6 min readingMusculoskeletal disorders (MSDs) such as degenerative meniscal tears, rotator cuff tears, herniated nucleus pulposus (HNP), and adductor longus tendon ruptures are prevalent, affecting millions globally. Traditionally, surgical interventions have been considered the gold standard for treating these conditions. However, recent evidence suggests that conservative treatments like physiotherapy may offer comparable outcomes without the associated risks and costs of surgery. This blog explores the effectiveness of physiotherapy compared to surgical treatments for various MSDs, drawing insights from recent studies.
Degenerative Meniscal Tears
Degenerative meniscal tears, common among middle-aged and older adults, often lead to knee pain, swelling, and loss of function. Arthroscopic partial meniscectomy (APM) is a widely performed surgical procedure for this condition. However, evidence on its effectiveness compared to physical therapy (PT) is mixed.
A pivotal study published in the New England Journal of Medicine comparing APM with exercise therapy did not find significant differences between the study groups in functional improvement six months after randomization (Katz 2013). The next phase of the same trial (MeTeOR) described the five-year outcome of operative and non-operative management of meniscal tears in persons older than 45 years and concluded that pain improved considerably in both groups over 60 months, with no statistically significant differences in total knee replacement (TKR) use, although the APM group showed a greater rate of TKR conversion (Katz 2020). Other studies have corroborated these findings, demonstrating that pain scores at six months favored the exercise group, with no significant differences in knee function between the two groups at longer follow-ups. This indicates that PT can be as effective as surgery in improving knee function and reducing pain. Furthermore, PT has shown benefits in muscle strength and physical ability, making it a viable non-surgical intervention for degenerative meniscal tears (OE 2015).
Rotator Cuff Tears
Rotator cuff tears (RCTs) can severely impact shoulder function and have traditionally been managed by surgical repair. However, studies have shown that physiotherapy can be equally effective. A study comparing surgical and non-surgical treatments for RCTs found that both methods yielded similar results in terms of pain reduction and functional improvement over one year (Ranebo 2019). Another study on the treatment of nontraumatic rotator cuff tears with a two-year follow-up demonstrated that conservative treatment is a reasonable option as the initial treatment for isolated, symptomatic, nontraumatic supraspinatus tears in older patients (Kukkonen 2015).
Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder, also known as adhesive capsulitis, is a common and debilitating condition characterized by pain and progressive stiffness of the shoulder joint. It typically affects individuals between 40-60 years of age and is more prevalent in women and people with diabetes or thyroid disorders. The condition often develops without a clear cause, progressing through stages of increasing pain and stiffness followed by gradual resolution, and can last anywhere from several months to several years.
An update of clinical guidelines in the management of frozen shoulder claims that conservative treatment is successful in up to 90% of cases and should be tried for 6-9 months before considering invasive options. Treatment strategies depend on the stage. In the first stage, the focus is on pain relief and gentle physical therapy. In the second stage, the aim shifts to improving the range of motion through structured mobilization exercises. The third (and last) stage mainly requires sustained physical therapy (Pandey 2021).
Herniated Disc (Herniated Nucleus Pulposus)
Herniated nucleus pulposus, herniated disc, or prolapsed disc often leads to back pain and radiating pain to the lower limb (sciatica). Surgical interventions like discectomy are frequently performed to relieve symptoms. However, conservative treatments, including physiotherapy, have shown promising results.
A study comparing prolonged physiotherapy versus early surgical intervention in patients with lumbar disk herniation showed significant improvement in disability and work status in both groups without statistically significant differences in the disability score at the second or third assessment. However, the Prolo scale became significantly better in the physiotherapy group than in the surgery group during the second and third assessments. The authors concluded that a prolonged physiotherapy and rehabilitation program is a beneficial and successful treatment in patients with recently diagnosed lumbar disk herniation (Elroos 2017).
A critical review evaluating physiotherapy interventions versus surgical interventions for patients with prolapsed lumbar intervertebral disc (PLID) showed that in the short term, surgery was more beneficial than conservative treatment. However, there was no discernible difference between physiotherapy and surgery after a long period of observation. Additionally, physiotherapy intervention had no adverse effects, whereas surgery had some adverse effects. The authors concluded that in all circumstances, physiotherapy intervention is more effective than surgery (Akter 2023).
Adductor Longus Tendon Ruptures
Acute adductor longus tendon ruptures, though rare, pose significant challenges, especially for athletes. Traditionally treated with surgery, recent evidence suggests that nonoperative management may offer comparable outcomes.
In a case series published in the American Journal of Sports Medicine regarding one-year clinical and imaging follow-up after exercise-based treatment for acute complete adductor longus tendon avulsions, the athletes returned to sport in 2 to 3 months. At the one-year follow-up after injury, athletes had high self-reported function, no performance limitations, normal adductor strength and range of motion, and signs of partial or full tendon continuity as shown on MRI. This indicates that the primary treatment for athletes with acute adductor longus tendon avulsions should be nonsurgical as the time to return to sport is short, there are good long-term results, and there is no risk of surgical complications (Serner 2021).
A study involving National Football League (NFL) athletes found that those treated nonoperatively returned to play significantly faster than those undergoing surgery, with similar success rates. Nonoperative treatment avoids surgical risks and complications, highlighting its potential as an effective alternative for surgery (Schlegel 2009).
Conclusion
The evidence suggests that physiotherapy can be as effective as surgical interventions for various musculoskeletal disorders, offering significant benefits without the inherent risks of surgery. Physiotherapy focuses on functional improvement, muscle strengthening, and flexibility, which are crucial for long-term recovery and prevention of recurrence.
At Kemtai, we leverage advanced computer vision technology and a comprehensive library of physiotherapy exercises to provide effective physiotherapy protocols with corrective guidance. Our platform not only monitors patient adherence and performance but also offers personalized rehabilitation plans accessible via any platform (phone, tablet, computer) in the comfort of the patient’s home. This ensures that patients receive the best possible care, maximizing their recovery outcomes.
Embracing physiotherapy, supported by innovative tools like Kemtai, can transform the management of musculoskeletal disorders, offering scalable, accessible, and effective treatment options.
