Lets [Foam] Roll

Everyone has seen those things in the corner of the gym. Some are smooth, some are round, some have spikes, but what are they for and how should they be used? Just to be clear, we are talking about foam rollers…but you already knew that from the witty title. 

Surprisingly, most of my clients already have a foam roller, or at least access to one. When I ask them if they use it, they usually tell me it serves as a great dust collector in the corner of their living room. I get it–these tools can be overwhelming, so lets talk about why you should be using them.

1. Why should I do it?

(**Disclaimer, this section briefly discusses the science of fascia and myofacial release, so if you don’t care skip down to the bold words**)

Foam rolling is a form of myofascial release. NERD ALERT! Contrary to popular belief, foam rolling does not “break down” fascia, adhesions, or scar tissue. You may have seen this article in the Washington post recently about fascia. There is a lot we don’t know about fascia yet, but this is what we do know: it is a three-tiered layer of connective tissue that surrounds the muscles, organs, nerves, and blood vessels. It is almost impossible to mechanically deform fascia by pressing on it–just ask surgeons who have to cut through it with scalpels. Rather than breaking it down, myofascial work increases the pliability and flow of fluid between each layer of tissue.

So, what the heck is the point? Consistent myofascial work with a foam roller:

  • Reduces muscle tension
  • Increases flexibility without decreasing muscle performance
  • Reduces delayed onset muscle soreness (DOMS) and perceived pain after exercise 
  •  Improves slide and glide of tissues and nerves
  • May lead to improved vascular function and parasympathetic nervous system function

2. When should I do it?

Ah, the big before vs. after exercise debate. Sorry to disappoint, but there are benefits to using a foam roller both before and after exercise.

  • Foam rolling before exercise can help improve muscle force production and decrease stiffness heading into your workout.
  • Foam rolling after exercise can decrease muscle pain and DOMS.

There is conflicting research on whether or not foam rolling improves flexibility long-term. The key to lasting results is to pair consistent foam rolling with mobility work.

Dr. Ryan DeBell, owner of Movement Fix, does a great job demonstrating how to incorporate foam rollers in a mobility routine. Watch how he uses self myofascial release to help stretch the hamstringslatspecsquads, and calves.

3. What should it feel like?

Remember that you are not breaking down fascia or adhesions, so pressing harder is not inherently better. On the contrary, going too hard with the foam roller can actually stimulate areas in the brain that want to protect us from injury. So instead of relaxing the muscle, it can end up causing more muscle tension and pain.


  • Stay in the “meat” of the muscle by avoiding boney areas
  • If it feels good to you, chances are it is doing good
  • If it is too painful, then either use a softer roll or stop

4. How long should I do it for?

Foam rolling around 30 seconds per muscle group should be plenty to create the desired effect. Roll each muscle group slowly and pair with deep breathing to maximize muscle relaxation.

So, grab your foam roller, dust it off, and get to it.

-Marley Lefelar, PT, DPT



No Pain No Gain…Right?

I can almost hear my old trainer screaming at me right now…”NO PAIN NO GAIN!!!” So what is the deal with this phrase? Is it true? Do we really need to experience pain in order to make gains, or does pain mean I am hurting myself and need to stop?

Let me introduce you to the traffic light system.

Green Light: good to go

  • Pain during exercise is a 0-3/10.
  • There is no increase in pain after the activity is over.
  • There is no change in your range of motion, strength, or function after the activity.
  • Consider increasing resistance or repetitions, or progress the exercise.

Yellow Light: may be too much too fast

  • Pain during exercise is a 4-5/10.
  • Pain may persist above your baseline after the exercise, but should return to baseline within 24-48 hours.
  • There is no change in your range of motion, strength, or function after the activity.
  • Consider decreasing resistance or repetitions, or regress the exercise completely.
  • Pain may be more common here if you are recovering from an injury or if you did a lot of eccentric exercise.

Red Light: stop immediately

  • Pain during exercise is a 6-10/10.
  • Pain may persist above baseline for days to weeks.
  • There is an obvious change in range of motion, strength, or function after the activity.
  • Stop the activity immediately and consider contacting your physical therapist or orthopedist.

**Pain is subjective and therefore different for everyone. Generally speaking, a 0/10 pain means you are experiencing no pain at all. 5/10 pain means it hurts enough to want to take something (i.e. Advil/Tylenol/Aleve/etc). A 10/10 pain is the worst pain imaginable and someone should call 911 because that is how badly it hurts.

