Marcos Jusdado

For most common joint and spine problems, including many disc herniations, meniscus tears and rotator cuff issues, physiotherapy treatments should be tried first, and a large share of people avoid surgery entirely by doing so. Surgery becomes the right call when there’s structural damage that physical treatment can’t fix, progressive nerve loss, or when a proper course of physiotherapy has genuinely failed to improve function.

It’s a stressful crossroads. A scan shows something, a doctor mentions an operation as an option, and suddenly there’s a decision to make with limited information and a lot of fear attached to the word surgery. Understanding how the two approaches actually differ helps make that decision less overwhelming.

Why isn’t surgery always the first move?

Imaging is part of the problem. Scans often show things like disc bulges or wear and tear that are common even in people with zero pain, so a scan finding doesn’t automatically mean surgery is needed. Research on conditions like disc herniations, meniscus tears in middle-aged knees, and rotator cuff tendinopathy repeatedly shows that a structured rehabilitation programme produces outcomes similar to surgery for a large portion of patients, without the risks, recovery time or cost of an operation.

When does physiotherapy make sense as the first step?

• Pain without progressive weakness or loss of function, even if it’s severe.
• Degenerative changes on a scan that match a slow, gradual pattern rather than a sudden traumatic injury.
• Tendon problems like tennis elbow, rotator cuff tendinopathy or Achilles issues, which usually respond better to loading exercise than to a knife.
• Most first-time disc-related back or leg pain, where nerve pressure often reduces with time and the right movement strategy.

When does surgery genuinely become necessary?

• Progressive neurological signs, such as worsening numbness, weakness that keeps getting worse, or loss of bladder or bowel control, which needs urgent medical attention, not a physiotherapy trial.
• Complete structural failure, like a fully torn ACL in an athlete who needs the knee to be stable for their sport, or a complete tendon rupture.
• Mechanical instability where a joint genuinely cannot function safely without repair.
• No meaningful improvement after a proper trial of physiotherapy, typically six to twelve weeks of consistent, well-guided treatment, not a couple of half-hearted sessions.

What does a fair trial of physiotherapy actually look like?

It’s not just a few passive treatments and a hope for the best. A proper trial involves an accurate assessment, a specific loading or movement programme, and regular reassessment to track whether function is actually improving, not just whether pain has dipped for a day. Six weeks is a reasonable minimum for most non-urgent conditions before deciding it isn’t working.

Can physiotherapy help even if surgery ends up being needed?

Yes, and this part gets overlooked. Going into surgery with better strength and movement, known as prehabilitation, tends to shorten recovery afterwards. And post-surgical physiotherapy is what actually restores function once the operation has done its job, since surgery repairs the structure but doesn’t retrain movement, strength or confidence on its own.

Who should make the final call?

Ideally a surgeon and a physiotherapist looking at the same picture together, rather than a decision made from a scan report alone. A physiotherapist in Dubai working closely with orthopaedic surgeons can usually give a realistic, non-biased view of whether a structured rehab trial is worth attempting before committing to theatre.

Does a bulging disc always mean I’ll need surgery eventually?

No. Most disc bulges improve with time and the right rehabilitation, and imaging findings alone don’t predict who will need surgery.

How long should I try physiotherapy before considering surgery?

Six to twelve weeks of consistent, well-structured treatment is a reasonable trial for most non-urgent musculoskeletal conditions.

Is it risky to delay surgery to try physiotherapy first?

For most degenerative or overuse-related conditions, a short delay to trial conservative treatment is safe, though anyone with progressive neurological symptoms should be assessed urgently rather than waiting.

Will I need physiotherapy after surgery even if the operation goes well?

Almost always. Surgery repairs the structure, but strength, movement and confidence need to be rebuilt afterwards through a dedicated rehabilitation programme.

Can a physiotherapist tell me if I need surgery?

A physiotherapist can flag red flag symptoms and assess whether conservative treatment is realistic, but the final surgical decision sits with an orthopaedic specialist working from imaging and examination findings.

