Surgery Isn't Always the Answer For Pain Relief - And Sometimes It Makes Things Worse

I want to be clear about something upfront: surgery saves lives. It is absolutely the right call in the right circumstances -- acute trauma, progressive neurological deficits, certain structural instabilities. I'm not anti-surgery.

But I am anti "surgery as the first resort" for pain that hasn't been given a real chance at conservative care.

Because here's what most people don't get told before they sign the consent form: the human body is an interconnected system. When you surgically alter one part of it, something else has to compensate. Always. And sometimes that compensation creates a new problem - one that takes years to surface.

Let's Talk About Spinal Fusion

Spinal fusion is one of the most commonly performed spine surgeries in the United States. The premise is straightforward: if a vertebral segment is unstable or causing pain, fuse it so it can't move anymore.

The problem is what happens next.

The spine isn't a single unit. It's a column of 33 vertebrae, each one designed to share load and distribute movement with its neighbors. When you fuse two or more of those segments together, you don't eliminate the need for motion - you just reassign it.

The vertebrae above and below the fusion now have to absorb the range of motion that the fused segment used to contribute. They weren't designed to handle that extra load. Over time, this causes accelerated degeneration at those adjacent levels - a well-documented phenomenon called adjacent segment disease.

Research published in Spine found that patients who underwent lumbar fusion had a significantly higher rate of adjacent segment degeneration compared to non-surgical controls, with up to 36% requiring additional surgery within 10 years.

You solved the immediate problem. You created a future one.

This Is Physics. It's Not Complicated.

I don't say this to be dismissive - I say it because understanding the kinetic chain makes this immediately intuitive.

Think of the spine like a suspension bridge. Every cable in that bridge shares load with every other cable. Cut one of the cables - or in this case, rigidly fix it so it can't flex - and the adjacent cables have to carry more. Do that long enough, and they fail.

The same principle applies up and down the chain. A stiff ankle changes how the knee loads. A tight hip changes how the lumbar spine rotates. A fused segment changes how the vertebrae above and below it move.

Everything is connected. This is basic biomechanics. But surgical planning often doesn't account for the full chain - it accounts for the painful segment.

Knee Replacements, Rotator Cuff Repairs, and the Pattern Beneath the Pain

Spinal fusion is the most dramatic example, but the same principle applies broadly.

Knee replacements are performed at very high rates - and many of them are appropriate. But knee pain is so often a downstream consequence of hip weakness, ankle stiffness, or altered gait mechanics that have been present for years. Replacing the knee without addressing those underlying drivers means the biomechanical problem is still there, now operating on an artificial joint.

Rotator cuff repairs, shoulder decompressions, Achilles surgeries — in each case, the question isn't just "is this structure damaged?" but "why did it get damaged? What upstream or downstream dysfunction contributed to this outcome?"

A landmark study published in The New England Journal of Medicine found that arthroscopic surgery for osteoarthritis of the knee was no more effective than sham surgery - a placebo procedure where the surgeon made incisions but performed no actual intervention.

That's not a fringe finding. That's one of the most cited surgical studies ever published. And it should prompt serious questions about what we're actually fixing when we operate.

What Conservative Care Can Actually Accomplish

I've worked with clients who came to me scheduled for surgery - some of them weeks away from going under the knife. And some of them never needed it.

Not because I performed a miracle. Because their pain was being driven by a movement pattern, a muscular imbalance, or a compensatory chain that hadn't been properly identified. Once we addressed the root cause - not just the painful area - the pain resolved.

That doesn't mean surgery should never happen. It means surgery should almost never be the first thing that happens. Conservative care - proper physical therapy, movement retraining, load management, addressing the full kinetic chain - should come first, and come thoroughly.

A comprehensive review in JAMA Internal Medicine found that for most common musculoskeletal conditions, including low back pain, rotator cuff disease, and knee osteoarthritis, conservative management is equally or more effective than surgical intervention... with fewer risks.

Questions to Ask Before You Agree to Surgery

If a surgeon is recommending a procedure, these are worth asking:

• Have I completed a full course of physical therapy with a therapist who looks at the whole kinetic chain -- not just the painful site?

• What does the evidence say about surgical versus conservative outcomes for my specific diagnosis?

• What are the downstream risks -- adjacent segment issues, compensatory strain elsewhere -- and how will we manage them?

• If I have this surgery and the pain continues, what's the next step?

  
  

You are entitled to ask these questions. A good surgeon will welcome them.

The Bottom Line

Your body is a system. Pain in one location is rarely caused entirely by that location. Surgery that addresses only the symptomatic site -- without understanding what drove the problem in the first place -- risks creating new problems down the chain.

I've seen this play out too many times: a client who had a fusion, or a knee replacement, or a shoulder repair, only to develop new pain eighteen months later at the adjacent joint. Not because the surgery failed. Because the underlying pattern was never addressed.

You deserve a full picture before you make a permanent decision about your body. That means understanding not just what hurts — but why, and what it connects to.

Every post I write comes from the same place -- the belief that your body deserves more than a surface-level fix. If you want to understand the full picture of how I approach pain, movement, and lasting wellness, the philosophy page is where it starts.

[Read the Philosophy - realignedbyregan.com/philosophy]