Overview
Not every spine problem needs an operation — most don't. Conservative, or non-surgical, care covers the full range of treatment that helps the spine heal and function better without surgery: guided physical therapy and activity changes, medication management, and targeted image-guided injections. For the majority of patients Dr. Gerlach sees, this is where treatment begins, and often where it ends.
It can seem counterintuitive to see a surgeon when you're hoping to avoid surgery, but that's precisely why it makes sense. A spine surgeon brings the full picture — imaging, exam findings, and an understanding of what surgery could and couldn't fix — to the conversation. That means you get an accurate diagnosis and an honest map of every option, including the one where surgery isn't needed at all, rather than a plan built by someone who can only offer non-surgical tools or someone who can only offer surgical ones.
Dr. Gerlach's stated approach is non-operative management whenever appropriate. That philosophy shapes every visit: build a clear, well-sequenced conservative plan first, track how you respond to it, and reserve surgery for the cases where it's genuinely the better path — not the default one.
Treatment Options
Physical Therapy & Activity Strategy
Movement is often the foundation of conservative care. A directed physical therapy program builds strength and flexibility around the affected area of the spine, improves posture and mechanics, and helps take pressure off irritated nerves or joints. Alongside formal PT, Dr. Gerlach works with patients on practical activity strategy — what to modify short-term, what to keep doing, and how to return to normal activity as symptoms allow, rather than defaulting to prolonged rest.
Medication Management
Anti-inflammatory and other medications can calm pain and inflammation enough to let the rest of a conservative plan — therapy, activity, time — do its work. Medication management is used thoughtfully, matched to the specific problem and to what a patient has already tried, as one piece of a broader plan rather than a stand-alone fix.
Image-Guided Injections
Injections placed under imaging guidance serve two purposes. Diagnostically, they help confirm exactly which structure is generating a patient's pain — valuable information when exam findings and imaging don't tell the whole story. Therapeutically, they can meaningfully reduce inflammation and pain around an irritated nerve or joint, often providing enough relief for a patient to progress further in therapy and activity.
When to Escalate
Conservative care isn't open-ended. Dr. Gerlach sets clear criteria up front for what progress should look like and by when, and revisits the plan at defined check-ins. If symptoms aren't responding, if there are signs of progressive nerve involvement, or if a patient's goals simply aren't being met by non-surgical treatment, that's the point to have a direct, shared conversation about surgical options — a decision made together, not handed down.
Frequently Asked Questions
Why see a surgeon if I don't want surgery?
Seeing a spine surgeon first gets you an accurate diagnosis and an honest map of every option that applies to your case — including "no surgery." Dr. Gerlach's stated approach is non-operative management whenever appropriate, so the conversation starts with conservative care, not an operating room.
How long should I try conservative care?
A trial of conservative care commonly runs six to twelve weeks, though the right timeline depends on your specific condition and how you're responding. That timeline shortens if red-flag symptoms — such as progressive weakness — appear, in which case the plan is reassessed sooner.
Do injections fix the problem?
Not on their own. Injections calm symptoms and help clarify exactly where pain is coming from — they're a tool within a broader treatment plan, not a cure. Many patients use the relief an injection provides as a window to make more progress in physical therapy.