If you’ve been told surgery is an option and want a clearer picture of whether rehabilitation could work first, an assessment can help you make that decision with real information rather than guesswork. You can book a session here.

Pain on the outside of the hip, right over the bony point you can feel through your trousers. It gets worse lying on that side at night, worse walking uphill, worse climbing stairs. Most people call it hip bursitis and leave it at that, but the outside of the hip is a busier area than that label suggests.

Lateral hip pain is most often a tendon problem rather than pure bursitis, and understanding that difference changes how it should be treated.

What is actually causing pain on the outside of the hip?

The area over the bony point of the hip, called the greater trochanter, is where several structures meet: the gluteus medius and minimus tendons, a few small fluid-filled sacs called bursae, and the iliotibial band passing over the top. For a long time, any pain here was labelled trochanteric bursitis, but research has shown that in most cases the bursa is not actually inflamed. The real problem is usually the gluteal tendons, a condition now more accurately called gluteal tendinopathy or greater trochanteric pain syndrome.

This matters because bursitis and tendinopathy are treated quite differently. Tendons respond to a specific type of progressive loading, while true bursitis responds more to reducing compressive positions and inflammation. Getting the diagnosis right changes the whole plan.

Who tends to get lateral hip pain?

• Women more than men, particularly around and after menopause, likely linked to changes in tendon quality
• People who walk a lot on one hip hitched out to the side, a subtle habit that compresses the tendons
• Runners, especially those who cross their feet over the midline while running
• Anyone who sits with legs crossed for long periods, which compresses the gluteal tendons against the hip bone
• People who sleep on their side without proper support, which loads the tendon directly all night

How is lateral hip pain diagnosed properly?

A physiotherapist assessing lateral hip pain will press directly over the greater trochanter to reproduce the pain, test the strength and control of the hip abductor muscles, and look closely at walking pattern and habitual positions like standing with weight shifted onto one hip. Scans are not usually needed to start treatment, since the clinical picture is often clear enough, though imaging can help in more complicated or longstanding cases.

What actually helps lateral hip pain?

• Avoiding compressive positions in the short term, such as crossing the legs, standing with the hip jutted out, or lying directly on the painful side
• A gradual, progressive strengthening programme for the gluteal muscles, combined with manual therapy to ease tension in the surrounding hip muscles, since tendons need loading to recover, not just rest
• Correcting the walking pattern if the hip drops or hitches to one side with each step
• Adjusting sleep position with a pillow between the knees to reduce direct compression on the tendon overnight

Complete rest is one of the most common mistakes with this condition. Tendons that are unloaded for too long become weaker and more irritable, not less. The goal is finding the right amount of load, not avoiding load altogether.

How long does it take to settle?

Gluteal tendinopathy is usually a slower recovery than an acute injury, often taking eight to twelve weeks of consistent, progressive strengthening to see substantial improvement, with the sharpest, most compression-sensitive pain often easing sooner. Rushing back into aggravating positions too early is the most common reason it drags on for months instead.

Frequently asked questions

Is lateral hip pain the same as hip arthritis?

No. Hip arthritis usually causes pain deep in the groin, particularly with rotation, while lateral hip pain sits over the outside bony point and is a tendon or bursa issue, not a joint surface issue.

Should I stretch the outside of my hip if it hurts?

Generally no. Stretches that pull the leg across the body often compress the already irritated tendon further and can make symptoms worse rather than better.

Can lateral hip pain come back after it settles?

It can, particularly if the underlying strength deficit or walking pattern that caused it in the first place was never addressed, which is why the strengthening phase matters as much as the pain relief phase.

Is walking bad for lateral hip pain?

Walking is not inherently bad, but the amount and pattern matter. Shorter, more frequent walks are often tolerated better than one long walk, especially early on.

Do I need an injection for lateral hip pain?

Injections can reduce pain temporarily in some cases, but they do not address the underlying tendon weakness, so they work best alongside a proper loading programme rather than instead of one.

If the outside of your hip has been nagging at you for weeks, especially at night or on stairs, it is worth having it properly assessed rather than assuming it will settle on its own. You can book a session here.

