*This article was contributed by Dr. Austin Misiura of Pure Physical Therapy Miami*What if I told you that “fixing” a torn meniscus, labrum, or rotator cuff tear with surgery leads to the same beneficial outcome as just doing rehab, yet adds a huge risk for complication or permanent damage?Sorry for stealing one of ESPN’s opening phrases, but I really wanted to get your attention.There is now a plethora of research data to show that orthopedic surgery (most specifically arthroscopic procedures) leaves the patient no better off than physical therapy alone. What's more, is that due to negative side effects - like the surgeon's knife adding more scar tissue - there are cases where people are left worse than before the procedure. Or, because pain is multifactorial, “fixing” the tissue damage that shows up on MRI doesn’t change the pain at all.Many times one little procedure starts a cascade of “needing” another surgery to fix an issue stemming from the first surgery, and then a third to fix the second, and so on. It's almost impossible to lead a normal life - much less function at a high level athletically - once you start down that path.Imagine if it was a common thing to need rehab because of damage caused by rehab? Would we accept this as OK, or demand better methods? And yet, there are millions of unnecessary arthroscopic procedures done every year. How can this be?I’ll tell you the reason in a second. But first, a little background...In a study published the day after Christmas in 2013 (I’ve heard it was in this particular journal edition because certain people were trying to keep the results hush-hush, and nobody pays attention to medical research during the holidays), a group of physicians in Finland conclusively showed the world that shaving off the torn tissue from a degenerative meniscus lesion worked EXACTLY THE SAME as a “sham surgery.” So basically half of the participants got the regular procedure, and then in the sham group, the surgeons made the incision, put the tools onto the meniscus, and then skipped the “shaving out the damage” part. The part that physician is telling people is actually “fixing” the problem. And the outcomes in both groups were still identical!Yes, these surgeons actually cut into people’s knees and poked the meniscus with a dull piece of metal in half of the participants to simulate everything about the surgery except what we are led to believe is the important part. These dudes are badass. Simple logic should tell us that the “fixing the meniscus” part of the procedure can’t possibly be important if leaving it out changes nothing, so why did the sham patients still get better?The patients in the sham group still thought they had the "real" procedure done, so they had to rest, take it easy, recover, etc. for a few days, and then go do their rehab steps. The surgery made them rest and recover so that the body could heal, the surgery didn’t actually do the healing. Also, the power of placebo was on display big time here. But if we know that the placebo is a placebo, let’s stop wasting our time and money on it!Would you have surgery if your doctor told you it didn’t matter if you had it or not? Hell no, but that is what they should be telling you. That is what I’m telling you.So if it doesn’t matter - not in the slightest - if the surgeon fixes your torn labrum, ligament, meniscus, whatever it is, would that change your decision? If all surgical patients knew this beforehand, I’d bet most wouldn’t elect to get the surgery done. Why not just skip the hassle and just go straight to the therapy, right?Despite this data being widely available, over 700,000 (!!!) arthroscopic partial meniscectomies are performed in the United States every year. That number is insane. At a cost of $4 billion, we are sitting here wondering what can be done about the health care problems in this country.And that’s just for knees!Hip arthroscopic surgery is on the rise as well. Despite more and more research that says surgery doesn’t work, the threshold of symptoms for MDs to be able to perform surgery continues to get lower and lower. There’s also a recent 746% increase in shoulder surgery for impingement despite glaring evidence that surgical patients did no better than those treated conservatively.The fact that more than 50% of patients whose chief complaint was back pain stated they would undergo spine surgery based ONLY on abnormalities detected on MRI tell me that we are doing something horribly wrong when it comes to educating the public about this stuff. I’ve “saved” a bunch of people who were scheduled for surgery and luckily came to me first before going through with it. But what about all the people that don’t get referred to a physical therapist that can help them before it’s too late? We need to be better educated as a community in order to be able to choose the best treatment options for things that can be fixed without spending crazy amounts of money and putting lives at risk. The grassroots movement needs to start with the patient asking more questions, and seeking out conservative care first even if the physician doesn’t refer them for PT.In Florida, you don’t need a physician referral to do physical therapy - you can just come right in!When I first learned this information I was a young, naive physical therapist. I mostly trusted that what physicians chose as intervention for orthopedic problems was the standard of care because it was actually good for the patient, and it worked. I looked quizzically at my first boss and mentor after he showed me the results of the meniscus sham study and asked “if surgery doesn’t work, and it’s proven to not work, why do all the doctors keep doing it?”Why are all the surgeons so quick on the trigger when it comes to cutting people up? Here’s what he told me: "It’s all about the benjamins,' Austin.”OK so he didn’t say it like that, but it would have been cool if he did.Money makes the world go ‘round, and nobody is excluded from that universal law. “Those guys just want to get paid”, he said. My mind was blown. “The system” is providing substandard medical care in the name of making more money. I was shocked, appalled, and frankly, didn’t believe him. I still thought physicians were God-tier.Not anymore!I really don’t want this to turn into a bash on physicians. Like every profession, there are good ones, and there are bad ones. Without MDs, a whole lot more people would be sick and dying, or already dead. But when it comes to movement, injuries, rehab, and recovery, the current paradigm is not only lacking, but straight up harming the fitness community.It’s time for a shift in our thinking. “Damage” to tissue on MRI is a normal part of aging. The majority of MRIs performed on shoulders, backs, knees, hips come up positive for a tear - and that’s in people who don’t have any pain! How is it that my patient with a tear in their rotator cuff can be pain free and lifting overhead, playing catch, and carrying groceries once I work with them, but the one who goes to the surgeon needs the tear “fixed” first in order to do all that normal stuff? Could it be that the second patient could have been treated with PT also, but they never got to find out?I’m encouraging everyone to make sure they find out. Try the conservative care first. Ask your physician for a PT referral, or just walk into a therapist on your own. The worst thing that could happen if you still elect surgery is that you delay the procedure a little bit.If I can reach just one person with this information, I’ll be happy. I really hope to get into the heads of everyone here in Miami and start a shift in thinking, but I realize I’m fighting an uphill battle against one of the most powerful groups in the country. And to prove I’m not in it for the $$$ like your surgeon is, I’m offering a deal that is - up until now - completely unheard of.If you are considering surgery, or are scheduled for surgery, come work with us first for a month. Afterward, if you still decide to go through with getting cut up (which you won’t, because you will feel amazing) I’ll give you 100% of your money back.Yup. It will literally cost you nothing if I’m wrong. You’ll never hear a surgeon say they will pay you back if the surgery doesn’t work… instead you’re just out of luck.Come to us instead, and learn that moving better = less pain. Let me teach you first hand that tissue damage is such a small part of your symptoms, and that your brain and your body has an INSANE amount of healing potential once you learn to unlock it. Let us begin to save some money in our broken system and maybe get things on the right track in this country as far as the healthcare system goes. Miami is a great place to work on this because we are all passionate about our health and fitness, and the rest of the country is watching us.You don’t have to take my word for it. I’m literally guaranteeing success for you. If you think I’m full of it, I can put you in touch with some of my previous patients that were supposed to get sliced up. They’ll be happy to tell you how good they feel and how happy they are that they didn’t go through with the operation.A movement starts with one person.Is that person you?ReferencesArthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear.Raine Sihvonen, M.D., et. al. for the Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. New England Journal of Medicine; 369. December 26, 2013.Femoroacetabular Impingement Surgery Is on the Rise-But What Is the Next Step? Reiman MP, Thorborg K. Journal of Orthopedic and Sports Physical Therapy. 2016 Jun;46(6):406-8.
