Spinal Stenosis: PT or Surgery?May 20, 2015
If you have ever experienced low back pain, you are definitely not alone. Low back pain is very common and many individuals eventually undergo surgery for their pain. Lumbar spinal stenosis is one cause of low back and leg pain and is commonly treated with surgery as well. What if going under the knife is too extreme and surgery is not an option for you? Good news! Conservative treatment, such as physical therapy, can provide similar outcomes to surgery and is much less invasive. A recent study shows that physical therapy for lumbar spinal stenosis is just as effective as surgery in the long term timeframe. The study by Delitto et al. compared individuals with lumbar spinal stenosis receiving physical therapy to those undergoing decompression surgery.
What is Spinal Stenosis?
Spinal stenosis is once cause of low back pain that affects the vertebrae, of bones of your spine. Your spine contains vertebrae that are stack on top of each other. In between each vertebrae is a disc that provides space and serves as a cushion or shock absorber. Inside each vertebrae is a boney ring and together they form a hollow tube that your spinal cord runs through, called the spinal canal. With stenosis, the boney ring formed by your spine becomes narrow, resulting in less space for your spinal cord. The decrease in space causes increased pressure on your spinal cord and nerves. Spinal stenosis can be cause by normal wear and tear over the years that flatten the discs between your vertebrae. When the discs are flattened, this creates less space and more pressure on your nerves. Also, conditions such as arthritis can cause bumps on the bones of your spine, or bone spurs, which protrude into your spinal canal, adding pressure on your spinal cord or nerves. Another cause of spinal stenosis is being born with a spinal canal that is narrower than normal, putting you at risk for developing spinal stenosis later in life.
Lumbar spinal stenosis usually progresses slowly over time, since the main cause of stenosis is wear and tear or degeneration. Majority of your symptoms will affect your legs, since the nerves being pressed on in your low back control the movement and sensation in your lower legs. With lumbar spinal stenosis, you may experience:
- Pins and needles into your hips, thighs, or legs.
- Weakness or heaviness in your legs.
- Issues with bowel and bladder
- Symptoms relieved with bending forward or sitting
- Increased symptoms with walking, standing, or bending backwards
Bending forward may help your pain with spinal stenosis because it widens the spinal canal, decreasing the pressure on your spinal cord or nerves. On the other hand, bending backward can make the spinal canal smaller, making your symptoms worse.
Your physical therapist will perform a thorough history and ask specific questions in order to rule out other possible conditions. They will ask you questions about your pain or other symptoms you are experiencing, watch how you move, assess your strength and flexibility, examine your balance, and test your sensation. Your therapist will work closely with your physician as well to make sure you receive the proper treatment. An x-ray or MRI may be performed to confirm the diagnosis as well. If your symptoms are severe and greatly affecting your function, surgery may be recommended. Otherwise, physical therapy has been shown to have similar or better results in all but extreme cases of spinal stenosis.
How Can Physical Therapy Help Me?
Your physical therapist will design an exercise program based on what they have found during their examination. The goal is to increase your ability to participate in your everyday activities while reducing your symptoms. Your therapist will educate you on what positions you should avoid in order to prevent increased pressure on your nerves. Therapy will also include:
Strengthening – Exercise that strengthen the muscles around your back and legs will add support, helping to reduce any added stress to your low back.
Stretching – Your therapist will show you stretches to increase motion at your back and legs, in order to reduce your symptoms and ensure proper movement.
Hands on treatment – Manual therapy can also help to improve your symptoms and reduce stiffness at your joints.
Posture training – Individuals with stenosis tend to have a bent forward posture, resulting in shortened or tight muscles, that can further increase your symptoms. Your therapist will instruct you on proper sitting, standing, and walking postures without making your symptoms worse.
Physical therapy is an excellent first line of defense when it comes to treating your symptoms of lumbar spinal stenosis. Surgery can be invasive and expensive, without any added benefit compared to physical therapy.
Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, Fye M, Welch WC. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med (2015); 162:465-473