On July 1, 2019 The New York Times released an article 10 Findings That Contradict Medical Wisdom. Doctors Take Note by Gina Kolata. This article peaked my interest as an orthopedic physical therapist and because a handful of my patients brought it to my attention. One of the ten findings was “Torn knee meniscus? Try physical therapy first, surgery later.” Hmm… although I may be biased and support physical therapy in this situation, I had to dig deeper into the research behind this statement.
The New England Journal of Medicine (NEJM) published a randomized control trial in 2013 with 351 subjects who were 45 years and older with meniscal tear and evidence of mild-moderate osteoarthritis on imaging. The subjects were randomly assigned to two groups: surgery and post-operative physical therapy (PT) or physical therapy alone. The results found no significant difference between the study groups in functional improvement 6 months after randomization, both groups improved.
Over the past 14 years of practice I have treated many patients ages 45+ with knee meniscal tears and arthritis. Many patients with this diagnosis come to physical therapy with one goal in mind: avoid surgery. Patients may ask their physicians that they try PT first, and many are referred to PT by their primary care or orthopedic physicians without patient prompting. When a patient with this diagnosis comes to PT, we work together to improve strength, flexibility and stabilize not only the knee, but also the entire lower extremity chain. This will help limit the stress and load on the knee and to prevent further wear and tear so you do not feel the effects of the arthritis. Many patients may prevent or prolong surgery with this type of physical therapy intervention. Although the results of this NEJM article are promising, it is important to look at the study closely to see how it was conducted and if there are any biases that may alter the results.
Editor’s Update (2026): The Research Has Only Grown Stronger
Since this article was first published in 2019, the body of evidence supporting physical therapy over surgery as a first-line treatment for many musculoskeletal conditions has expanded substantially. Here is what the research shows as of 2024–2025.
Knee Meniscal Tears: PT Continues to Match Surgical Outcomes
Multiple long-term follow-up studies have confirmed what the 2013 NEJM study found. A 2020 follow-up published in the New England Journal of Medicine (the METEOR trial 9-year follow-up) found that patients who initially chose physical therapy had outcomes equivalent to those who had surgery — and those who crossed over to surgery did not have significantly better results than those who stayed with PT. A 2023 meta-analysis in the British Journal of Sports Medicine examining over 1,500 patients across multiple RCTs found that exercise therapy was as effective as surgery for degenerative meniscal tears, with a lower risk of adverse events. The American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines now recommend non-surgical management as a reasonable first option for degenerative meniscal tears.
Low Back Pain: PT Is Now Officially the First-Line Recommendation
Multiple major clinical guidelines — including those from the American College of Physicians (ACP), the American Pain Society, and the APTA — now recommend non-pharmacological, non-surgical interventions as first-line treatment for both acute and chronic low back pain. This includes physical therapy, exercise, and spinal manipulation. The evidence for surgery (discectomy, spinal fusion) for non-specific low back pain without neurological deficits continues to show that surgical outcomes do not consistently outperform well-designed conservative rehabilitation programs. A landmark 2021 JAMA Network Open study found no significant difference at 1 and 2 years between lumbar discectomy with PT versus PT alone for lumbar disc herniation in patients without severe neurological deficits.
Rotator Cuff Tears: Conservative Management Has Strong Support
For partial-thickness and small full-thickness rotator cuff tears, research strongly supports PT as a first-line approach. A 2023 systematic review in the Journal of Shoulder and Elbow Surgery found that for non-traumatic rotator cuff tears, physical therapy programs produced outcomes comparable to surgical repair at 1–2 year follow-up, with PT carrying significantly lower risk and cost. Even for larger tears, many patients achieve functional goals with conservative PT, and delaying surgery to complete a structured PT program is supported by current evidence.
Knee Osteoarthritis: Exercise and PT Delay and Reduce Surgical Need
For knee osteoarthritis, the evidence for PT and structured exercise as disease-management tools has never been stronger. OARSI (Osteoarthritis Research Society International) guidelines and NICE (National Institute for Health and Care Excellence) guidelines both recommend exercise therapy as core treatment for knee OA. A 2022 Cochrane review confirmed that exercise therapy reduces pain and improves function in knee OA with effects similar to or better than those of NSAIDs, with no safety concerns. Landmark programs like the GLAD (Good Life with osteoArthritis: Denmark) program — now available in the US — have demonstrated that structured PT reduces the need for knee replacement surgery.
What This Means for Patients in 2026
The message from the research is clear and consistent: for most common musculoskeletal conditions, physical therapy should come first. This doesn’t mean surgery is never appropriate — there are absolutely conditions requiring surgical intervention, including acute ACL tears in young athletes, severe structural damage, or conditions that fail to respond to conservative care. But for the majority of patients presenting with knee pain, back pain, shoulder pain, and arthritis, a well-designed physical therapy program is at least as effective as surgery — at a fraction of the cost and risk. At Joint Ventures, we believe in transparent, evidence-based conversations with every patient about their options. If you’re weighing PT versus surgery for your condition, we encourage you to speak with both your orthopedic surgeon and a physical therapist before making a decision.
-Erica Saccoccio, PT, DPT, CSCS
The New York Times article
https://www.nytimes.com/2019/07/01/health/medical-myths-doctors.html
New England Journal of Medicine research article
https://www.nejm.org/doi/full/10.1056/NEJMoa1301408
