Physical Therapy vs. Surgery: What One Research Study Finds and Thoughts From a PT Perspective
On July 1, 2019 The New York Times released an article 10 Findings That Contradict Medical Wisdom. Doctors Take Note by Gina Kolata. This article peaked my interest as an orthopedic physical therapist and because a handful of my patients brought it to my attention. One of the ten findings was “Torn knee meniscus? Try physical therapy first, surgery later.” Hmm… although I may be biased and support physical therapy in this situation, I had to dig deeper into the research behind this statement.
The New England Journal of Medicine (NEJM) published a randomized control trial in 2013 with 351 subjects who were 45 years and older with meniscal tear and evidence of mild-moderate osteoarthritis on imaging. The subjects were randomly assigned to two groups: surgery and post-operative physical therapy (PT) or physical therapy alone. The results found no significant difference between the study groups in functional improvement 6 months after randomization, both groups improved.
Over the past 14 years of practice I have treated many patients ages 45+ with knee meniscal tears and arthritis. Many patients with this diagnosis come to physical therapy with one goal in mind: avoid surgery. Patients may ask their physicians that they try PT first, and many are referred to PT by their primary care or orthopedic physicians without patient prompting. When a patient with this diagnosis comes to PT, we work together to improve strength, flexibility and stabilize not only the knee, but also the entire lower extremity chain. This will help limit the stress and load on the knee and to prevent further wear and tear so you do not feel the effects of the arthritis. Many patients may prevent or prolong surgery with this type of physical therapy intervention. Although the results of this NEJM article are promising, it is important to look at the study closely to see how it was conducted and if there are any biases that may alter the results.
The New York Times article
New England Journal of Medicine research article