I will always remember a lovely old lady who presented with low back pain in my first few months working clinically. I asked her to bend forward and touch her toes, part of the standard examination for low back pain. Her response will stay with me forever: “Young man”, she said, “If God wanted me to touch my toes he’d have put them on my knees”. And how right she was. Did she need to be able to touch her toes? Maybe not. Does a long distance runner require upper body strength? Absolutely not. Or does somebody with a restriction in end of range knee bend with no pain need surgery to fix what in this scenario is probably a meniscal tear that is not causing pain or worthwhile repairing.
This week I attended a study evening hosted by two of the countrys top orthopaedic surgeons from the Sport Surgery Clinic in Santry. They are both enthusiastic, intriguing and approachable and keen on building relationships with physiotherapists. And it was music to my ears to hear how they themselves are sometimes reluctant to operate. There’s a saying: “If you go to a butcher you’ll get meat”. The idea that surgeons will always want to operate may be fast fading. The non compliant patient is clearly one not isolated to physiotherapists. Failed surgeries happen. The recurrence rate for anterior cruciate ligament injury is 5-8%. All too often patients having undergone spinal fusion end up needing further surgery for other levels not initially involved. Poor adherence to rehab programmes happen. Incorrect and inappropriate rehab programmes happen. The patient sitting in front of them must have an understanding of the role they themselves will have in the process – a huge responsibility. There is an expectation from patients that surgery will resolve their pain and fix their problem. For anyone considering surgery know what’s ahead of you and that this may not be the case. Know not just what is involved during the surgical procedure but what is involved afterwards to make it a success. Know there will be pain for a period afterwards. Look at the wound that is left tender for a while around where the incisions were made. Now think of what went on inside that knee, or ankle or hip during the operation. Is it any wonder pain can linger for up to 6 weeks following the procedure whatever it may be. Would a surgeon who removes a tumour from a smokers lung advise that patient to continue smoking? Not likely. Similarly for knee surgery that patient must address the problems that likely caused it in the first place, i.e. muscle imbalance, poor hip, knee and core control.
Like every profession clinicians differ on their opinion. With surgeries one will have their way of doing a procedure while others a different approach, both usually with valid arguments for each. Where these two leading clinicians are in agreement is that the surgical procedure is only as good as the rehabilitation that follows it. Surgery will not change what may have caused that problem in the first place. The treatment plan needs to address the needs of the patient be that surgical, conservative or both.
If you think you might need onward referral for consultation with an orthopaedic surgeon contact the clinic for an appointment.
For more information on any of the issues addressed throughout this article please contact Rob via email at firstname.lastname@example.org, Twitter @mccabephysio, Facebook at McCabe Physiotherapy or visit http://www.mccabephysiotherapy.com
Rob McCabe MISCP
MSc (pre reg) Physiotherapy, BSc Sport Science and Health, MSc Sports Physiotherapy, PG Dip Orthopaedic Medicine
Orchard House, Moorefield Rd, Newbridge, Co. Kildare