Physical Therapy for Spinal Stenosis Yields Same Outcome as Surgery

Photo of a man with a spine model.
Physical therapy for spinal stenosis can help you move better and feel better. UpperCut Images/Getty Images

A recent study indicates that physical therapy for lumbar spinal stenosis yields the same outcome as surgery for stenosis.

If you have low back pain or leg pain from lumbar spinal stenosis, you may benefit from physical therapy to help you improve your mobility and decrease your pain.  You physical therapist can teach you how to effectively manage your symptoms through exercise and postural correction.

Symptoms of lumbar spinal stenosis typically include:

  • Back pain
  • Leg pain or tingling that is worse with walking and better with sitting
  • Difficulty walking due to pain
  • A flat back posture with a slight forward lean

Sometimes your doctor may recommend you visit a surgeon to help you manage the pain from lumbar spinal stenosis.  The surgeon may perform an operation called a lumbar laminectomy, a procedure designed to decompress the nerves in your back by removing parts of your spinal bones.

But is surgery the best option to manage lumbar spinal stenosis?

The Case Against Surgery for Spinal Stenosis

A study published in 2015 in the journal Annals of Internal Medicine compared the long-term effects of surgery versus physical therapy for lumbar spinal stenosis.  In the study, 169 patients who were scheduled for surgery for spinal stenosis were randomized into one of two groups - 87 patients had surgery, and 82 study participants participated in a standardized physical therapy treatment program for lumbar stenosis.

At the conclusion of the study, 74 surgical patients and 72 PT patients were used in the data analysis.

The main outcome measure in the study was the score on the Short Form 36, a measure of physical function.  Other outcomes were measures of physical function at various points after the study began.

After 24 months, there was virtually no statistically significant difference between the two study groups.  It didn't matter if you had surgery or participated in physical therapy for lumbar spinal stenosis - after 2 years, your overall physical function was the same.

Some study participants did cross over from the physical therapy treatment to the surgery treatment; obviously, no participant was able to cross form surgery to PT - once the surgery is done, it's done.

Risks of Surgery for Spinal Stenosis

No surgical procedure is without risks.  Risks of lumbar spinal stenosis surgery include, but are not limited to:

  • Infection
  • Blood loss
  • Death
  • Paralysis or paresis
  • Failure to adequately relieve your symptoms or worsening of your symptoms

These risks are rare, and you should discuss the risks of any surgery with your doctor before having the procedure.

Risks of Physical Therapy for Spinal Stenosis

The risks of participating in physical therapy for lumbar spinal stenosis are minimal.  They may include:

  • Failure to relieve your symptoms or worsening of your symptoms
  • Temporary muscle soreness, known as DOMS

Since physical therapy can be effective for lumbar spinal stenosis and the risks are minor, a trial of PT exercises and postural correction may be a good choice when facing laminectomy surgery for stenosis.  Your physical therapy program should be active, and your PT should teach you specific exercises designed to relieve pressure off your spinal nerves and improve your mobility.  Worst case scenario: PT is ineffective in relieving your symptoms and you elect to have surgery for your stenosis.

If you do have lumbar surgery for spinal stenosis, you may benefit from physical therapy after your back surgery to help you manage your pain and regain your normal level of mobility and function.

Bottom Line

According to this study, the 2-year outcome for surgery for lumbar stenosis and physical therapy for lumbar stenosis appear to be similar.  This doesn't mean you should avoid surgery at all costs - some people benefit from surgery for spinal stenosis.  It does mean that your doctor should explain to you the risks and benefits associated with the surgery, and he or she should offer you alternatives to surgery.  Physical therapy should be one of those alternatives, as it has been proven to offer pain relief and improved function for spinal stenosis with very few risks.

If you have lumbar spinal stenosis, visit your doctor to determine the best course of treatment for your specific condition.  If spinal surgery is one of your options, be sure to ask about engaging in an active course of physical therapy for lumbar spinal stenosis to attempt to conservatively manage your symptoms and improve your mobility. 

Source: Delitto, A. etal. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 162(7) April, 2015. 465-73.

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