As an orthopaedic spine surgeon who performs about 500 procedures a year, my favorite type of patient is one I’ve never seen, not even once. The reason is that this means that their musculoskeletal (MSK) problem — any condition or injury that affects joints, bones, tendons or muscles — has not progressed to the point where they need to consult 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 a healthy diet or physical therapy, can successfully address many of MSK’s problems while reducing healthcare spending.For example, when physical therapy is the first line of therapy, according to system assesment In the Journal of Physical Therapy and Rehabilitation, it lowers overall health care costs, fewer doctor visits and better patient mobility.
Unfortunately, many people still end up consulting a surgeon, even though it’s clear that their condition is not yet at the point where invasive surgery is required. In many of these cases, diet, exercise, and physical therapy are not first-line treatments, although these are often the most effective and affordable treatments for most MSK injuries.
It’s not the patient’s fault. This is a systemic industry problem. When patients feel pain and desperately need a solution, they seek immediate treatment for MSK Sloan problems. GPs are usually not specialists at MSK Sloan and will refer patients to plastic surgeons to determine if a patient needs surgery. A referral to a plastic surgeon may sound innocuous, but seeing a specialist is expensive for both insurance and patients. Plus, surgeons are best at performing operations.
Also, according to one study, orthopaedic surgery is not more effective than other non-surgical interventions in some cases. 2021 Meta-Analysis ReviewThe study concluded that “despite the lack of strong evidence, some of these procedures are still recommended by national guidelines in some cases.” Even if most people avoid surgery, one wonders how many 4.8 million elective orthopaedic MSK surgeries It actually needs to be done once a year, like a knee or hip replacement or spinal fusion.
There needs to be a shift in industry perception of MSK Sloan issues, and both patients and physicians need to adopt a holistic approach to treatment prior to referral to an orthopaedic surgeon. A holistic approach may include one or a combination of physical therapists, nutritionists, behavior change health coaches, or a comprehensive digital MSK program.
Here’s what everyone needs to be told before visiting a plastic surgeon:
- Surgery is not a quick solution
Before making an appointment with an orthopaedic surgeon or other MSK Sloan specialist, do the following quick assessments:
- Is weight an issue?
- Is stretching a regular part of the day?
- Can strengthening improve the condition?
- Was surgery considered because it was considered a quick fix?
It can be very difficult to start exercising and changing your diet, especially when a person is in pain. Behavior change is one of the hardest things to accomplish. With this in mind, it makes perfect sense for people with chronic MSK pain and stiffness to get to the point where surgery seems to be the best and only answer to a quick fix.
While it’s a valid and normal feeling in this situation, surgery isn’t always the best quick fix or the only answer. Any surgery has risks. In many back surgeries, the patient will be under general anesthesia, and then the surgeon will make an incision and remove part of the bone, spur, or ligament in the patient’s back.
Even so, there is no guarantee that the pain will go away and mobility will return. Afterwards, most patients are asked to undergo physical therapy, eat a healthy diet, and do stretching exercises. Why not skip surgery and go straight to holistic non-surgical treatment?
- Most people need help to get started and stay committed
A small percentage of people with MSK Sloan problems will benefit from surgery. More people can make adjustments to their lifestyle, including exercise, stretching, and diet, to address MSK conditions. But to be successful long-term, they won’t be able to do it all alone. Most of us need help. A new active lifestyle is both mental and physical.
For patients struggling to make a difference, I recommend that people find a health coach who can help motivate them while providing support and guidance. A health coach can be a physical therapist or a behavior change coach who specializes in helping people follow a health regimen to strengthen the body and reduce pain.
Often, a health coach can put you in touch with others who are experiencing similar issues with MSK, either in person or remotely.Social Support is a well-known contributor long term success.
- Virtual MSK Program Provides Guidance and Facilitation
With the rapid adoption of digital health in recent years, patients have access to a variety of exciting new virtual physical therapy and MSK solutions. These can be an app on your phone or accessed via a laptop, including access to health coaches and workout videos.
When exploring digital health options, whether as a consumer, a cost-saving health plan, or as an employer of new benefits, consider the following criteria when choosing a solution provider:
- Does it have a clinically validated program and individualized recovery pathways that meet the high demands of MSK?
- Are virtual programs flexible enough to accommodate individual progress? Some solutions are set to a specific number of weeks.
- Are health coaches part of the solution? Much of recovery at MSK is behavioral change, and a health coach can help individuals stick to the program, which is key to ensuring recovery.
- Does the solution require additional hardware or equipment? Many people find these devices intrusive, which affects access and compliance. Additionally, devices such as sensors can add substantial costs to health plans or employers.
A great added value of digital MSK products over traditional physiotherapy is that procedures are done almost on demand, and communications can be synchronous or asynchronous. Instead of making an appointment and driving to a physical therapist’s office or gym, you can get treatment from the comfort of your home. During a pandemic, that means staying out of harm’s way.
As an industry, we need to consider an alternative surgery-first mentality. It starts with ensuring that everyone suffering from MSK Sloan issues has access to all the necessary health care professionals and tools to help him or her successfully recover. This will save time, money and reduce healthcare costs. Surgeons can focus on those who need them most. You can’t go wrong adding exercise, stretching, and healthy food to their lives.
Photo: Srisakorn, Getty Images