It’s a particular kind of frustrating. The shoulder is manageable during the day, maybe a bit stiff or achy, but liveable. Then you lie down, roll onto that side, or even just settle into bed, and the pain wakes you up. Some people end up propped on pillows or sleeping in a chair just to get a few hours of rest. Night-time shoulder pain is one of the most common complaints seen in physiotherapy clinics, and it almost always has an identifiable, treatable cause.

Why does shoulder pain get worse at night specifically?

Several things conspire together after dark. Lying down removes the support that gravity and upright posture normally give the shoulder, so the joint and surrounding tissues have to be held in position differently. Direct pressure on the shoulder when lying on the affected side compresses inflamed structures like the rotator cuff tendons or the bursa. And without the distraction of daytime activity, the nervous system tends to pick up on pain signals more easily, which is why aches that were background noise during the day can feel much sharper once you’re trying to sleep.

What conditions typically cause night pain?

• Rotator cuff irritation or tears, where the tendons are compressed by side-lying pressure
• Shoulder impingement, which flares with certain arm positions used unconsciously in sleep
• Frozen shoulder, a condition where night pain is often the very first and most severe symptom
• Bursitis, where the fluid-filled cushion around the joint becomes inflamed and sensitive to pressure
• Referred pain from the neck, which can mimic shoulder pain and often worsens with certain pillow positions

How can I tell what’s causing mine?

The pattern gives useful clues. Pain that’s sharp specifically when lying directly on the shoulder, but eases when you roll onto your back or the other side, points more toward rotator cuff or bursa irritation. Pain and stiffness that’s severe in almost every position, combined with a shoulder that’s becoming genuinely hard to move in all directions, particularly reaching behind the back, is a strong sign of frozen shoulder. Pain that changes with neck position, or comes with pins and needles down the arm, often traces back to the neck rather than the shoulder joint itself. A proper assessment sorts out which of these is actually going on, since the treatment differs for each.

What can help in the short term?

• Sleeping on your back with a small pillow or rolled towel supporting the affected arm
• If side-sleeping on the unaffected side, hugging a pillow to keep the sore arm supported and slightly forward rather than letting it fall across the body
• Avoiding sleeping directly on the painful shoulder altogether until it’s settled down
• A pillow under the head that keeps the neck in a neutral position, particularly if the neck may be contributing

These adjustments buy some relief, but they’re a workaround, not a fix. The actual solution depends on treating whatever is driving the irritation in the first place.

How is it actually treated?

Once the specific cause is identified, treatment typically combines manual therapy to reduce irritation and stiffness with a graded exercise programme to rebuild strength and control in the shoulder. For frozen shoulder, treatment focuses more on gently restoring range of movement over time, since forcing strength work too early can aggravate it. A physiotherapist in DIFC will often also look at how the shoulder is being used, and not used, during the day, since a shoulder that’s stiff or weak from long hours at a desk is more likely to react badly to being loaded awkwardly overnight.

Frequently asked questions

Why does my shoulder only hurt at night and not during the day?

Lying down changes the pressure and position on the shoulder, and the absence of daytime distraction makes pain signals more noticeable, which is why symptoms that are mild during the day can feel much worse once you’re trying to sleep.

Is night pain a sign of something serious?

Not usually, most causes are mechanical and treatable, but persistent night pain that doesn’t improve with position changes and rest is worth having assessed properly rather than ignored.

Will changing my pillow fix it?

It can reduce the irritation enough to sleep better, but it doesn’t address the underlying cause, so symptoms are likely to return once you stop being careful with positioning.

How long until night pain improves with treatment?

Many people notice better sleep within two to four weeks of starting the right treatment, though full resolution depends on what’s actually causing it.

Could it be coming from my neck rather than my shoulder?

Yes, this is common. Neck-related shoulder pain often changes with head and neck position and can include tingling down the arm, which a physiotherapist can distinguish from a true shoulder problem.

