Exercise Rehabilitation: Before or After Surgery?

The most common injuries we see in workplace accidents occur at the lower back, shoulders and knees, so it’s not surprising that these three areas of the body are some of the most common areas operated on each year, especially shoulders and knees. But as a society, are we to quick to jump on the operating table and opt for surgery rather than focusing on rehabilitating the injury using a more conservative method such as exercise.

A meniscus tear is a very common injury and one we see occurring in workplaces all the time. It is estimated that over 2 million people each year with this injury opt for arthroscopic surgery to repair a meniscus over exercise rehabilitation. For this reason, researchers in Denmark and Norway organised a clinical trial to compare treatment with surgery versus treatment with exercise therapy. Out of 140 adults with meniscal tears, half received arthroscopic surgery and were given exercises to perform at home and the other half were prescribed 12 weeks of supervised exercise sessions, two to three times a week. After the first 12-week period, the second group scored higher on tests of thigh muscle strength than the surgery group and after two years, improvements in both groups were equal (Kise, Risberg, Stensrud, Ranstam, Engebretsen & Roos, 2016). There are cases were a meniscus tears can restrict the knee’s range of movement and in instances like this surgery may be the best option, however if a meniscus tear does not cause any restriction, exercise therapy is just as affective with a lot less risk of complications and you can begin treatment straight away and start to see improvements immediately.

The shoulder is another common injury site and I am currently assisting two injured workers with shoulder injuries, one who opted for surgery and the second who chose to stick with exercise. They both presented with the same diagnosis of a rotator cuff tear, but are now both at very different stages in their rehabilitation. My first client who opted for surgery ended up needing another 2 surgeries due to complications that set him back and cost him over 6 months of time. He is now 1 month into his exercise rehabilitation with me and he still has very limited range of motion through all planes of movement (less than when the injury first occurred), he can’t lift his affected arm without assistance and finds it hard to perform even the simplest of daily tasks such as brushing his teeth. My other client who chose exercise as a mean of rehabilitation is just over 2 months into his exercise programme and now has full movement, strength and is already back to full time work with no restrictions. This isn’t to say my client who had surgery won’t get to this point at some stage, but there is a chance he could already be there if he chose exercise over surgery.

A recent study conducted by Edwards, Ebert, Joss, Bhabra, Ackland and Wang (2016) has suggested that patients with rotator cuff tears opting for physical therapy have demonstrated high satisfaction, an improvement in function, and success in avoiding surgery. When considering the increasing rate of shoulder surgery and the associated economic and social burden rotator cuff surgery places on both the patient and the health care system, non-surgical management such as physical therapy and exercise may, in selected cases, be a treatment alternative to surgical repair.

Exercise Rehabilitation is an evidence-based, pivotal strategy to improving patient recovery, which should begin as soon as possible for any injured worker. If surgery is required, exercise therapy can be an effective tool to use before surgery to ensure the patient is in good shape leading up to the surgery and should be used after surgery as soon as the patient is ready to begin. At Absolute Balance we are committed to using exercise as a means of rehabilitation to assist with all health conidtions and provide injured workers with the tools and confidence to return to work. If you have any questions about a workplace injury or would like advice about exercise rehabilitation before going down the path of surgery, please get in contact with us.

Tyler Hall (B.EXSportsSc, Grad.Dip.(Clin.Ex.Phys))

Accredited Exercise Physiologist (AEP) (ESSAM)

References

 

Edwards, P., Ebert, J., Joss, B., Bhabra, G., Ackland, T & Wang, A. Exercise Rehabilitation in the non-operative management of rotator cuff tears: A review of the literature. International Journal of Sports Physical Therapy (2016).

 

Keast, K. The role of exercise in rehabilitation. Health Times (2016).

 

Kise, N.J., Risberg, M.A., Stensrud, S., Ranstam, J., Engebretsen, L & Roos, E.M. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: Randomised controlled trial with two-year follow-up. Science Daily (2016).