Why didn’t surgery fix my pain?

I just want to start off by saying that there are definitely some injuries/traumas that need some sort of surgical intervention in order to be fixed, especially in the case of car accidents and other major trauma. However, there are some, including back, knee and hip surgeries that are often a waste of time and money as the client still ends up having pain or discomfort 6 months to a year afterwards. 

How common is surgery?

Surgery is quite common amongst the population, over the three-year period 2012–13 to 2014–15, there were 14,746 hospitalisations for lumbar spinal fusion, representing an average rate of 26 hospitalisations per 100,000 people aged 18 years and over (88% of these were private paying patients). Many of these are spinal fusions, where rods are inserted into the spine to stop them moving. This does not include the number of people who have surgery on other parts of their body such as neck, knees and hips. Many of these people, despite what their surgeons tell them, still have pain after the surgery. 

But hang on, I thought surgery was going to fix the pain? That’s what your surgeon wants you to believe so that you commit to the surgery and they get your money! The surgeon is only acting on what he sees on a scan, whether that be x-ray, ultrasound, MRI etc. The problem is though, sometimes the issue seen on the scan is not necessarily the issue causing the pain. There is lots of research out there comparing abnormal imaging on scan and its relationship to back pain. These studies show that there is NO relationship. People with bad looking spines on scans, might not even have pain! So in fact, your surgeon could be giving you surgery that you don’t really need.

This table shows the % of people who have some sort of imaging finding but show no symptoms

The other point to consider is how you got your pain in the first place, is it an acute injury or is it more long term chronic condition? Also, what are the potential reasons for the pain? What we see the most in the clinic is poor movement quality and strength. Poor movement quality, especially when it comes bending and rotating can be a significant risk factor for injury as it puts increased load on the joints, rather than getting the back and hip muscles to take the load. Putting this into context, having surgery doesn’t fix the potential original cause of the injury, and can even make the movement quality worse. 

So what should I do? 

First, you should consult an Accredited Exercise Physiologist (AEP) who has the skills to properly assess your movement quality and strength and then you should start exercising. Exercise in this context doesn’t mean going and lifting 10kg weights, it could just be getting the body, especially the spine and hips, moving properly again and increasing flexibility. Once this is done it is a matter of getting strong and stable as this will enable the joints to have less load go through them and more load go through the muscles, whose whole job it is to stabilise and de-load the joints.

Bennett Tucker is an Accredited Exercise Physiologist and Level Two Strength Coach. He has been in the industry for 7 years and worked with a variety of professional athletes. Bennett specialises in athlete rehabilitation and lower back, knee and hip pain. His clinic is located in Croydon, Victoria.

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