Providence, RI – Patients diagnosed with lumbar spinal stenosis are often surprised to learn that physical therapy for low back pain can be as effective as surgery without the associated costs and complications. The debilitating and painful diagnosis is a daily struggle for nearly 400,000 Americans.
The results of a study published in the Annals of Internal Medicine suggest that patients with lumbar spinal stenosis should first turn to a physical therapist trained to treat low back pain. The study team directly compared a single, evidence-based physical therapy regimen with decompression surgery in 169 participants who agreed to be randomly assigned to either approach.
The study research revealed comparable long-term outcomes regardless of whether patients were assigned to the surgery or the physical therapy cohort. Additionally, study authors concluded that increases in function followed similar trajectories from baseline onward in both groups.
Symptomatic lumbar spinal stenosis frequently leads to lifestyle-limiting back and lower-extremity pain in older patients. A physical therapy regimen for spinal stenosis is designed to reduce soft tissue pain, improve function and build muscle strength.
Physical therapists at Performance Physical Therapy effectively treat lumbar spinal stenosis with a combination of patient education, manual therapy, mobility and strengthening exercises, and aerobic conditioning. Therapists here apply evidence-based manual therapy techniques directed at the lumbar spine, thoracic spine, hips, and lower extremity to help improve pain levels and mobility in these patients. Improvements in therapy are then reinforced with therapeutic exercises including flexion based stretching to the lumbar spine, thoracic extension exercises, stretching to hip flexors, and strengthening to hip and core musculature.
Performance physical therapy also offers antigravity treadmill training and underwater treadmill training which can be used early in therapy to progress walking tolerance, and then progressed to a land-based walking program. Patient education is one of the most important aspects of care and includes a progressive home exercise program, self-management strategies, and good prognosis with conservative care.
Although the long-term outcomes of surgery and physical therapy are similar for this patient population, the short-term risks differ. Immediate decompression surgery—which involves removing the bony plate on the back of the vertebra where the stenosis is located—is an invasive procedure that comes with a high price tag and the prospect of complications. Meanwhile, similar outcomes can be achieved with an active, standardized physical therapy regimen that involves general conditioning, lower extremity strengthening exercises, and postural education.
Another component of the research worth noting is the importance of constructive provider-patient communication. Study authors stress the need for patients to engage in shared decision-making conversations with their healthcare providers to select the appropriate treatment plan for each specific case.