Pain is an important way for your body to communicate with you, but not all pain means you are injuring yourself. Think of getting into a hot tub. It burns when you first try to get in, but eventually your skin gets used to it and you can relax and enjoy the bubbles. The nervous system works this way too–it warns of a potential threat, but settles down as it realizes the threat will not injure you.

So pain during exercise is not always bad, but scratch the “no pain no gain” phrase and use the traffic light system instead.

Marley Lefelar, PT, DPT


Sleeping 101: The Pillow Factor

Written by Anna Borissow, DPT

Did you know that up to 1/3 of our lives is spent in bed sleeping? For this reason, proper pillow positioning is important for preventing neck, shoulder, and low back pain.

Individuals need to position their pillows so that their head, neck, and back are in a neutral position, which in other words means, when the body is most relaxed and joints are in mid-range. Whether you are a side sleeper or prefer to be on your back, having the proper pillow height and positioning are important for overall well-being of your neck, shoulder, and back. Getting that restful sleep at night is crucial for your body to recover after a long day of movement.

Here are some tips to consider when choosing the right pillow for your body and in finding “neutral” position.

When choosing the right pillow for your body, you want to support your unique posture and simultaneously not add or promote faulty postures.

  1. The soft/shallow pillow:

A pillow that is too soft and shallow may make your head bend back excessively, if you prefer to sleep on your back. The tipping of your head backwards can compress certain neck segments, which may overtime cause stiffness to some segments and increased flexibility to others. Maintaining optimal segmental alignment is vital for your spinal discs to get restorative nutrition and circulation while you sleep.

If you are a side-sleeper, your head may bend sideways towards the pillow if the pillow is too soft. This position is also not optimal because only some neck segments and soft tissues are being supported by the pillow. This can lead to increased contraction of the neck muscles to balance out the forces of gravity and of not being adequately supported. People sometimes place one arm under the pillow to support the neck. This is usually an unconscious sign that the body is telling us that the head is positioned too low. Placing an arm under the pillow will place increased compressive forces on the shoulder joint, which can potentially lead to injury overtime.

2. The thick/uncompromising pillow:

If your pillow is too thick or hard, your head may be forced to bend forward bringing your chin closer to your chest when back sleeping. This type of posture can impair breathing, feed into a forward head posture, and further compress the spine and neurovascular structures.

If you are a side sleeper and the pillow is too thick or hard, the head will tend to bend sideways upward, bringing your ear closer to your shoulder. This posture can create fulcrums to certain spinal segments in the neck, which is not healthy for your neck health. During sleep, the tissues in your body should completely relax. When a hard structure is pressing and creating a fulcrum on a spinal segment, such as with a hard pillow, It can lead overtime of overstretching ligaments and other supportive structures of the spine, leading to instability at those segments.

So, what is the BEST PILLOW?

The perfect pillow height is unique to each person based on their overall posture. In general, when lying on your back, your head should rest in the middle of your body, head not tipped back or forward, in neutral, and the pillow slightly under the top of the shoulders. You should be able to breathe fully and feel no tension in the neck. Oftentimes, people with forward head and forward shoulders feel more comfortable by placing towels or small shallow pillows under the arms for added support. This postural adjustment helps support the shoulder joints and keep it in neutral position. Adding a small pillow under the buttocks and legs help offload the low back and keep the body in neutral.

If you are a side sleeper, you need to maintain a neutral spine in the whole body from the top of the head to the tailbone, making one straight line. When sleeping on your side, the pillow should be squishable, like a down pillow, so that it can fill in all the gaps between your neck and shoulder equally. The space between your shoulder and head is the pillow height and can be used when finding the correct thickness pillow for yourself. People who have chronic shoulder dysfunction, neural tension, or neck radiculopathy often feel more comfortable by offloading the top shoulder with a pillow under the entire arm. This decreases any tugging on the neck structures and shoulder joint by the weight of the arm falling down by gravity at night. An added pillow between the legs from the tailbone to the ankles can help maintain a neutral pelvis and help with overall relaxation of the body.

If you don’t know what the best sleeping arrangement is for your body, ask your Physical Therapist at ANMPT to help you achieve your optimal sleeping position. You don’t have to wake up feeling sore and tired. Let us help you get that restorative sleep you crave!

