“Will I Need Surgery?”
When we suffer an injury, whether acute or long standing, the pain and loss of function can be a distressing experience. On top of that, the next step of deciding what to do about it next can be overwhelming. As a chiropractor, I have many people that come into my office looking for guidance through this difficult process. A question I frequently get asked, even before a thorough assessment begins, is “Do you think I’m going to need surgery?”.
The quick and simple answer: most likely no. For the vast majority of musculoskeletal injuries, including low back pain or extremity injuries, as long as no significant structural damage is suspected (fractures, complete ligament tears, etc.), surgery is typically not advisable right away. Instead, most sources in the literature will recommend that a 6-week course of ‘conservative care’ is the best first-line option to address the condition.
The good news is that most of these injuries will respond just fine to this strategy! Now then… what the heck is ‘conservative care’?
What is Conservative Care?
The term ‘conservative care’ is quite vague and can mean a number of different things. As a chiropractor I deliver this type of care in terms of non-invasive treatment such as muscle release therapy, joint mobilization/manipulation, rehabilitative exercise prescription and contemporary acupuncture. All of these treatment methods are non-invasive (aka. CONSERVATIVE) techniques that are intended to reduce pain, improve range of motion and ultimately return patients back to their full pre-injury function.
Some other health professions that come to mind when considering conservative care:
- Massage Therapy
- Naturopathic Medicine
Why Go This Route First?
Knowing that the vast majority of injuries will improve with conservative care, it seems like a no brainer to go with this as the first line of treatment, even when the initial pain is severe (such as an acute disc herniation, OUCH). As long as the practitioner who assesses you is skilled at diagnosing the condition and competent in providing the appropriate form of management, non-invasive techniques are generally highly effective and recommended.
The added benefit to this approach is that once we get patients out of the initial painful phase, greater focus is given to correcting the UNDERLYING CAUSE of the condition. Identifying muscle tension imbalances, movement inefficiencies, and/or compensation patterns that may have contributed to wear and tear in certain areas in the body can sometimes be the key to a long-term solution. Surgical interventions can be great in the short-term (but not always) for alleviating pain, but might not address these underlying factors that contributed to the injury in the first place and thus may not provide the best long-term prognosis. Finally, the fact that surgical interventions come with increased risk of serious complications, it seems wise to avoid the invasive method as the first stop solution.
When to Consider Surgery?
If there is no improvement or worsening of symptoms after at least 6 weeks of conservative care, surgery may be warranted. Of course just because one method has not succeeded, does not mean you have to stop there. Sometimes finding the right practitioner who is competent and a good fit for you can take a few tries, whether it’s chiropractic, physiotherapy or another profession.
- GENERALLY SPEAKING… If no red flags are present upon the initial history taking and physical examination, a trial of conservative care is typically warranted before the consideration of surgical intervention.
- If you have a complaint that you feel would benefit from a trial of conservative care, come and see me at gesund!
- Gugliotta M, da Costa BR, Dabis E, Theiler R, Jüni P, Reichenbach S, Landolt H, Hasler P. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ open. 2016 Dec 1;6(12):e012938.