Healing from an injury or chronic orthopedic condition can be challenging, and many patients are unsure about their options for recovery. For example, will your condition require physical therapy or surgery, and when is it necessary to see a specialist?
Melissa Leber, MD
In this Q&A, Melissa Leber, MD, Associate Professor Orthopedics, and Emergency Medicine at the Icahn School of Medicine at Mount Sinai, explains the different options patients have to relieve their pain. Dr. Leber is also Director of Player Medical Services at the US Open and Director, Division of Emergency Medicine Sports Medicine.
If I have a chronic orthopedic condition or injury, when should I see a specialist?
If you’re developing pain, whether it’s your knee or shoulder or another body part, you can try a course of anti-inflammatories, rest, and activity modification. If your pain is really debilitating—for example, if it’s greater than a three or four out of 10 on a pain scale, or it’s starting to affect your everyday life and the things you love to do—that’s when you should see a specialist.
When is physical therapy the best option, and when is surgery called for?
After evaluating the patient, we decide on whether to recommend surgery or non-operative treatments. Most of the time, we can present the patient with various options and decide on what is best for that particular patient. It depends on age, medical history, and their goals. Occasionally, surgery is 100 percent necessary to get you back to your normal function, but most of the time, surgery is elective. It’s not a black and white answer on whether you have to do surgery or have to do physical therapy. It may depend on whether you’re an athlete, how quickly you want to return to normal activity, whether you’re okay functioning at 80 percent versus 100 percent, and some of that is a personal discussion between you and your physician.
Are my age and general health important factors in choosing surgery versus physical therapy?
Your age and general health definitely affect whether we might recommend non-operative treatments versus surgery. Some of that depends on what your goals are for return to activity, and on what other conditions you may have: diabetes, high blood pressure, heart conditions, etc., Some medical problems may make you less fit for surgery. Sometimes it’s not really a choice, because, in the case of a hip fracture, for example, you may never be able to walk again without surgery. It depends on the condition.
If my orthopedist recommends surgery, what questions should I ask?
- What will the recovery time look like?
- Should I expect to be in any kind of a brace or a sling after the surgery?
- How much physical therapy will I need to return to normal?
- When should I expect to be at 80 percent functioning versus 100 percent functioning after the surgery?
- What is the success rate of this surgery? Is it a 100 percent success rate, 80 percent success rate?
- What are the risks of this surgery?
- Is it possible that I may come out of the surgery having continued pain?
- What would you do or recommend if I were your sibling or parent?
You will weigh the pros and cons of the surgery based on how much discomfort you’re in now and how much it’s affecting your everyday life. For example, a patient with knee pain may have knee arthritis as well as meniscus tearing, and we have to choose which patients we recommend for surgery, in which case we might say, “Okay, let’s focus on the non-operative treatments for now.” If you’re not doing well, we might recommend you consider surgery later. Some of that depends on how much arthritis is in the knee, and that’s a much more in-depth conversation.
What are some of the common misconceptions patients have about orthopedic surgery?
One of the biggest misconceptions we hear from patients is that they prefer not to see an orthopedic surgeon because they automatically think they’ll be recommended to have surgery, and that’s not true. Most of the time, the orthopedic surgeon will try non-operative treatments or conservative treatments rather than jumping straight into surgery. It really is a case-by-case situation. In general, you shouldn’t be afraid to go to see the specialist, because they may have great advice and ideas regarding the non-operative treatments that may help you—interventions such as injections and even platelet rich plasma and other things that we can offer.
What else should people know about physical therapy and surgery?
Going into physical therapy takes time and patience, but in general, you can work on functional correction using strength training, balance, stretching, and all the modalities that physical therapy can offer. Most of the time, physical therapy can work wonders. If you’re willing to put the time and effort in, you really can do great things with physical therapy and rehab. Try to find a therapist who you trust and connect with as physical therapy will go better. You can always switch to a different physical therapy clinic if you don’t love the place you are going. Ask your doctor for recommendations on which physical therapist or physical therapy location would be best for you.
Should I try taking medications at home?
Many patients come to see us having not tried taking any over-the-counter medications at home. Taking a few doses of anti-inflammatories known as NSAIDs—non-steroidal anti-inflammatories—can help considerably. Naprosyn or ibuprofen are different types of NSAIDs that can help a lot, even just two or three doses. Of course, check with your primary care doctor if you aren’t sure whether it is safe to take NSAIDs given your other medical problems and medications.
If my doctor tells me I need to rest, does that mean I can’t do anything?
When a doctor recommends rest after you’ve had an injury or an area of pain, it doesn’t mean complete rest. It just means sometimes doing more low impact exercise or trying to avoid over stressing that area of pain or that joint. If you have an injury or an area of pain, ask what exercises you can do, because many times there are a lot that you’re able to do to stay active. As you get older, if you stop exercising completely, you get deconditioned quite quickly, and that can hurt your recovery and your performance. I recommend trying to stick with activity but alter that activity to do something slightly different so you’re not injuring that area further.
How much strength training versus cardio should I do?
Patients shouldn’t focus on cardio 100 percent of the time. I often see patients coming in with knee or hip pain, and they walk 10,000 to 20,000 steps a day, or they run three to five miles every day. Sometimes it’s actually best to focus on resistance and strength training more than cardio. As patients get older, strength training becomes more and more important. When someone is 20 years old, they could do 80 percent cardio, 20 percent strength training. When they’re 80 years old, it should be the opposite, where they do 80 percent strength training and 20 percent cardio. If you have the capability, getting a personal trainer can be extremely helpful towards maintaining a healthy and pain-free life. They can watch your technique and help avoid injury while also making you stronger.