The information that follows is for educational purposes only and is not a substitute for seeing a licensed healthcare professional face-to-face for a thorough physical examination and treatment recommendations.
Non-Surgical Treatment / Pathway
by Terry Kane, Registered Physiotherapist | Owner & Founder of OrthopaedicsCanada.com Network
“There is no joint that I can’t make worse through surgery. That’s why surgery is always the last treatment option.”
Anon, Orthopaedic Surgeon
- Given the risk of complications with surgery, it’s always considered the last treatment option, unless it is (a) a medical emergency or (b) the patient has exhausted all reasonable non-surgical treatment options – without improved function.
- Every day there are patients around the world who return to work and sports without the need of an MRI, cortisone injection, or seeing a surgeon.
- This short article identifies the stages in the non-surgical pathway of treating musculoskeletal / orthopaedic injuries and conditions.
- The keys to avoiding surgery are (1) getting an accurate and reliable diagnosis as soon as possible and (2) starting the most appropriate treatment program – as soon as possible.
Stage 1: Obtaining an accurate clinical diagnosis.
- Pain and disability can be caused by one or more injured tissues.
- The success of any treatment plan depends on the ability to determine exactly what tissue(s) are causing your pain or disability.
- An accurate clinical diagnosis can only be made from a face-to-face, hands-on physical examination – NOT over the phone or video call.
- A physical examination by an experienced physician is critical to get an accurate diagnosis and rule out serious conditions that may require urgent medical care (fractures, infections, neurological injuries, tumors, pediatric injuries).
- Regrettably, many patients assume their pain will just go away so they don’t see a physician and consequently, put themselves at increased risk of delayed healing, developing chronic pain, and permanent disability.
Stage 2: Early Healing & Pain Control (Protection)
- Stage two consists of protection at the site of injury.
- Protection at the site of injury allows early repair tissue to form and prevents accidental re-injury.
- Protective devices such as casts, slings, braces, splints, and crutches are often used during this period.
- How long a joint needs to be protected depends on (1) what tissue has been injured and (2) z how much damage there is to the tissue.
- It is important to understand the absence of pain does not mean your injury has fully healed.
- Premature exercise or activity can result in re-injury, delayed healing, chronic pain, and disability.
- Ultimately your physician and your physiotherapist will determine how long to protect your injured tissue before safely progressing to stage three.
Stage 3: Early Exercise (Range of Motion)
- Although protecting a joint in a cast or brace can be helpful, it can lead to joint stiffness as well as a loss in muscle strength.
- Stage three consists of exercises to restore the joint range of motion.
- Range of motion exercises are performed slowly and carefully to restore the full range of motion without disturbing immature repair tissue.
- Your physiotherapist will select safe and appropriate mobility exercises based on your injury and stage of tissue healing.
Stage 4: Middle Exercise (Muscle Strength)
- Stage four consists of restoring muscular strength and endurance – without disturbing repair tissue at the site of injury.
- Strength exercises involve light resistance, to begin with, and progress in resistance based on the recommendation of your physiotherapist.
- Your physiotherapist will select safe and appropriate strength exercises based on your injury and stage of tissue healing.
Stage 5: Late Exercise (Neuromuscular Function)
- Stage five consists of rehearsing neuromuscular “motor programs” also known as tasks or skills.
- The goal in this stage is to perform tasks with the required speed, accuracy, endurance, and power to prevent re-injury from a premature return to work or sports.
- Running, jumping, throwing and swimming are examples of sports motor programs.
- Work tasks include things like house cleaning, carrying tools, climbing ladders, and bending and lifting boxes.
- Based on your work or sports tasks, your physiotherapist will select safe and appropriate exercises for your condition.
Stage 6: Return to Work & Sport (Medical Clearance)
- Stage six consists of seeing your physician or physiotherapist for medical clearance before returning to work full duties and/or sports.
- Returning to work or sports prematurely and without medical clearance, can result in delayed healing, chronic pain, and permanent disability – that may not be corrected by surgery.
Your Checklist
- See a physician for a face-to-face physical examination as soon as possible to get an accurate clinical diagnosis.
- See an experienced orthopaedic physiotherapist for a written non-surgical treatment protocol for your condition/injury.
- To avoid re-injury, always follow up with your physiotherapist before progressing to the next stage in your protocol.
- Reduce the use of pain and anti-inflammatory medications as soon as possible.
- Stop smoking in any form – it can delay tissue healing.
- Don’t return to work or sports without your physician and physiotherapist’s permission.
