CSA Physio Blog

Waiting for joint surgery? Stop waiting, and start rehabbing.

Posted on: September 11th, 2018 by Jeffrey Begg

Why does our system think it’s OK to wait 14 months for joint surgery?

The Alberta healthcare system provides excellent and timely care for life-threatening conditions.  A sore knee or hip is considered not life-threatening, and therefore you get thrown in the queue to wait for joint surgery.

What if that sore knee stops you from biking and walking for 14 months?  Your blood pressure may start to rise and your blood sugars may increase.  You might now be dealing with diabetes and  hypertension.  In fact, this 2018 study from the journal BMC Medicine concludes that if you have hip or knee arthritis, you may be as much as 17% more likely to develop cardiovascular disease.  In the long term, that is certainly life threatening.

The flaw in our system

I worked in the US healthcare system for four years. I am intimately aware of the wonderful efficiencies of that system, as well as its limitations and exclusivity. Having worked now in the Canadian healthcare system for more than 15 years, I’m a huge proponent of our universal care. But when we are faced with waiting lists, it’s important to understand how you can work within the system to achieve your best outcome.  Unfortunately, failing to support evidence-based treatment for people on joint surgery waiting lists is a flaw in our system.

The mini-scandal that no one in the Health Ministry talks about

You may have an arthritic knee joint that is 5 years away from needing a replacement.  Alternatively, you may need one now, but the wait is 16 months. Often times you’ll find that you are offered no treatment options other than medication, or perhaps a joint injection. That’s a failure of the system.  In fact, there are a number of published Systematic Reviews of high-quality research that tell us there is a host of rehabilitation options that help people with arthritic hips and knees.  Why aren’t you being offered these options? Most of them involve some type of physical therapy and guess what? The Alberta healthcare system has slowly been reducing funding for physical therapy for the past 25 years to a bare minimum at present. Imagine how awkward it is for the Health Ministry to have to acknowledge the great benefits of physiotherapy, but have to explain that they do not fund that treatment for most Albertans. Hence, it’s not talked about. (*)

How you can access good quality care while waiting:

Step 1: Clarify your diagnosis

Step one is clarifying your diagnosis.  You may have been told you have a “torn labrum” in your hip or shoulder, or that you have an arthritic hip or knee.  I will review your history and your imaging, perform a thorough examination, and confirm that we’re on the right track.  It’s not unusual for me to find that you’ve been misdiagnosed.  In fact, as one of Alberta’s only Clinical Specialist physiotherapists, patients often seek my advice to get the diagnosis right.

rehab for joints, physiotherapy, joint surgery

There is lots you can do!

Step 2: Identify the best treatment options

“The list of  the six best exercises for shoulder rotator cuff tear that works for everyone” does not exist.  What you need is a thorough examination to identify your specific deficits.  Based on that I will come up with a highly personalized list of treatment options.  The most effective options will be considered, as well as alternatives for you to choose from.  Here’s a chart that gives an example of the treatment options we will consider.

Step 3: Get started on physiotherapy for your joint!

Step three is getting you on the right program.  Sometimes that’s showing you exercises to do on your own.  Other times it means being ‘in physio’ for 4-6 weeks.  This might be required to get some hands-on treatment, needling or electrical stimulation.  I’ll help you decide the best plan.

Step 4: Evaluate progress and change the plan

If things improve as expected, you’ll be happy, and able to carry on with less pain.  If they don’t improve as expected, we’ll change plan and consider the next treatment option, until we arrive at a reasonable solution that prolongs the life of your sore joint.  With our highly integrated, multi-disciplinary network at CSA, my partners and I provide virtually all of the possible treatment options for your condition, with the exception of surgery.  

Perhaps it’s time for you to stop waiting, and to start rehabbing.


(*Note: Alberta health funding for physiotherapy is available, but very limited.  Alternatively, most extended health benefits plans do include physiotherapy)

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