Viewpoint by Dr. Benedict Nwachukwu
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Surgery Isn’t Always the Fastest Path to Healing
When most people think about recovering from musculoskeletal (MSK) issues, they assume surgery is the quickest fix. But according to Dr. Benedict Nwachukwu, orthopedic surgeon at Hospital for Special Surgery, a conservative approach is often the more effective — and safer — starting point.
The Scope and Cost of MSK Conditions
MSK conditions are the leading cause of long-term disability in the U.S., with back pain alone being the top driver of disability worldwide. They carry a growing economic burden, costing nearly $1 trillion annually.
Patients Often Skip First-Line Conservative Care
Despite strong evidence supporting physical therapy and other nonoperative care, many patients show up expecting surgery without having tried these less-invasive treatments. Dr. Nwachukwu sees this as a systemic issue where conservative care is mistakenly treated as optional or secondary.
Lessons from the NBA Bubble
During the COVID-19 pandemic, Dr. Nwachukwu served as a team physician in the NBA’s isolated bubble. With limited access to surgery, athletes recovered effectively using conservative therapies guided by a multidisciplinary team. It was a powerful example of what can be achieved without defaulting to surgical intervention.
A Vision for Hybrid, Personalized MSK Care
Dr. Nwachukwu envisions a future where care pathways include in-person and digital options, making conservative care more accessible and tailored to the individual. He also emphasizes the importance of connecting patients with the right specialists, including non-surgeons, before considering operative treatments.
A Call to Reframe the Role of Surgeons
Rather than being the starting point, surgeons should enter the care journey after conservative options have been explored. This ensures surgery is used appropriately and delivers better outcomes, especially when there is functional decline and therapy is not effective.
Conclusion: “You Don’t Need Me Yet”
The future of MSK care is hybrid, evidence-based, and personalized. By shifting the focus toward conservative care first, healthcare providers can close treatment gaps, reduce unnecessary surgeries, and help patients recover in smarter, safer ways. Sometimes, as Dr. Nwachukwu says, the most valuable thing a surgeon can offer is reassurance, not a scalpel.
