When to Choose Chiropractic Care Over Injections or Surgery

A scary MRI report. A quick recommendation for injections. A surgeon saying, “Let’s schedule it.” If you’ve ever felt rushed toward a procedure, we made this conversation for you. Dr. Alexander Telfair of Telfair Chiropractic maps out a clearer, safer way to decide when chiropractic care and conservative treatment make sense and when surgery is truly the right next step.

We start with the non-negotiables: red flags and emergent conditions that need medical attention first. From there, Dr. Telfair explains why the research often supports a three to six week trial of conservative care for many injuries before moving to invasive interventions. We also dig into the real role of steroid injections for acute pain, including when they can help someone tolerate movement and rehabilitation and why they are not a casual, one-size-fits-all fix.

Then we tackle one of the biggest traps in modern pain care: treating imaging instead of treating the person. You’ll hear why MRIs and X-rays must be matched to symptoms and clinical presentation, how people can end up rehabbing the wrong problem for months, and why unnecessary surgery happens more often than anyone wants to admit. We also talk quality of life, arthritis, and the overlooked truth that rehab is part of the deal even after surgery, so trying rehab first can be the smartest “fast” path. 

If pain is slowing you down, take these decision tools with you to your next appointment, and consider getting a second opinion before you commit to a procedure. Subscribe, share this with a friend who’s weighing surgery, and leave a review so more active adults can find conservative options that keep them moving.

To learn more about Telfair Chiropractic visit:
https://www.TelfairChiropractic.com
Telfair Chiropractic  
630 S Orange Ave, Ste 300B, Sarasota, FL 34236  
941-685-2415 

Transcript

Welcome And The Conservative Approach

SPEAKER_00 0:00

Welcome to the Sarasota Pain Podcast with Telfair Chiropractic, hosted by Dr. Alexander Telfair. This is the show for active adults who want to move better, feel better, and stay in the game. Without jumping straight to extreme solutions, because let's face it, your body might have a few miles on it, but it's far from retired. Here we help you optimize your potential, one podcast at a time.

SPEAKER_01 0:27

Before choosing injections or surgery, there's a whole world of conservative care that can help you move better, feel better, and avoid procedures you may not need. Hello, everyone. I'm Kaylee Frankie, co-host and producer here in the studio with Dr. Alexander Telfair, chiropractic physician at Telfair Chiropractic. How are you doing today, Dr. Telfair?

SPEAKER_02 0:47

I'm doing well. Well, how are you?

SPEAKER_01 0:50

I'm doing pretty well myself.

When To Try Chiropractic First

SPEAKER_01 0:52

Um, so this is something so many active adults wonder about. When should someone consider chiropractic care instead of surgeries or injections? I'd like to hear your perspective on how people can make that decision.

SPEAKER_02 1:05

Yeah, so first things first, it should always be a decision based on um, you know, conversation that you have with your doctor. Um, and just to ensure that you don't have any red flags or anything that is emergent that does require surgery right away. Um, because there's certainly some conditions that present that you, you know, you need to get checked out and make sure that uh conservative care is a viable option for you. Now, with that being said, I would say uh in general, injuries should always have a trial of conservative care prior to uh moving towards more invasive intervention such as surgery or injections.