Anna Borissow, DPT

Dr. Borissow is the owner of Advanced Neuromuscular Physiotherapy, LLC located in North Bethesda, MD


Let’s Take Some (Cortisone) Shots!

Cortisone injections are a hot topic these days – are they good or are they bad? Should we take some shots??

Cortisone is a synthetic corticosteroid produced by the body’s adrenal glands. A cortisone injection can be administered to suppress pain and localized inflammation and can last anywhere from a few weeks to six months. Cortisone injections provide temporary pain relief. For acute conditions, the main goal of an injection (along with activity modification) is to decrease pain long enough to allow the injury to heal. For pain lasting longer than three to six months, also known as chronic pain, cortisone injections must be part of a larger treatment plan. It is important to remember that cortisone does not provide a permanent cure. People who are interested in long-term relief should participate in physical therapy to address why the injury occurred in the first place. Physical therapy is essential to ensure proper joint biomechanics, movement patterns, posture, strength, muscle mobility, and nerve mechanics, just to name a few. A cortisone injection may be a great tool to decrease a person’s pain so that they are able to participate in physical therapy.

The results of cortisone shots vary depending on the individual and reason for treatment. Injections may result in increased pain for a few days, but significant relief should ensue. Chances are if the first shot doesn’t do anything significant for you, another shot probably won’t either. Cortisone generally has minimal side effects; however, its use can lead to thinning of the skin, tendon weakening or rupture, lightening of the skin around the injection site, and temporary increase in blood sugar. Side effects increase with larger doses and repeated injections, which is why physicians usually limit the frequency and number of cortisone shots given. Individuals who do receive repeated injections without additional treatment usually notice shorter and shorter periods of pain relief, which is a sign of progressive joint degeneration. Again, physical therapy and lifestyle changes can help slow down or stop joint degeneration.

If you want some research…

A 2017 study looked at the effectiveness of deep friction massage (a type of manual therapy) versus a cortisone injection for tennis elbow. At early follow-up (6-12 weeks after receiving the treatment), both groups had improvements in pain, grip strength, and level of perceived function. At 6 months post-intervention, only the manual therapy group demonstrated improvements in all three categories.1 A similar study done in 2009 reported “findings indicated that corticosteroid injections are effective at short-term follow-up, and physiotherapeutic interventions are effective at intermediate- and long-term follow-up.”2

Sooooo shots? Overall, cortisone injections can be a great tool for someone experiencing musculoskeletal pain. I think people make the mistake when they eliminate physical therapy or other rehabilitative medicine from the equation. Just simply getting an injection without fixing the cause is Band-Aid medicine. Like most medications, cortisone is best used only when indicated and not too frequently. If you have additional questions about cortisone, ask your physical therapist or doctor for more information.

Thanks for reading!

Marley Lefelar, PT, DPT



  1. Yi R, Bratchenko WW, Tan V. Deep friction massage versus steroid injection in the treatment of lateral epicondylitis. 2017. doi: 10.1177/1558944717692088.
  2. Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial.JAMA.2013;309(5):461–469. doi:10.1001/jama.2013.129.


To PRP, or to not PRP?

You may have heard about PRP on ESPN. Tiger Woods, Isaiah Thomas, and Kelly Oubre are just a few names that pop up when you google PRP. Platelet rich plasma (PRP) has become increasingly popular in the past few years. “Should I get PRP?” is a question my patients ask me all the time. PRP is considered regenerative medicine, and the goal of these type of therapies (think stem cell therapy and prolotheapy) is to help the body heal itself, instead of using drugs or surgery. When tissue healing is impaired due to aging, disease, or because an injury is extensive, regenerative medicine approaches may be indicated. So, what is the answer? What is all the hype about PRP? And what does it have to do with physical therapy? Stay tuned.

