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  • Writer's pictureAndrew Ivanchenko



The best surgery is the one you managed to avoid.

Nikolay Pirogov

Surgery and Rehabilitation: From intervention to recovery, trust our expert care for tailored solutions to restore mobility and vitality effectively. Your journey to wellness starts here.

The original name of this chapter was “To be or not to be – to heal or to cut?” but I decided not to scare my readers that much. On the other hand, some patients do think of surgery as a remedy of last resort, something like capital punishment or a flight to the Moon.

The complementarity principle

Surgical intervention is a legitimate means of keeping the patient mobile for years to come and even preventing further degeneration of joints.

Surgical intervention is often a legitimate means of keeping the patient mobile for years to come and even preventing further degeneration of his joints. We all know that a knee or hip joint injury means agonizing pain and immobility, but it can also cause damage to intervertebral disks in the lower back. A patient who procrastinates with a decision to have surgery would eventually get rid of his damaged joint but still suffer from radiculitis.

Surgery is not the nicest thing in the world. Surgery is scary. Anesthesia, the risk of cardiac arrest, hemorrhage, and infection are all common dangers (albeit lessened in recent times when surgery became less invasive). Patients who went through surgery before these recent advances are still sharing horror stories about the consequences and complications of the procedures they underwent. Many years ago, I also used to be wary of surgery and did my best to keep my patients away from the surgeon’s knife for as long as possible. Time does not stand still, however. A yesterday’s dream or a fortunate exception is becoming today’s standard. Surgery brings most patients a welcome recovery from years of brutal pain.

You may ask why a specialist in conservative rehabilitation medicine would advocate surgery. What’s in it for me? After all, I’m interested in patients who have not yet made it to the operating room. Right? No way. Rehabilitation is not the opposite of surgery and vice versa. They are just two complementary stages in the recovery of and care for the musculoskeletal system.

Patients who receive pre-surgery therapy fare much better after the operation, their recovery is easier and faster.

Patients who receive pre-surgery therapy fare much better after the operation, their recovery is easier and faster. And those who enlist in an early rehabilitation program do not only get rid of pain but also strengthen their joints and muscles related to the ailing joint.

Here is a graphic example from my practice.

A case history

We tried to battle this patient’s herniated disk and pinched nerve root for over a year with varying success. He came to me in a hopeless condition, in acute pain, after a failed treatment with powerful painkillers and several spinal injections that provided but a modest relief for a few days. An NMR test revealed a good-sized disk protrusion in the fifth lumbar segment and a herniated nerve root. I instantly told him his chances were not good. To my surprise, after the two initial sessions he started feeling better, stopped limping and could bend and straighten himself up again. He believed that a miracle happened.

Surgery is one of the oldest fields of medicine. Bladder stone removal and trepanation were already performed six thousand years B.C.

Unfortunately, the age of miracles is gone. In a month, he was back in our clinic with a new bout of disease. This time his recovery was sluggish and far less impressive. After a few months, I started talking the patient into surgery, something he had been advised by other doctors for several years. He finally agreed… and disappeared for about a year. A month ago he limped into our clinic again with a crutch, though this time his herniated disk was not the reason. A year ago, happy to get rid of his problems, he saw no reason in post-surgery rehabilitation that I recommended.

A few months after he was strolling joyfully post-surgery without any back pain, his knee joints began to hurt. Happy with the success of the previous surgery, he again sought help from an orthopedic surgeon. Not considering him yet ready for an operation, the doctor injected hormonal anti-inflammatory medication into his knees. The relief, however, was limited and short-lived. As the patient’s condition kept deteriorating, he remembered about our clinic – and walked out after the very first visit carrying the crutch under his arm. Now we are working on an integral (holistic) recovery of his joints and muscles using a time-tested combination of manual decompression, acupuncture, medication, pain-killing injections, and exercise therapy.

This instructive story once again demonstrates a close link between surgery and rehabilitation. They are indeed complementary rather than antagonistic.

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