Do you have back, hip or knee pain? What to consider before consulting an orthopedic surgeon


As an orthopedic spine surgeon who performs around 500 surgeries a year, my favorite type of patient is one I never have to see, not even once. This is because it means their musculoskeletal (MSK) problems – any condition or injury affecting the joints, bones, tendons or muscles – have not progressed to the point where they need to see a surgeon.

To put it bluntly, surgery is not always the best answer. Surgery is invasive, expensive and sometimes risky. Often, behavioral changes that help with weight loss and increased mobility, such as exercise, stretching, and healthy eating or physical therapy, can successfully resolve many musculoskeletal problems, while reducing health expenditure. For example, when physiotherapy is the first line of treatment, according to a Systematic review in the Physical Therapy & Rehabilitation Journal, this translates to lower overall health care costs, fewer doctor visits and better patient mobility.

Unfortunately, many people still end up seeing a surgeon even though it’s clear that their condition isn’t to the point of requiring an invasive operation. In many of these cases, diet, exercise and physiotherapy have not been the first-line treatment, although these are often the most effective and affordable treatments for the majority of lesions. musculoskeletal.

It’s not the patient’s fault. It’s a systemic industry problem. When patients are in pain and desperate for a solution, they seek immediate treatment to resolve their musculoskeletal issues. GPs are often not MS experts and refer patients to orthopedic surgeons to determine whether a person needs surgery or not. A referral to an orthopedic surgeon may seem innocuous, but a visit to a specialist physician is costly for both insurance and patients. Also, what surgeons do best is perform surgeries.

Also, in some cases, orthopedic surgeries are no more effective than other non-surgical procedures, according to a 2021 review of meta-analyses. The study concluded that “despite a lack of strong evidence, some of these procedures are still recommended by national guidelines in certain situations”. Although most people avoid surgery, one wonders how many 4.8 million elective orthopedic MSK surgeries performed annually, such as knee or hip replacements or spinal fusions, are in fact necessary.

A shift in the way the industry thinks about musculoskeletal issues must occur, from both patients and physicians, towards a holistic treatment approach before any referral to an orthopedic surgeon. A holistic approach may include one or a combination of a physical therapist, nutritionist, behavior change health coach, or a comprehensive digital MSK program.

Here is what everyone should know before seeing an orthopedic surgeon:

  1. Surgery is not a magic bullet

Before making an appointment with an orthopedic surgeon or other MSK specialist, go through this quick assessment:

  • Is the weight a problem?
  • Are stretching part of the day?
  • Could reinforcement improve the condition?
  • Is surgery being considered because it is seen as a quick fix?

It is extremely difficult to start exercising and changing diets, especially when a person is in pain. Behavior change is one of the most difficult things to accomplish. With that in mind, it makes perfect sense for someone with chronic musculoskeletal pain and stiffness to come to a point where surgery seems like the best and only quick fix.

While it’s a valid and normal feeling in such circumstances, surgery isn’t always the best quick fix or the only answer. All surgery carries risks. In many back surgeries, the patient will be under general anesthesia and then a surgeon will make an incision and remove portions of bone, bone spurs or ligaments in the patient’s back.

Even then, there is no guarantee that the pain will go away and mobility will be restored. Thereafter, most patients will be advised to undergo physical therapy, healthy eating, and stretching. Why not skip the surgery and go straight to a non-surgical holistic treatment first?

  1. Most people need help getting started and staying engaged

A small number of people with musculoskeletal problems will benefit from surgery. Many more people can adjust their lifestyle to include exercise, stretching, and diet to treat a musculoskeletal condition. But to succeed in the long term, they cannot do everything alone. Most of us need help. A new active lifestyle is as much mental as it is physical.

For patients who are struggling to make a change, I recommend people seek out a health coach, who can help with motivation while offering support and guidance. A health coach can be a physical therapist or a behavior change coach who is dedicated solely to helping people follow a health regimen to strengthen their bodies and reduce pain.

Often, a health coach can connect you, in person or remotely, with a group of others dealing with similar MS issues. Social support is a known contributor to long term success.

  1. Virtual MSK programs offer coaching and convenience

With the rapid adoption of digital health in recent years, patients have access to a variety of new and exciting virtual physiotherapy and MSK solutions. This can be an app on a phone or access through a laptop and include access to a health coach and exercise videos.

When exploring digital health options, whether you’re a consumer, a health plan looking to cut costs, or an employer to add as a new benefit, consider the following criteria when selecting solution providers:

  • Does it have clinically validated programs and individualized recovery pathways for a wide range of musculoskeletal needs?
  • Is there flexibility in the virtual program to accommodate an individual’s progress? Some solutions are fixed at a certain number of weeks.
  • Is a health coach part of the solution? A big part of MSK recovery is behavioral change and a health coach can help individuals adhere to programs, a key to ensuring recovery.
  • Does the solution require additional hardware or peripherals? Many people find these devices intrusive, affecting access and adherence. Additionally, devices such as sensors can add significant costs to be covered by the health plan or employer.

A great added value that digital MSK products offer compared to traditional physical therapy is that programs are performed virtually on demand and communication can be synchronous or asynchronous. Instead of having to make an appointment and travel to the physiotherapist’s office or gym, sessions can be done from the comfort of your own home. And during the pandemic, that means staying safe from harm.

As an industry, we need to consider alternatives to a surgical mindset. It starts with making sure that everyone with musculoskeletal issues has access to all the necessary medical professionals and tools that will allow them to have a successful recovery. This will save time, money and reduce healthcare costs. Surgeons can focus their efforts on those most in need. No one can go wrong adding exercise, stretching, and good healthy eating to their life.

Photo: Srisakorn, Getty Images


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