I had the pleasure of spending time with Dr. Mayo Friedlis and Dr. Ben Newton at Stem Cell Arts, where they let me to watch many of these regenerative procedures. Platelet rich plasma (PRP) is a concentrate of blood that contains a high number of platelets and associated growth factors.1 PRP is created by taking a sample of your blood and putting it through a multi-stage centrifugation process that removes red and white blood cells, leaving you with a final platelet concentrate that is 5-8 times the normal level.1

PRP concentrate

This final concentrate can be injected into muscles, tendons, ligaments, and joints to trigger a healing response. The American Journal of Sports Medicine recently released a study about the clinical efficacy of PRP in January. This study reviewed the use of PRP vs. a control (i.e. saline, corticosteroid shots) in over 1,000 subjects with tendinopathies, and determined that the use of leukocyte-rich platelet-rich plasma (LR-PRP) treatment lead to better outcomes than controls.1

One issue with PRP is that it has different effects on different tendons. For example, researchers found that acute hamstring injuries respond significantly better to rehabilitation exercises and not so much to PRP injections.2 Another issue with PRP is that there is no standardized way to produce it or use it.3 A PRP you get with Dr. A could be completely different from the PRP Dr. B produces. Dr. A might do 5 fenestrations at the injection site while Dr. B does 50, and that is the area that remains fuzzy. The good news is, clinics like Stem Cell Arts do not use a one-size-fits-all approach like many orthopedists do, because regenerative medicine is what they do. They have an in-house lab where technicians create individually tailored platelet concentrates by hand. So, if you are interested in PRP, save yourself the time and money and do it somewhere like Stem Cell Arts.

If you do get PRP therapy, you are probably going to need physical therapy as well. Correcting mechanical asymmetries, muscular imbalances, and movement dysfunctions before PRP will lead to better results. Let’s say you are getting PRP injected into your gluteal tendon. Well, why did it become injured in the first place? Sure, PRP will help heal the tendon, but what’s to say you aren’t going to end up with the same injury years down the road because you never fixed the problem. Physical therapy is also important after PRP and is different from normal rehab. Instead of trying to calm the inflammation down, physical therapists want to help facilitate the inflammatory process for another week or so to maximize the benefits of PRP. In brief, this stuff works. PRP injections combined with physical therapy produce positive, lasting results without undergoing surgery. Advances in regenerative therapies will continue, and PTs need to be educated on how to handle these procedures if they want to keep up with the future.

Check back in next week for information on stem cell therapy,

Marley Lefelar, PT DPT


  1. Fitzpatrick J, Bulsara M, Zheng M. The effectiveness of platelet-rich plasma in the treatment of tendinopathy. Am J Sports Med. 2016;45(1):226-233.
  2. Hi P, Reurink G, Tol JL, Weir A, Winters M, Moen MH. Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and mata-analysis. Br J Sports Med. 2015;49(18):1197-1205.
  3. The role of pts in regenerative medicine. American Physical Therapy Association Web site. http://www.apta.org/PTinMotion/2016/3/Feature/RegenerativeMedicine/. Updated March, 2016. Accessed July 16, 2017.

What I Wish I Would Have Known as a Female Athlete

Yes, it is my job as a physical therapist to fix the injured, but I also feel a duty to help prevent musculoskeletal injuries from occurring in healthy populations. I was 14 years old the first time I tore my ACL and meniscus. I grew up playing basketball, baseball, and soccer, but was only exposed to injury prevention and specific strengthening after my first knee surgery. Even playing varsity basketball in high school, there was no strengthening program we followed specific to injury prevention. My coach would lead us to the weight room and my teammates and I would end up doing skull crushers, which does nothing for the lower extremity (obviously). This does not come at any fault to the coaches because unfortunately, there is a knowledge gap, especially with female athletes.

Anatomically, females generally have shorter legs, smaller ligaments, smaller muscle cross-section, more joint laxity, and a wider pelvis resulting in knee valgus or “knock-knees.” There are also conditions that females experience that our male counterparts will not such as menstruation and bone density issues due to the presence of estrogen. On average, menstruation begins between 10 and 15 years of age, which is right when female athletes begin to ramp up sport-specific training. We learn about periods and how our body shape might change, but no one ever talked about my joints becoming more lax or my risk of sport injury increasing. More importantly, no one ever told me what I could do to prevent these injuries from occurring.

Some of the most common injuries seen in female athletes are patellofemoral (knee) pain, ACL tears, ankle sprains, and stress fractures. Patellofemoral pain syndrome (PFPS) involves your patella (knee cap) and your femur (thigh bone) and is one of the most common causes of anterior knee pain. PFPS is about twice as common in women, and mainly affects young active women. There are many risk factors for developing PFPS such as poor patellar tracking, pelvic malalignment, muscle weakness or dysfunction, muscle and soft tissue tightness on the outside of the knee, altered lower extremity biomechanics, and training errors or overuse. During pre-season training, we used to run the bleachers to get in shape. The forces transmitted through your kneecap when going up stairs is three times your body weight. Now imagine running up and down the stairs for extended periods of time without the proper pelvic stability. I can promise you, your knees are probably not going to be happy. Do not take pain lightly – cut back on your mileage at the first sight of pain and make sure you are wearing good shoes. The best way to prevent PFPS is to address the risk factors listed above. These assessments are best performed by qualified sports medicine professionals or physical therapists, and highlight the importance of injury prevention screenings.

