The world we live in is constantly changing and evolving. You only have to take a look at the way technology (such as mobile phones) have changed in appearance and capability over the last ten or even five years.
The field of medicine is exactly the same, with new studies published daily on the best available ways to treat each and every condition. All of our therapists here at 4 Life Physio Pinjarra take great pride in keeping up with all of these developments in Physiotherapy practices.
Over the last few years there has been a growing body of evidence that some of the injuries that were previously thought only fixable by surgery can actually be managed through to a full recovery, including return to previous level of sports, conservatively, with a rehab program alone. In fact, there is high-quality scientific evidence to validate these programs, that can be used clinically so patients can avoid unnecessary imaging, medication, injection therapies and elective surgery.
It often comes as a great surprise for patients, and even other people in the medical field, when they are told that just some of the issues that can be conservatively managed to a full recovery without the need for surgery include:
Full thickness ACL tears
Massive rotator cuff tears
Achilles tendon ruptures
Lateral ankle ligament ruptures
Shoulder bursitis / sub acromial spurs
Lumbar disc bulges
Some meniscal tears
There are certain criteria that must be met in order to proceed down the conservative management route of these problems and in some cases surgery may be required. However; our therapists are having great results in returning many patients back to their best without the need for the added stress, expense and time off work required by imaging, injection therapies and surgeries that can sometimes be avoided. All of these programs are based on the latest available evidence and supported by research. (See Below)
If you have one of the issues above, or would like to discuss your options and possible suitability for a conservative rehabilitation program for any other issue then please get in touch today.
Some of the Research:
Over 10,000 people have ACL reconstruction surgery in Australia each year, with this number increasing by around 6% year on year. This gives us the highest rate of ACL reconstructions per population in the world. Of confirmed ACL tears, 90% are reconstructed with patients waiting an average of 268 days for their surgery (Inglis 2017).
Previously the consensus was that some people could manage basic activities of daily living without having reconstructive surgery but anybody wanting to return to sport, particularly any sport requiring change of direction or pivoting would need to have surgery. In fact, there are now documented cases of English Premier League footballers returning to their previous playing levels in domestic and even international soccer within 3 months of an ACL tear.
The big concern many patients have when deciding between surgery or conservative management is possible arthritis later in life. Studies have followed up the 2 groups at 5, 10 & 20 years after and found no difference in any osteoarthritis changes, meniscal issues or functional outcomes (van Ypren et al 2018).
This is why a recent research review stated that “the current evidence would indicate that people following ACL rupture should receive, non-operative interventions before surgical intervention is considered”.
Rotator Cuff Tears
In Australia, around 14,000 rotator cuff repair surgeries are performed annually, with direct medical expenses for this estimated at $250 million per year. This is why many studies have been conducted to look for the best possible management. In their 2018 systematic review of all available high-quality research, Jeanfavre et al found that of 2010 ‘massive’ rotator cuff tears treated with a structured exercise program, 81% of patients improved in ROM, 85% improved in strength and 84% reported improvements in overall function. These numbers are better still in the older population, where the tears are not traumatic in nature and probably more degenerative.
For more information on any of the subjects above please get in touch today and one of our physiotherapists will be happy to speak to you further.