San Antonio, TX

Too Many People Are Skipping Physical Therapy in Favor of Surgery

Zachary Walston

Do people try to avoid spine surgery? If so, what methods do they use? A recent study gives us a piece of the answer.

A research team reviewed the charts of 411 patients treated at Brooke Army Medical Center in San Antonio, Texas in 2014 and 2015. All patients were beneficiaries of the Military Health System. The researchers wanted to know which patients were prescribed opioids, exercise therapy, or physical therapy the year before undergoing spine surgery.

Of the 411, 143 (34.8%) patients had a physical therapy plan of care, 140 (34.1%) had at least 1 visit that included exercise therapy, and only 60 (14.6%) had a minimum of 6 exercise therapy visits. However, 347 (84.4%) patients received at least 1 opioid prescription fill (mean of 6.1 unique fills).

These results fly in the face of current evidence, including clinical practice guidelines.

One of the primary reasons we are still in an opioid epidemic is the frequent prescription of medication as a first line of defense. This approach spreads a dangerous message. Immediate medication signals pain should be avoided at all costs. Instead, we should look at pain as an alarm system telling us damage may have or may occur. Pain does not always mean our body is hurt.

Our bodies are remarkably adaptive and resilient. They are not broken and in need of “fixing” through surgery and medicine. They often simply need movement.

Pain is complex and attempting to mask it through medication or "fix" it through surgery fails to address the psychosocial drivers of pain.

It's disconcerting to see these numbers. Perhaps it is specific to the San Antonio region. Perhaps it is specific to the Military Health System. Regardless, we have a lot of work to do.

In some cases, surery may be necessary, but surgery is often not the answer for chronic pain. Exercise therapy and physical therapy should be first line of defense.

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I am a physical therapist, researcher, and educator whose mission is to challenge health misinformation. You will find articles about health, fitness, medical care, psychology, and professional development on my site. As the husband of a real estate agent, you will also find real estate and housing tips.

Atlanta, GA

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