Physical Therapy Versus Surgery: Weighing the Pros & Cons for Musculoskeletal Issues


According to the World Health Organization, around 1.71 billion people worldwide live with musculoskeletal conditions like chronic back pain, rheumatoid arthritis, osteoporosis, and fibromyalgia. The adverse effects of musculoskeletal conditions range from mildly irritating to frequently debilitating.

Although many musculoskeletal conditions can’t be fully cured, what’s important to remember is that the pain can be treated.

Besides pain medication, physical therapy (PT) and surgery are the two primary pain management solutions for various types of musculoskeletal conditions.

In this article, we’ll cover the benefits and risks associated with each pain management solution, starting first with physical therapy.

Physical Therapy

Various PT subdisciplines are used to treat musculoskeletal pain. These include:

Physiotherapist helping a man with exercise

  • Acupressure
  • Chiropractic Care
  • Aerobic Exercises
  • Posture Reformation Training
  • Core Strengthening Exercises
  • Flexibility & Stretching Exercises
  • Hot & Cold Therapy
  • Passive Versus Active Physical Therapy

    The two primary classifications of physical therapy are active and passive. Active PT includes treatments where the individual is directly involved in performing exercises, like stretching, walking, lifting weights, and doing yoga. Passive physical therapy involves treatments performed on the individual, like chiropractic adjustments, acupressure, traction, and massage.

    A combination of passive and active physical therapy treatments can help improve the three major classifications of back pain: axial, referred, and radicular.

  • Axial pain is constrained to a single location or area and can be dull, sharp, intermittent, or constant.
  • Referred pain moves from one place to another, varies in intensity, and tends to be achy and dull.
  • Radicular pain travels along the spine and is most often shock-like or stabbing.
  • PT can also help improve musculoskeletal conditions, including scoliosis, nerve irritation or compression, osteoarthritis, and fibromyalgia.

    When to Expect Pain Relief

    Please keep in mind that physical therapy alone cannot cure back pain and other musculoskeletal pain, but it is typically quite successful at reducing it. The exact source of musculoskeletal pain can be difficult to assess and isolate as every person is different, and the manageability of musculoskeletal is likewise unique.

    How soon you can expect pain relief with PT depends on several factors, including your level of pain tolerance, the severity of the pain you’re experiencing, and whether the physical therapy services you’re receiving are appropriate for your specific needs.


    Female patient lying down on a mat, exercising with her physiotherapist

    Common benefits of appropriate physical therapy include:

  • Reduces Pain
  • Improves Motion & Mobility
  • Aids in Muscular Function & Strength Restoration
  • Builds Self-Confidence
  • And perhaps best of all, routine PT often helps people avoid costly surgeries.


    While most people experience significant benefits from regular physical therapy services, there are some potential risks and side effects, including:

  • Unimproved or Decreased Mobility
  • Pre-Existing Conditions Worsening
  • No Improvement or Worsening of Pain
  • Increased Blood pressure and/or Heart Rate
  • Incurring Injury During PT
  • You may experience a decreased range of motion during or after PT, which typically self-resolves when your muscles become accustomed to the new routine. Of course, you may also experience DOMS (delayed onset muscle soreness), which is normal and typically subsides within a few days.


    There are many types of musculoskeletal surgeries, ranging from minimally invasive to invasive. Because back pain is so prevalent, two of the most common musculoskeletal-related surgeries are lumbar decompression surgery to relieve vertebral pressure and spinal fusion to join two or more vertebrae with bone grafts and metal rods, plates, and/or screws.

    Some other types of musculoskeletal surgeries include:

  • Discectomy to remove the herniated section of a disc
  • Laminectomy to remove bone to create more room for nerves
  • Kyphoplasty (vertebroplasty) to repair vertebral compression fractures
  • Soft Tissue Repair to fix torn tendons and ligaments
  • Osteotomy to realign joints or fix deformities.
  • Joint replacement to remove damaged joints.
  • Surgery saves lives and is sometimes necessary, especially after experiencing severe physical trauma.

    Total Recovery Time

    Recovery time will vary based on the type of surgery you had. Pre-surgery activity and current fitness level will also impact your recovery time. In many cases, a course of physical therapy is recommended before surgery so that it takes less time to recover.

    In general, the less invasive the surgery, the shorter the recovery time. For example, lumbar decompression surgery has a recovery time of approximately four to six weeks, while fusion surgeries are associated with considerably longer recovery times, typically between eight and twelve months.

    When to Expect Pain Relief

    Similar to recovery time, when to expect pain relief after surgery depends on the type of operation that was performed. However, considering all types together, it takes two months on average to heal.

    There are no guarantees with surgery, and some clinical studies have shown that it can take up to two years to notice significant symptom improvements, if any at all.


    Musculoskeletal surgeries produce beneficial results in many patients including:

  • Reduced Pain Symptoms
  • Increased Productivity
  • Improved Mobility & Function
  • Reduced Symptoms of Depression
  • Risks

    Most people who receive musculoskeletal surgery experience minimal complications, if any at all. However, that’s not to say that major complications don’t occur.

    The possible risks of musculoskeletal surgery, or any other type of invasive operation, include:

  • Death
  • Infection
  • Heart Attack
  • Blood Clotting
  • Excessive Bleeding
  • Decreased or Complete Loss of Mobility
  • Adverse Reactions to Anesthesia or Other Administered Drugs
  • It’s also possible to experience nerve damage during surgery, which can subsequently cause pain, weakness, paralysis, loss of bowel and bladder control, and/or sexual dysfunction. Furthermore, certain pre-existing health conditions can increase a patient’s risk of complications during surgery.

    Choosing the Right Option

    Although it’s difficult to live with musculoskeletal pain, it’s important you make the most informed health care decisions. Please consult your primary care physician if you need help determining which option is best for your unique situation. If you don’t have a primary care physician, we recommend starting with non-invasive solutions, like physical therapy.

    Schedule a Consultation With Total Health Systems

    Total Health Systems is a multi-disciplinary wellness center dedicated to helping individuals achieve pain-free living. Our professional staff specializes in acupuncture, chiropractic care, fitness coaching, functional medicine, massage, nutrition, and physical therapy services.

    If you’re unsure whether surgery or physical therapy is the best solution for your back pain or other musculoskeletal conditions, contact one of our six wellness centers today to schedule a consultation.

    Total Health Systems's Bio