independence at any age.

A non-surgical treatment protocol is designed (1) to help facilitate the restoration of anatomy (healing) and (2) to restore physiological function through safe and appropriate exercises at each stage of tissue healing.

Every stage in a protocol consists of a combination of protection at the site of tissue damage and exercises to help restore function.  In the early stages, protection is the priority (healing), however as repair tissues mature, the need for protection diminishes and the amount of exercise increases.

Because injuries can vary in severity and involve multiple tissues (bone, cartilage, tendon, muscle, etc), there is no such thing as a single protocol that fits every patient. This is why protocols are individualized by orthopaedic physiotherapists to every patient based on the clinical presentation at each stage of tissue healing.

Stages in Orthopaedic Protocols

Stage 1: Obtaining an accurate clinical diagnosis

Stage one involves seeing a physician in-person and undergoing a thorough physical examination in order to arrive at an accurate clinical diagnosis – so the patient can be put on the most appropriate treatment program.

An accurate clinical diagnosis cannot be made from watching a Tik-Tok video, a zoom call, an MRI or an x-ray – the patient must always be physically examined in-person, face-to-face.

Not only is the diagnosis important but it’s critical to see a physician to rule out serious conditions that may require urgent medical care (fractures, infections, tumors, pediatric injuries).  

Stage 2:  Early Healing & Pain Control (Protection)

Stage two consists of a period of protection at the site of injury. Reduced motion and / or load at the site of injury helps early repair tissue to form and prevents re-injury. Examples of protective devices include casts, braces, splints, crutches etc.

Stage 3: Early Exercise (Range of Motion)

Stage three consists of a period of resuming some activities of daily living and gentle range of motion exercises. The exercises are gentle to prevent joint stiffness without disrupting early repair tissue.

Stage 4: Middle Exercise (Muscle Strength)

Stage four consists of a period of safe, appropriate and progressive rehab exercises to restore full range of muscular strength and endurance without disrupting repair tissue.  

Stage 5:  Late Exercise (Neuromuscular Function)

Stage five consists of rehearsing neuromuscular motor programs specific to the patient’s work and sports activities. The goal is to be able to perform tasks with the required speed, accuracy, power in order to prevent re-injury from a premature return to work or sports.

Stage 6: Return to Work & Sport (Medical Clearance)

Stage six consists of a progressive return to work and / or sports performance (work hours, sports drills) but also seeing your physician and physiotherapist for medical clearance before returning to work full duties and / or sports.

Each Stage of a written protocol should include the following information;

  1. Goal(s) of the stage.
  2. Patient education on activities to modify or stop. (protection).
  3. Safe and appropriate exercises as indicated.
  4. Clear instructions on the load and volume of exercise (sets and reps)
  5. Clear instructions on when it is safe to progress to the next stage of rehab.
  6. A date for a follow up appointment with a physiotherapist to determine if it is safe to progress to the next stage of rehab.

Your to-do list.

  1. See a physician for a face-to-face hands-on physical examination and clinical diagnosis. 
  2. See an experienced orthopaedic physiotherapist and ask for a copy of a progressive non-surgical treatment protocol for your condition/injury.
  3. To avoid re-injury, always follow up with your physiotherapist before progressing to the next stage in your protocol.
  4. Reduce the use of pain and anti-inflammatory medications as soon as possible.  Masking pain with medications can result in delayed healing, internal bleeding, ulcers, kidney damage, high blood pressure and drug dependency.
  5. Stop smoking. Smoking delays tissue healing.
  6. Don’t return to work or sports without your physician and physiotherapist’s permission.
  7. Check out the patient education videos below to learn about your injury, condition and treatment options.