Steroid Injections In Acute Pain

SPEAKER_02 1:40

Um, I'll kind of get into the role that injections may play in the early phase uh or the acute phase of treatment because sometimes there is uh some indication for that to be utilized to uh expedite patient outcomes or allow them to get into the rehabilitative phase of uh recovery. But yeah, so generally speaking, um so long as there's no red flags, there's no uh you know, no tears, fractures, dislocations, deformities, stuff like that that may indicate the need for uh you know surgery right away, um, there should be about a three to six week trial of conservative care. Um at least that's what the literature uh tends to state. So um, with that being said, sometimes again injections can be part of that acute phase of treatment. And the reason being we're kind of more so thinking about steroid injections here in terms of anti-inflammatories, because uh you know that that harsh inflammatory cascade at the at the beginning or onset of an injury can really hinder or prolong a uh rehabilitative process. And if we can get in there and decrease the inflammation, which I don't do in my office because I can't do injections, but um yeah, the other places such as you know your primary or places like that may be able to do that sort of thing. Um, but and I don't even recommend this for everybody because uh steroid injections have their own woes. Like there's also plenty of literature stating that essentially interferes with collagen production, which can weaken tendons, weaken cartilage, and almost you know contribute towards more of a uh deleterious outcome for the patient. So it has to be used wisely, but again, this like acute phase of injury during the inflammatory phases where it is more of an option. But again, not it's not for everybody. It's more so it's like for me, the indication for a steroid injection in this early phase is if the pain is so severe that it's hindering you from uh, you know, doing anything that could rehabilitate the injury and help with you know reducing the pain. If you can't do anything to reduce the pain, then we need to do something so you can at least get to you know doing some movements without significant pain, which is where that injection might come in. But again, that's a case-by-case uh scenario, doctor discretion advised, and uh and it's just you know it's not ideal for everybody, but it has a time and a place.

Why Imaging Can Mislead Treatment

SPEAKER_02 3:55

Um, second thing going into that is uh so imaging. Um there's a lot of doctors that like to not well, I can't say that, but some doctors will base a treatment off of imaging, right? And I personally, and I would say the uh literature disagrees with that. And I say that because there's there's a lot of times where you might have an image, and I've had plenty of patients present with stuff like this where you know we find um something on imaging that looks that looks pretty bad. You know what I mean? But then you look at the the patient's uh presentation, you're like, man, you don't have any of the symptoms that would align with that diagnosis or that finding. And that is that is just essential because the last thing we want to do, especially in terms of a surgery, the most invasive thing we can do, right, is uh is go in and and surgically repair something that wasn't the pain generator, and the patient comes out of surgery and says, Yeah, I'm still in pain. I mean, that happens more often than than anybody would like to admit. Um and and same goes with conservative care. There's plenty of times where people treat some, you know, a chiropractor, a PT, whomever, um, treats an injury they find on imaging or that the radiologist reported on an imaging, but they didn't clinically correlate it in practice. And therefore they end up treating the wrong thing for this patient, and and the patient goes through a year of having no relief. I've had plenty of patients like that where they come in with, you know, they had severe spinal or low back findings, so perhaps like a disc herniation or something like that, right? But their clinical presentation didn't correlate with that finding. And uh, you know, I come to find out that it was really just like, you know, I release uh a muscle in their buttock that can compress that nerve as well. And they had literally they went from an eight out of ten for a year to a one in one treatment, which makes me look really good, obviously. But it's like it's uh you know, it's frustrating because we just we need to be comprehensive in our approach in terms of you know, not just basing things on imaging and uh and making sure that that image correlates clinically with what the patient's presenting with, right? Um so I think that's that's what I had to say about the imaging aspect. It's just yeah, you're and there there's a doctor I I follow who he tends to say something I I kind of agree with. It's like you're you're not your diagnosis, that's not your identity. You're not your identity in diagnosis is not based on imaging either. It is really it's like what are you clinically presenting with? And let's let's go with that. And then imaging is more of a supplemental thing to see does your clinical presentation align with what the imaging findings present, you know. Um, so those are my that's

Tears Surgery And Quality Of Life

SPEAKER_02 6:25

my spiel on imaging and it's its usage for this. So again, imaging can be a great tool for it for determining red flags if it's surgical. So when I say surgical, I'm talking like tears, right? Because there's nothing we can do conservatively that's gonna repair the tear. Now, doctor discretion comes in in that scenario in the sense of um sometimes the tear is not gonna be impacting quality of life, right? And with every surgical procedure, there comes risks. And so it comes to a scenario of do the benefits outweigh the risks of the surgery, and if not, in the sense of if it's not impacting quality of life, then perhaps we don't need to do the surgery. You know what I mean? So there's a time and a place for even tears being repaired because again, they might not be impacting quality of life. Um, so let's see here.

