When Surgery Isn’t the First Answer: A Physical Therapist’s Perspective on Orthopedic Injuries

By Dr. Hanna Sattler PT, DPT

As a Doctor of Physical Therapy, I work with patients every day who are navigating pain and injury, and the often overwhelming decision of how to treat it. One of the most common assumptions I encounter is that surgery is the “quickest fix” or the most definitive solution—especially when imaging shows something like a torn ligament, disc herniation, or joint degeneration. While surgery absolutely has its place and can be life-changing when appropriately indicated, it is not always the best first step.

In many cases, conservative treatment—such as physical therapy—should be the initial approach.

Understanding the Body’s Ability to Heal

The human body is remarkably resilient. Tissues like muscles, tendons, and even certain cartilage structures have the capacity to heal, adapt, and become stronger with the right stimulus. Pain and imaging findings don’t always correlate as directly as people think. For example, many individuals with disc herniations or meniscal tears have little to no pain and full function, while others with minimal structural findings may experience significant discomfort and very limited function.

This is where conservative care becomes critical. Physical therapy focuses not just on the “injury,” but on how the entire system is functioning—movement patterns, strength, mobility, stability, and neuromuscular control. By addressing these factors, we can often reduce pain and restore function without the need for invasive procedures.

The Risks and Realities of Surgery

Surgery is not without risk. Even in the best-case scenarios, it involves anesthesia, recovery time, potential complications, and a period of reduced mobility. There’s also no guarantee that surgery will completely resolve symptoms. In fact, some patients experience persistent pain or develop new issues post-operatively.

Additionally, even the simplest surgeries require rehabilitation afterward—meaning physical therapy is still a necessary component of recovery. If therapy is needed regardless, it makes sense to explore whether it alone can resolve the issue before pursuing a surgical route.

Evidence Supports Conservative Care First

Research consistently shows that for many orthopedic conditions—such as low back pain, rotator cuff tears, knee osteoarthritis, meniscus tears, and even some ACL injuries—non-surgical management can be just as effective as surgery, particularly in the early stages.

Patients who commit to a structured physical therapy program often see improvements in pain, strength, and function that allow them to return to their normal activities without ever entering an operating room. 

Empowering Patients Through Movement

One of the most powerful aspects of physical therapy is that it puts patients in control of their recovery. Rather than relying on a procedure to “fix” the problem, patients learn how to move better, build strength, and prevent recurrence. 

This approach not only addresses the current issue but also reduces the likelihood of future injury. It’s not just treatment—it’s long-term investment in your health.

I focus on educating my patients throughout the entire process so they are equipped with the tools they’ll need after therapy is completed to monitor their performance and recovery. This allows them to independently modify their programming to avoid another injury, or return to physical therapy for preventative work for a few sessions to make sure they’re still on the right track.

When Surgery Is the Right Choice

It’s important to acknowledge that surgery is sometimes necessary. Significant trauma, complete tendon ruptures, fractures, or cases where conservative treatment has failed may require surgical intervention. The goal is not to avoid surgery at all costs, but to ensure it is truly the most appropriate and effective option.

A Thoughtful Approach to Care

Choosing how to treat an orthopedic injury should never be rushed. It should involve a thorough evaluation, a clear understanding of the diagnosis, and an honest discussion about all available options.

In many cases, starting with conservative care provides a safer, lower-risk path that can lead to excellent outcomes. And if surgery is still needed down the line, patients who have undergone physical therapy beforehand have better short term and long term surgical outcomes.

Before opting for surgery, ask the question: “Have I truly given my body the chance to heal?”

You might be surprised by what it can do.