If your shoulder is costing you sleep night after night, that’s worth sorting out properly rather than adapting around it indefinitely. You can book a session here.

For most musculoskeletal problems, a course of physiotherapy treatments somewhere between 4 and 12 sessions is realistic, often spread over four to eight weeks. A mild muscle strain might settle in three or four visits. A long-standing back problem, a post-surgery knee, or a nerve issue like sciatica can reasonably take twelve or more. Anyone quoting an exact number before even examining you is guessing.

It’s a fair question to ask before committing money and time, especially in Dubai where sessions are rarely cheap and packages get sold in bundles of five or ten. The honest answer is that it depends on more than the diagnosis alone.

What actually determines the number of sessions?

• How long the problem has been there. Pain that started last week generally resolves faster than pain that has been building for two years.
• Tissue involved. Muscle strains heal quicker than tendon or nerve-related issues, which need more time to remodel.
• Consistency with home exercise. People who do their prescribed exercises between sessions almost always need fewer visits than people who only do the work in the room.
• Underlying contributing factors. Posture, movement habits, stress, sleep and even how someone sits at a desk all influence recovery speed.
• Whether it’s a first episode or a repeat. Recurring pain usually points to an unresolved movement pattern, which takes longer to retrain than to simply calm down.

What does a realistic recovery timeline look like?

A typical plan starts with an assessment, followed by two sessions a week for the first two to three weeks while pain is at its worst. As things settle, sessions usually taper to once a week, then every two weeks, finishing with a home programme designed to prevent a repeat episode. That taper matters. Stopping the moment pain disappears is one of the most common reasons people end up back in the clinic a few months later with the same issue.

How can you tell if physiotherapy is actually working?

By the third or fourth session there should be some measurable change, more range of movement, less pain on a specific activity, or better tolerance to sitting or walking. It doesn’t need to be dramatic, but it should be noticeable. If nothing has shifted after four sessions, that’s the point to have an honest conversation about whether the plan needs to change, or whether further scans or a different specialist are needed.

Do chronic conditions need ongoing sessions forever?

Not usually as frequent treatment. Chronic conditions like long-standing back pain often move from an active treatment phase into a maintenance phase, where someone might check in once a month, or simply return if something flares up. The goal of good physiotherapy is to make itself less necessary over time, not to create a dependency on weekly visits.

Does insurance affect how many sessions you get?

In Dubai, most insurance plans cap physiotherapy sessions per year or require pre-approval after a certain number, so it’s worth checking the policy limit early rather than discovering it mid-treatment. A physiotherapist in DIFC dealing with corporate insurance plans regularly can usually help estimate what a plan will realistically cover.

Can one physiotherapy session fix back pain?

Occasionally a single session brings significant relief, especially for a minor, recent strain, but lasting change usually needs a short course of treatment plus exercises done at home.

Is it normal to feel worse after the first session?

Mild soreness for a day or two is common, especially after manual therapy or a new exercise, but sharp or worsening pain beyond that should be reported back to the physiotherapist.

Should you keep going if there’s no improvement after a few sessions?

Not without changing something. If there has been no meaningful change after four sessions, ask for a reassessment rather than continuing the identical plan out of habit.

Is more sessions always better?

No. Past a certain point, extra sessions without progress usually mean the plan needs adjusting, not repeating, and a good physiotherapist will say so rather than keep booking you in.

Can you space sessions further apart to save money?

Yes, once the acute phase has settled, spacing sessions out is normal and often recommended, as long as the home exercise programme is being followed consistently in between.

If you want a realistic estimate for your own situation rather than a generic number, an assessment will give a far clearer picture than guessing from a search engine. You can book a session here.

A deep pinching feeling in the front of the hip when you squat down, tie your shoelaces, or get out of a low car seat. It is not the same as a muscle ache. It feels more mechanical, like something is catching, and it usually happens at a very specific point in the movement.

That description matches hip impingement, also called femoroacetabular impingement or FAI, one of the more common causes of deep hip pain in active adults. It happens when the ball and socket of the hip joint do not glide smoothly, because of the shape of the bone, the position of the labrum, or both, and they pinch against each other at certain angles.