Weak Tight
Hip abductors Hamstrings
Deep hip rotators Quadriceps
Quadriceps Iliotibial band (ITB)
Core Calves
Table 1: Example of commonly weak vs. tight muscles in those at risk for developing PFPS


The next topic is something I am very familiar with. ACL tears. Between 14 and 20 years of age, I tore my ACL four times and underwent a total of five knee surgeries. Unfortunately, these numbers aren’t a rarity for female athletes. Females show a sharp increase in the incidence of ACL tears during puberty due to the resulting ligamentous laxity, which is why prevention is so important. Surprisingly, around 70% of ACL tears happen from non-contact injuries. Risk factors for ACL tears include high BMI, asymmetry between the right and left lower extremity, core and pelvic weakness, hip and ankle joint tightness, decreased neuromuscular control of the knee, and movement dysfunctions. Weakness in your core abdominal and hip musculature can lead to pelvic drop, increased internal rotation of your femur, knee valgus (knock-knees), external rotation of your tibia (lower leg bone), and over-pronation of your foot and ankle. I know there are a lot of big words in that last sentence, but you can probably sense that those are all bad things that lead to increased tension through your ACL.  Additionally, multiple studies have shown that a poor hamstring to quadriceps strength ratio is a significant risk factor for ACL injury. Female athletes generally have much weaker hamstrings than quadriceps, so it is important to strengthen both. Now let’s talk about tightness. Each joint in our body is generally suited for either mobility or stability. For example, the pelvis should be stable, the hips should be mobile, the knees should be stable, and the ankle should be mobile. If your hips or ankles are tight, your body is going to get the mobility from somewhere—and usually it comes at the expense of the stable knee. Once you have normalized your mobility, you have to learn how to jump, land, decelerate, and cut properly. Try this out in front of a mirror: are you able to jump up and land with your knees aligned over your 2nd toe, or do your knees collapse in towards each other? Next try jumping on one leg. If you are not able to land on one leg without your knee collapsing, you are at a huge risk for an ACL injury.

Ankle sprains are another largely prevalent injury among female athletes, and most commonly seen in soccer players. The Journal of Bone and Joint Surgery released a meta-analysis in 2017 concluding that prevention programs are effective at reducing the risk of ankle injuries by up to 40% in soccer players. The studies reviewed included neuromuscular training, proprioceptive training, strengthening, and stretching exercises in their prevention protocols. Proprioception is your joint’s ability to determine its position in space and the main way to train this is through single leg balance drills. Once you can balance on one leg for at least 30 seconds you can progress to standing on a variable surface (i.e. foam, pillow), with your eyes closed, or with arm or head movements. Neuromuscular training is the ability to maintain stability during more advanced movement patterns and is crucial before transitioning to jumping, cutting, and landing. It’s scary how most female athletes are thrown into jumping and cutting at full speed before they can even balance on one leg without falling over, isn’t it? As far as strength, it is most important to strengthen your gastroc (calf) and your peroneal muscles to optimize ankle stability and prevent your ankle from turning out after landing awkwardly. After you sprain your ankle even once, you slowly stretch out your lateral ligaments and are prone to recurrent ankle sprains. Unfortunately, ligaments are like laffy taffy, and cannot tighten up after they have been stretched. If your ligaments don’t do a good job of stabilizing your joint, your muscles are next in line, which is why they have to be strong. As far as stretching, you need to have to good calf mobility. Try this—put a piece of tape four inches away from a wall. Place your toes on the tape, and attempt to touch your knee to the wall, keeping your heel flat on the ground. If you cannot reach the wall from four inches, you do not have sufficient ankle mobility to run, squat, or play without increasing stress through the ankle (and knee).