The Rehab You Cannot Skip

SPEAKER_02 7:11

Um, so I something else I often talk about with my surgery, you know, patients that have gone to an orthopedist um or somebody of that nature and got in a surgical recommendation is I kind of let them know, like, hey, just so you know, like you're resistant to rehab rehab right now, to trying to do conservative care to get over this because you want to just jump to surgery because you think that's like the instant gratification thing. And I don't know if that's what they've been told or that's what ChatGPT said or what. But with every surgery, there's going to be extensive rehab post-surgery as well. Um, so it's like you can either try to fix your pain on the front end, which honestly a lot of pain presentations will can be fixed on the front end, right? Especially if it's done in a comprehensive fashion that's personalized to the patient's needs, but um, which is you know what we do here at Telfare Chiropractic. But um, no, but secondly, yeah, it's like you're gonna have to do rehab on the back end anyway. So you may as well try it on the front end, and it's gonna probably be less extensive on the front end, honestly. But it just again, that's that's a harsh statement. That's really dependent on the patient's presentation and what's going on. Um, but yeah, I always say may as well try rehab now because you're gonna have to do rehab later anyway. And we'll know in in three weeks essentially, if you're a candidate for rehab on the front end, so that we can, you know, perhaps not have to do the surgery. Because you you'll likely have, I mean, if if you're a conservative candidate, you should have a good response to care within about that three week span. Some something should improve, right? There shouldn't just be stagnancy or worsening of symptoms in the body. Then we start to reconsider. Um so and then in terms of again surgery versus conservative care, um, injury type matters, I would say most osteoarthritic arthritic patients,

Arthritis When Surgery May Help

SPEAKER_02 8:55

so just you know, uh general arthritis, most of those people um should have a trial of conservative care. Like 90, 95%, probably, right? There's some situations where the degeneration is so severe where it's causing deformity, it is causing severe pain because there's nothing else that could be contributed to. And it's, you know, and again, even in those situations, though, it might be ideal to just try conservative care. Maybe you lean more towards two weeks or something for relief just to see is there any benefit to you know giving this a try? But you certainly don't want to waste anybody's time, right? Um I already talked about tears a little bit. And then, yeah, the last thing about so you know when to do conservative versus uh interventions such as surgery or even injections. Um,

Second Opinions And Safer Decisions

SPEAKER_02 9:43

I just want to emphasize that it's always best to work with your doctor to determine uh you know how your condition, your specific condition should be managed, um, and just to rule out red flag conditions that might might indicate the need for uh you know surgical intervention, right? Um and secondly, people I think undervalue this, but and and I don't think it should be an insult to the treating physician, right? Um you should get a second opinion on surgical recommendations or even conservative care, but like especially surgical recommendations, you know, and and when you get that second opinion, try to go to somebody that might lean more conservative or or less conservative, depending on where, you know, the place you're coming from, in the sense of if somebody recommends final surgery, go to somebody who you know tends to be more conservative and see what their opinion is, and then vice versa. Somebody recommends conservative care, say, hey, you know, go to somebody that well, no, because usually those people always recommend surgery. So yeah, give or take on that one. But I would definitely say it's it's always safe to get a second opinion and kind of see, you know, just get uh more brains on the matter and uh and determine what the best uh you know what what the best prior the best prognosis slice essentially.

SPEAKER_01 10:54

Dr. Telfair, thank you for breaking that down. It's empowering to know um people have options before jumping into procedures, and we will see you next time.

SPEAKER_02 11:04

All right, sounds good.

Closing And How To Schedule

SPEAKER_02 11:06

Thank you.

SPEAKER_00 11:06

Thanks for listening to the Sarasota Pain Podcast with Telfair Chiropractic. If pain is slowing you down, Dr. Alexander Telfair at Telfair Chiropractic specializes in conservative, comprehensive care designed to keep you active, mobile, and doing what you love without unnecessary procedures or downtime. Because the goal isn't just to feel better, it's to move better, live stronger, and truly optimize your quality of life. For more information or to schedule your visit, go to Telfarechiropractic.com or call 941 685 2415. Until next time, keep moving, keep improving, and remember a well maintained body performs better than a brand new excuse.