“I definitely thought that surgery was in my future. But now I'm not so sure. Having been in this program, I have learned so much, and I feel great. I feel like I've been given a second chance. And that doesn't happen very often.”
Ramón, a past Hinge Health participant, tells a story that countless others can relate to.
It’s true that some injuries and conditions are best addressed with surgery. But shortly after starting the Hinge Health program, Ramón learned what thousands before him have: that surgery should never be your first option for reducing persistent pain. In order to understand why, let’s talk through a few things.
Surgery Is Not as Effective as We Once Thought
We know a lot more about pain now than we used to. The most recent research shows that surgery doesn’t always address the root cause of persistent pain.
One study that looked at patients one year after having a total hip replacement showed that 23% of people still had “severe walking restrictions.”  More encouraging, though, is the evidence to show that exercise therapy can increase mobility, decrease pain, and reduce the likelihood of even needing surgery.  Harvard affiliate Dr. Eric Berkson says that exercise and weight loss should actually be the first line of defense. 
Experts recommend delaying surgery as long as possible. But should it become necessary, even people with advanced hip osteoarthritis are still encouraged to be as active as possible before surgery to increase positive outcomes and surgery success. 
While these studies may or may not reflect your personal experience, they do show that a dramatic treatment like surgery doesn’t guarantee a dramatic change in pain.
Scans Don’t Show Pain
Imaging has an important place in medicine. But it’s proven to be quite unreliable when dealing with persistent pain because scans don’t tell your whole pain story.
If you’ve ever had an MRI or a scan, you may be familiar with the uneasy feeling of waiting for your doctor to give you bad news. Maybe your thoughts and emotions about your pain were influenced by an ‘abnormality’ your doctor saw on that scan.
Your hips are no different than the rest of your body in the sense that changes are normal as you age. Cartilage becomes thinner over time, and the space between the bones in your hips will narrow. But surgery usually isn’t needed to fix these changes. They’re natural, just as it’s natural to develop wrinkles on your skin and gray hair on your head.
A study published in The American Journal of Sports Medicine found that 73% of pain-free individuals showed hip abnormalities an on MRI.  And studies done on cadavers reveal that up to 96% of people who reported no hip pain when they are alive have labral tears. 
You see, persistent pain is incredibly complex. An MRI may reveal an ‘abnormality,’ but that doesn’t actually tell us why you have pain.
Control What You Can Control
In the previous playlist, you learned about the many different factors that can contribute to your pain. Some treatment options, like exercise, address multiple factors in your backpack.* Other treatments only address the physical contributors to pain. Surgery is a perfect example of this.
We now know that the best way to manage persistent pain is to focus on the pain contributors you can change.
You can’t control your genetics or previous injuries. But you can make changes to your exercise and movement routine. You can set goals to work toward better stress management and sleep. You can make an effort to learn more about persistent pain. And when you focus on changing those factors in your backpack, it’s possible to avoid surgery altogether.*
Regardless of whether you’ve already had surgery, believe it’s inevitable for you, are determined to avoid it, or are unsure of what to think, we want you to feel confident in having an empowered conversation with your doctor about what’s best for you.
What you see on a scan should not dictate whether or not you have surgery to treat your pain. And it’s almost always worth it to address pain with movement and exercise therapy before having surgery. You too could end your story like Ramón and countless other Hinge Health participants.
“Before starting this program I just assumed surgery would be in my future (with increasing discomfort and my age). I figured it was just the cost of aging. I'm really excited at the prospect of avoiding surgery.”
* We added a video and additional content to the article “Rethink Your Pain,” which you read in a previous playlist. In case you missed it, be sure to take a look at “Rethink Your Pain” in the Library of your Hinge Health app for important background information and context.
Surgery should never be your first choice for reducing persistent hip pain.
Pain is personal and multifaceted.
By focusing on what you can control, you may be able to avoid surgery altogether.
Williams, O., Fitzpatrick, R., Hajat, S., Reeves, B. C., Stimpson, A., Morris, R. W., … Gregg, P. J. (2002). Mortality, morbidity, and 1-year outcomes of primary elective total hip arthroplasty. The Journal of Arthroplasty, 17(2), 165–171. https://doi.org/10.1054/arth.2002.29389
Exercise Benefits for Hip Osteoarthritis. (n.d.). Retrieved from https://www.arthritis.org/health-wellness/healthy-living/physical-activity/getting-started/exercise-benefits-for-hip-osteoarthritis
Harvard Health Publishing (June, 2014). When is back surgery the right choice? Retrieved June 12, 2019, from Harvard Health website: https://www.health.harvard.edu/pain/when-is-back-surgery-the-right-choice
Register, B., Pennock, A. T., Ho, C. P., Strickland, C. D., Lawand, A., & Philippon, M. J. (2012). Prevalence of Abnormal Hip Findings in Asymptomatic Participants. The American Journal of Sports Medicine, 40(12), 2720–2724. https://doi.org/10.1177/0363546512462124
Groh, M. M., & Herrera, J. (2009). A comprehensive review of hip labral tears. Current Reviews in Musculoskeletal Medicine, 2(2), 105–117. https://doi.org/10.1007/s12178-009-9052-9