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Comment by ashelmire | Hacker News Reader

Physical therapy is evidence-based health practice. This is sort of a "no shit" piece. Doctors want to operate on you - it's what they are trained for, it's how the make money. Hospitals make money off of surgery. Yet physical therapy gets better results.

Lookup washout studies vs knee surgery with results like this [1].

1. https://www.scientificamerican.com/article/study-suggests-co...

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Yes. I'm not sure this is so true for full thickness tears, but in general I think your point stands.

That said, patients also want surgery. I can't tell you how many patients I have referred to physical therapy for conditions which we know are improved by physical therapy (like routine lower back pain, minor muscle strains, etc) and they look at me like I'm crazy. I've seen it work in my patients that actually went and participated, but most go through the motions and stop going after a session or two because 'it wasn't helping'. I think part of american culture is that we want instant fixes, even for problems that have been brewing for decades like heart disease and diabetes... /endRant

People want a magic pill to be healthy, pretty, famous and rich. It’s human nature, we want everything right now.

It's interesting how relative it is too. For people who like to be active some of these new rehab programs and findings are essentially "magic pills". "Wait, you mean all I have to do is just 15 minutes of exercises only once every day and my knee/wrist/elbow/shoulder might be 100% in 6 months?! Amazing!"

How do I find your practice IRL? It’s hard to find people that don’t just recommend surgery because the system wants them to.

sorry for delayed response. I'm a hospitalist, so don't have an outpatient practice...

Yeah, I'm guilty of thinking this way as a patient. I had bursitis issues, but I convinced myself that it was a rotator cuff tear, partly because I didn't know that the bursa were a thing. I was skeptical of PT, but that along with anti inflammatories pretty much made me good as new. I was down to 170 just from avoiding upper body due to excruciating pain, but after PT I am now stronger than before and back up to 195ish.

At face value, full-thickness tears are different. Maybe you don’t need whatever muscle you broke in half, but that seems surprising.

After reading the article I’m not sure what the outcomes actually are. Did the shoulder compensate and just let that muscle atrophy? Did it reattach? Either way this is definitely not a no-brainer.

Absolutely. IMO for a lot of injuries surgery should be the last option. Anyone taking rehab not seriously should be well warned of the consequences.

The doctors I've spoken to in Australia all considered surgery a last resort when I asked why they didn't mention it for this sort of thing. They will happily admit the risks outweigh the benefit until all other options are exhausted. Having universal health care would have a lot to do with that.

I've seen a whole lot of people go through rehab who just don't want to do the work or see that time is necessary. It's really sad how they just don't allocate time for their healing.

> Doctors want to operate on you - it's what they are trained for, it's how the make money.

Is that it, or is it more if you are a hammer everything looks like a nail. A surgeon only knows how to fix things by operating on them. They are going to suggest that.

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