What actually causes hip impingement?

Femoroacetabular impingement comes from a mismatch in the shape of the femoral head (the ball) or the acetabulum (the socket). Some people are simply born with a slightly different bone shape, which is called cam or pincer type impingement depending on where the extra bone sits. This is not something you did wrong. It is anatomy, and a lot of people live with it and never have symptoms.

Symptoms tend to show up when the surrounding muscles, particularly the deep hip rotators and glutes, are not controlling the joint well enough to keep the femoral head centred during movement. Heavy squatting, football, martial arts, and dance are common triggers, but so is simply sitting very low or very often, since deep hip flexion is exactly the position where impingement tends to pinch.

What are the typical symptoms?

• A sharp or pinching pain deep in the groin or side of the hip, often described with a C-shaped hand gesture over the hip
• Pain that appears at a specific point in a squat, lunge, or when crossing the legs
• A feeling of the hip catching, clicking, or locking briefly
• Stiffness getting in and out of a car, or discomfort sitting in low seats
• Pain that can radiate into the buttock or down the front of the thigh

Does hip impingement mean I need surgery?

Not necessarily, and this is worth saying clearly because a lot of people assume a bony diagnosis automatically means an operation. Research over the past decade has shown that many people with the same bone shape on a scan have no pain at all, which tells us the shape alone is not the whole story. Movement pattern, muscle control, and joint loading matter just as much.

A structured physiotherapy programme, often combining manual therapy with targeted exercise, is usually the first approach, focusing on improving hip control, addressing compensations in the lower back and pelvis, and gradually building tolerance to deeper ranges of hip flexion. Surgery is reserved for cases where conservative treatment has genuinely been given a fair trial and symptoms are still limiting daily life or sport.

How is hip impingement assessed?

A physiotherapist in Dubai will usually run through a series of specific hip movement tests to reproduce the pinching sensation, check the range of motion in different directions, and assess how well the deep hip muscles are controlling the joint. Imaging can help confirm the bony shape, but it is only one part of the picture, not the whole diagnosis.

It also matters to rule out other causes of deep hip pain that can feel similar, such as labral irritation without impingement, hip flexor tendon issues, or referred pain from the lower back.

What does treatment actually involve?

• Improving control of the deep hip rotators and glutes so the femoral head tracks centrally in the socket
• Gradually and carefully building range into deep hip flexion, rather than avoiding it completely
• Adjusting technique in sports or gym movements that consistently trigger the pinch, like deep squats
• Addressing lower back and pelvic mobility, since a stiff lower back often forces more range through the hip than it should absorb

Progress with hip impingement is usually gradual rather than instant. Most people notice fewer sharp pinching episodes within several weeks of consistent work, with continued improvement in strength and range over a few months.

Frequently asked questions

Can hip impingement go away on its own?

Mild cases can settle with activity modification, but if the pinching pain is frequent or affecting daily movements, targeted physiotherapy usually speeds up recovery considerably.

Is running bad for hip impingement?

Running itself is not usually the problem, since it does not involve deep hip flexion. Activities like deep squats, football, or dance are more commonly aggravating.

What is the difference between hip impingement and a labral tear?

They often occur together. Repeated impingement can gradually irritate or damage the labrum, the cartilage rim around the hip socket, so the two are closely related rather than separate problems.

Can I still exercise with hip impingement?

Yes, in most cases exercise should continue with some adjustments to depth and technique, rather than being avoided altogether. Complete rest rarely helps and can weaken the muscles that protect the joint.

How long does hip impingement rehab take?

Many people see a meaningful reduction in symptoms within six to eight weeks of consistent rehab, though full return to demanding sport can take a few months.

If deep hip pinching is stopping you from squatting, sitting comfortably, or playing sport the way you used to, it is worth getting it properly assessed rather than working around it indefinitely. You can book a session here.