The last pathology I am going to cover is stress fractures. Stress fractures account for up to 20% of all injuries treated in sports medicine clinics. The risk factors for stress fractures are low body mass index (BMD), menstrual irregularities, late period onset, dietary insufficiency, biomechanical abnormalities, and training errors. The female athlete triad is a well-known concept that has evolved over the last 20 years and describes the connection between energy availability, decreased BMD, and menstrual irregularities. Energy availability is the amount of caloric energy remaining after exercise energy expenditure. The female athlete triad is very real. Young girls, and especially young athletic girls, experience a lot of pressure as far as body image is concerned. Fad diets and diet pills are on the rise and are a scary combination with growing women who are expending a lot of energy on practices, games, and training. If a female athlete does not intake enough calories to cover her expenditure, her body will take energy at the expense of her overall health. Two of the most common examples are an athlete with a stable body weight but no period and an athlete with chronic stress fractures. Take care of your body girls!

One of the most common questions I am asked is “so…when should I stretch?” Female athletes (ESPECIALLY if you are on your period) should leave static stretching to after training/practices/games. Try not to sit down and statically stretch your hamstrings while you talk to your teammates for 3 minutes before practice. Your muscles need to be ready to move and protect your joints, so don’t relax them too much before you play. Dynamic stretching is better before training/practices/games to get blood flowing to your muscles so they are ready to go. Think high knees, high kicks, twisting lunges, etc.

All sports medicine professionals, coaches, and athletes need to be aware of the risk factors and pathologies to effectively prevent injuries. A few of the most important take home points are:

  • Have a pre-season physical by a qualified movement specialist (like a PT)!
  • Strengthen smart. Stretch smart. Train smart.
  • Avoid overuse. Try to take at least one season off so your body can recover.
  • Don’t fad diet. Don’t overly restrict your eating. Don’t skip meals. Don’t take diet pills, laxatives, diuretics, etc while you are training.
  • Talk to your coach(es) about injury prevention programs for the injuries we discussed in this blog.


Marley Lefelar, PT, DPT



Physical Therapy is a Better First Choice Before Surgery for Knee Osteoarthritis and Meniscus Tears

Knee osteoarthritis (OA) is the degeneration of the bones, cartilage, and muscles that form the knee joint, and currently affects over 9 million people in the United States. Meniscus injuries are observed in approximately 35% of individuals aged 50 and older, with two thirds of these tears being asymptomatic. Many people with mild meniscus tears and moderate knee OA are sent for arthroscopic knee surgery, but could one of the most popular surgical procedures be unnecessary for many of the 700,000 times it is performed each year?

A recent study published in The New England Journal of Medicine found no significant difference between individuals who received arthroscopic surgery and those who just received physical therapy. Even up to one year later, most patients in both groups said their knees felt better.1 Another study reported in the New York Times concluded that after two years, patients assigned to arthroscopic treatment had no greater improvement in outcomes than those who only received physical therapy.2

According to Dr. Edward Laskowski, co-director of the Mayo Clinic Sports Medicine Center, physical therapy can be used to conservatively treat many types of knee injuries, including MCL, PCL, cartilage, and even ACL tears in some cases. Dr. Laskowski has found that if someone is experiencing major pain but still has good range of motion, physical therapy will mostly likely settle down the symptoms over time.3

So why not avoid the unnecessarily invasive procedure, medical risks, and cost of surgery if physical therapy can be just as effective? Why are these surgeries still so common despite all the current evidence? Dr. Kenneth Fine, an orthopedic surgeon, reports that there is a lot of financial pressure for surgeons to operate. Dr. Fine states, “if a primary care doctor keeps sending me patients who are complaining of knee pain and I keep not operating on them, the primary care doctor is going to stop sending me patients.”2 The fact is, surgeons do surgery, which is why it so crucial that the general population is educated about the effectiveness of physical therapy.

Of course, these studies do not indicate that surgery is never needed, especially for younger patients and for those with acute injuries. Additionally, conservative management is not always successful, and in these cases surgical intervention may be warranted. There are many factors to consider when determining the appropriate surgical treatment, including the nature of your condition, your age, activity level, and overall health. Your physical therapist will recognize when to refer you to an orthopedic surgeon to discuss your surgical options.

Marley Lefelar, PT, DPT



  1. Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013;368:1675-1684.
  2. Kirkley A, Birmingham TB, Litchfield RB, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008;359:1097-1107.
  3. Juntti, Melania. Try Physical Therapy Before Surgery. Men’s Journal. Published April 29, 2013.