Our inpatient and uninformed society is too often polarized by the thought of surgery being a guaranteed quick fix to alleviate pain and dysfunction. When it comes to the neck and lower back, success rates after surgery and rehabilitation are about as “guaranteed” as a flip of a coin. And often times, surgery can cause more chronic long term pain and functional debilitation than before going under the knife.
Here’s why surgery should literally be the very last and final option after exhausting all conservative based treatments like physical therapy, chiropractic and exercise. Once you’re cut open, there’s no going back. Be well informed about your options and leave nothing to chance.
So You Want to Have Neck or Back Surgery?
Neck and low back pain are two of the most common musculoskeletal disorders in the Western world. If you haven’t experienced a bad episode of one of these in your life, just wait. It’s just a matter of time until you will. The very common and very poor postures we put our body through on a daily basis (sitting, couch lounging, driving, etc) are huge contributing factors. But lets be real, posture is just part of the dysfunctional equation with traumatic injuries, chronic stresses and a host of other mechanisms causing pain in the beck and back as well.
Now these conditions are commonly debilitating, robbing us of our vitality, physicality and normal daily activities. They’re also very scary. For those of you who have ever delt with serious bouts of lower back pain that keep you in bed for a week or neck pain which inhibits your ability to move your neck or ams, you know this to be true.
Often, both the general public think surgery is the best, easiest, or most complete solution to healing from injury. This may be because we live in a quick fix, want it here and now society where we are transfixed on professional athletes going under the knife routinely for every minor injury, but guess what. You are not a professional athlete, and you will most likely not get hours of therapy a day to expedite your recovery process with the best doctors in the world. And again, there’s no guarantee that surgery will fix anything I can’t reiterate that enough.
The very thought of surgery is misguided.
More often than not, we are too quick to jump into surgery as if it were a ‘cure all’ for spinal or joint problems. Perhaps we don’t know any better. Maybe we haven’t been advised that there are alternatives to surgery; or our questions are directed to only surgeons; or we haven’t found a medical provider that will look at what caused our issue in the first place; or we want to ‘stay in network’ with their insurance provider; or we just do whatever our friends, family, athletic trainer, coach, etc. tells us to do.
There are any number of reasons that people pursue a surgical solution to an ailing injury. Even so, I propose that surgery should be the last and final option for you, only after exhausting all other available options (with the exception being a life threatening or Neurological deficits that do require urgent surgical intervention) .
Why Conservative Therapy Should Be Your First Choice
There’s no doubt that our elite level athletic performance industry has made surgery the polarizing option for alleviating pain and improving function. But the question remains, is surgery really the best option for you as an individual to regain function? One of the single most common and flawed perspectives of the professional athlete (and non-athletes alike) is that surgery is a complete fix for injuries. This is simply not true. And often times, surgery only focuses on correcting the symptoms of the problem, and not the origins of the problem itself. This is the reason why having a positive response to spinal surgery is a coin flip at best.
Surgery often doesn’t address the imbalances and flawed movement patterns that actually cause the spine problem in the first place. The injury itself may be repaired but the source that caused the injury is still present which may result in repeat injury. This leads to continued pain and chronic issues in the spine. I can confidently say that majority of the time, I believe that unsuccessful surgical procedures and recoveries are due to people being misinformed about their options, and viewing surgery as a 100% quick fix.
A Herniated Disc CAN Heal Without Surgery
I routinly have patients walk into my office saying ‘I’m in back pain, I have a herniated disc. I need surgery’. On the very first visit we were able to see that a majority of patient’s hip rotation flexibility was limited and it was causing the vertebrae in their lower back to rotate too much which herniated her disc.
After some manual therapies, stretching techniques and corrective exercises, many patients were able to improve the rotational flexibility in their hips and improve core stability and control of the formerly injured disc. And guess what… they no longer asking about surgery when they are pain free and back to doing the things they love to do without restriction. In many cases, patient recoveries take weeks, not months or years when the correct conservative based treatments are implemented intelligently.
Today’s modern rehabilitation research reveals that herniated vertebral discs can be resolved without surgical intervention using chiropractic and other physical therapy techniques. Much research suggests how effective physical therapies can be in the treatment of back and neck pain. So if the discs in your neck can heal without surgery wouldn’t you want to give those therapies a shot? There are many methods of conservative non-surgical care that help to resolve vertebral disc issues.
