Not necessarily. Nerve block, meds, and physical therapy are usually the first steps. Unless the condition is spreading all over and progressing very fast then she'll want to start with the least invasive stuff first. Early on those treatments have a pretty high success rate. The physical therapy is the most important but the block and meds will hopefully give enough relief so that she CAN do the therapy. Also very important that she really do any at home exercises she is given if at all possible. It's move it or lose it with this condition. The pain will get worse with immobilization so avoid that. Also....NO ICE. Heat can be very good bit ice is a big no no for this condition and make sure the physical therapist knows this.