Hearing the words “rotator cuff tear” tends to land harder than it needs to. For a lot of people it conjures images of surgery and months out of the gym, when in reality plenty of tears are managed successfully without an operation at all. What matters is understanding what kind of tear it is, how big it is, and what your shoulder actually needs to recover.

The rotator cuff is a group of four muscles and their tendons that wrap around the shoulder joint, keeping the ball of the humerus centred in its socket while the bigger muscles do the heavy lifting. A tear means one or more of those tendons has torn, partially or fully, usually from a mix of wear over time and a specific triggering event like a fall or an awkward lift.

What causes a rotator cuff tear?

• Gradual degeneration of the tendon with age, which is why tears become more common from the mid-40s onward
• A fall onto an outstretched arm or a sudden heavy pull on the shoulder
• Long-standing impingement or tendon irritation that eventually wears through the fibres
• Repetitive overhead work or sport that loads the tendon beyond what it can repair between sessions
• Reduced blood supply to the tendon that comes naturally with age, which slows its ability to heal itself

How do I know if it’s a tear and not just a strain?

Some tears announce themselves clearly, a sudden sharp pain during a fall or lift, followed by weakness lifting the arm and difficulty sleeping on that side. Others are quieter, a gradual loss of strength and a nagging ache that slowly gets worse over months. Weakness is usually the biggest clue that separates a tear from a simple strain, particularly noticeable when trying to lift the arm out to the side or rotate it outward against resistance. A physiotherapist can test this clinically, though an ultrasound or MRI is often used to confirm the size and location of the tear.

Do all rotator cuff tears need surgery?

No, and this surprises a lot of people. Research consistently shows that many partial tears, and even some full tears, respond well to a structured physiotherapy programme, particularly in people who aren’t reliant on heavy overhead strength for work or sport. Surgery tends to be considered for larger tears, tears in younger or very active people, or cases where a solid course of rehab hasn’t restored enough function. The decision isn’t purely about the size of the tear on a scan, it’s about how the shoulder is actually performing and what the person needs from it.

What does physiotherapy for a rotator cuff tear involve?

The goal is to build strength in the remaining healthy fibres and in the surrounding muscles that can compensate for the damaged tendon, so the shoulder blade and the deltoid share more of the load. This starts gently, often with movements that don’t require the torn tendon to work in isolation, and progresses gradually as strength and confidence return. Manual therapy can help with stiffness and pain in the early stages, but the strength work is what actually changes how the shoulder functions long term.

What if I’ve already had surgery?

Post-surgical rehab follows a staged protocol, usually starting with protecting the repair while gently restoring movement, then building strength once the tendon has had time to heal into the bone. This is a slower process than non-surgical rehab and needs to be guided carefully, since pushing too hard too soon is one of the main risks to a surgical repair.

What happens if a tear is left untreated?

Small tears can sometimes stay stable for years without getting significantly worse, especially with good rehab. But an untreated tear that keeps being loaded awkwardly, or one where the surrounding muscles aren’t compensating well, can gradually enlarge and lead to more persistent weakness and pain over time. Getting it assessed early gives you more options.

Frequently asked questions

Can a rotator cuff tear heal on its own?

The torn tendon fibres themselves don’t reliably heal back together without surgery, but many people regain excellent function through strengthening the surrounding muscles, even with the tear still present.

Is it safe to exercise with a rotator cuff tear?

In most cases yes, with an appropriately adjusted programme. Complete rest tends to make the shoulder weaker and stiffer, which usually makes symptoms worse rather than better.

How long does non-surgical recovery take?

Most people see meaningful improvement within six to twelve weeks of consistent rehab, though building full strength back can take several months depending on the size of the tear.

Will the tear show up worse on a second scan later?

Not necessarily. Tear size and symptoms don’t always move together, plenty of people function well with a stable tear on imaging that never changes much over the years.

Can I still go to the gym with a rotator cuff tear?

Usually yes, with some exercises modified in the short term. A physiotherapist can help you adapt your programme rather than stopping training altogether.

If your shoulder feels weak or won’t lift the way it used to, it’s worth getting a proper assessment before deciding surgery is the only option. You can book a session here.