Here are some of your best conservative options:
- Corrective Exercises
- The right kinds of exercises can change your posture and the way you move your body. This will result in less strain and ‘overuse’ type injuries. These can be incorporated into your morning routine, or used at the gym as warm up or cool down exercises.
- Chiropractic offers a wide variety of manual therapies that can be real difference makers for people considering surgery. Just be sure to go to a chiropractor that spends more than 10 minutes with you.
- McKenzie Exercises
- Practitioners certified in the ‘McKenzie’ specialize in finding postures and poses that provide relief of disc based injuries in the spine. This is a great option for those that are uneasy about getting chiropractic adjustments.
- Physical Therapy
- Exercise based therapy has been shown to be more effective than surgery for long term positive outcomes, so this could be a great option for you.
- Active Release Technique (ART)
- A manual therapy technique designed to help release functional tightness and decrease tension overly tight soft tissues to improve the overall balance of musculature in your joints.
- And Many More…
The average “conservative ” approach will take 3-6 weeks to address the spinal pain. That means you won’t be completely fixed after one or two visits! Since people don’t want to “wait” that long, some think that surgery is a quicker option.
Strangely enough, the rehabilitation process after surgery will take a minimum of 4-6 weeks at VERY minimum. So, even if you end up electing for surgery, your recovery could possibly last longer in the long run and keep you out of your normal daily activities longer. Not only that, but there are ALWAYS risks to consider when undergoing spinal surgery…
- Blood clots
- Localized pain
- Increased arthritis and degeneration
- Recurring issues with the vertebrae above or below the affected segment
- Neurological loss of function
- The possibility of addiction to pain medications afterward
- And death… yeah, that’s a real one!
When You Should Consider Spinal Surgery
There are certain times when you should consider surgery. And just to make sure we are clear here, I did say consider! Here are some quick rules of thumb for you to follow. If you have any of these you may consider surgical intervention as a course of action:
- Continued Neurological Deficits
- Weakness of the arms or legs
- Inability to go to the restroom
- Atrophy (muscle wasting) of your arms or legs
- All Conservative Methods Have Failed
- Longer than 3-6 months of continued conservative treatment
But When It Comes To Surgery, Here’s The Deal
The golden rule is to avoid surgery whenever possible. When all else fails (I really mean exploiting ALL conservative options), go for it. These recommendations aren’t just limited to spinal surgery though.
Plenty of research shows that conservative therapy should be the preferred approach with shoulder, knee and other body injuries as well. Simply put, if you have pain or limited fuction, conservative treatment is and should always be your single best option for recovery. Surgery isn’t always the answer and often injuries that you didn’t think could heal or regenerate can with conservative therapy.
Don’t be too quick to go ‘under the knife’. You might end up be unhappy with the results afterwards especially if you haven’t gone through the process with a professional to ‘re-train’ how your body moves. And once you get cut open, there’s no going back. Whether you’re an athlete or not, dealing with pain or injury, please educate yourself on the different options at your disposal, and really work hard to diligently explore all options before choosing surgery as a final option for recovery.
About The Author
Dr. Scott Hoar is a sports medicine consultant and also a chiropractor. He’s led multiple NFL Combine prep camps and treated athletes from the NFL, NCAA, UFC, NHL and more. Dr. Hoar is a former Certified Strength and Conditioning Specialist (CSCS) and his practice, Mobility 4 Life Chiropractic and Sports Medicine is located in Boynton Beach, FL and Fort Lauderdale, FL. When he’s not treating patients he provides educational workshops for health and fitness professionals. He can be found at Mobility-4Life.com
Boyles, Robert et al. “Effectiveness of Manual Physical Therapy in the Treatment of Cervical Radiculopathy: A Systematic Review.” The Journal of Manual & Manipulative Therapy 19.3 (2011): 135–142. PMC. Web. 21 Aug. 2016.
Chiu, C.-C., and T.-Y. Chuang. “The Probability of Spontaneous Regression of Lumbar Herniated Disc: A Systematic Review.” Clinical Rehabilitation 29.2 (2014): 184-95. Print.
Schuldt, Jill Of. Conservative Treatment of Rotator Cuff Injuries to Avoid Surgical Repair (n.d.): n. pag. Web