As Physiotherapists we have a responsibility to deliver the best possible treatment options for our patients. Physiotherapy is a conservative management and a non-surgical treatment option. Physiotherapists will mostly consider conservative management first. However, some conditions may call for a referral to a specialist to discuss surgical intervention. If patients consult a GP or orthopaedic specialist as their first point of call then physiotherapy may not be included in their treatment pathway. If a patient is not given the opportunity to undergo physiotherapy assessment there is a chance that unnecessary surgery may be performed when physiotherapy treatment may have resolved the issue.

As a profession we are really proud to have physiotherapists among us who question medical practices and seek better ways to do things. This process of continued re-assessment and reflection assists our profession to deliver better service models and improved medical outcomes for those who receive physiotherapy.

An example of re-thinking the landscape of physiotherapy within a medical model is an Australian project that plans to use Clinical Pilates to reduce the number of unnecessary invasive surgeries. The 100 x 100 project, by Clinical Pilates Dance Medicine Australia, is an initiative to have 100 physiotherapy patients avoid surgery through receiving individualised Clinical Pilates treatment, ultimately meaning a reduction in 100 surgeries.

The research is out and provides a strong case for Clinical Pilates treatment proving an effective form of rehabilitation and as a result avoidance of surgery. Not only does this benefit the patients but at an estimated $30,000 per surgery this can save $300m! Patients, who according to the research could avoid surgery by participating in Clinical Pilates instead, include conditions such as sciatica, total knee replacement, anterior cruciate ligament, knee meniscus and shoulder impingement but are not limited to these conditions only.

Reasons for choosing Clinical Pilates management over surgical management are numerous. Firstly, the medical system relies upon commonly requested imaging such as x-rays and MRI scans to indicate surgical treatment is necessary. However, in many cases, what is evident on imaging does not correlate with the pain and symptoms a patient is experiencing and hence an unsuccessful result of surgery is likely. Secondly, a physiotherapist will complete a comprehensive assessment to determine the cause of pain and dysfunction and therefore provide a suitable treatment program to return a patient to normal.

Opinions amongst Physiotherapists predominantly support the concept of the 100x100 project. It is certainly acknowledged that Clinical Pilates may not always be the ideal treatment choice for some patients. It should, therefore, be highlighted that any personalised, rehabilitative exercise program delivered by a physiotherapist could also produce the same ultimate outcome of avoiding surgery.

The moral of the story is to seek physiotherapy first ….before consulting a surgeon!

More information about this can be found at https://www.clinicalpilates.com/about-us/surgical-suitability/