Low back pain, especially pain related to lumbar spinal stenosis affects a large number of people in the United States. Lumbar spinal stenosis is a common source of low back pain and can even cause pain that radiates down the back of the legs [3]. Lumbar spinal stenosis is fancy for: narrowing of the spinal canal that causes compression on the nerve roots [4].
Patients that experience symptoms as a result of lumbar spinal stenosis find themselves at a higher risk of falls. They may also experience chronic pain as a result of degeneration. While this is a common cause of lower back pain, many patients and providers find themselves with more questions than answers when it comes to effective treatment options.
The challenges of Lumbar Spinal Stenosis
Management and treatment decisions for patients with Lumbar Spinal Stenosis (LSS) often pose a significant challenge for primary care providers and medical specialists alike. To add to the challenge, nonsurgical treatment evidence has historically been limited by lack of quality evidence [2]. Basically, there has never really been enough high-quality research and evidence on non-surgical treatment options. This means that healthcare providers have been trying to make good decisions about treatment for and with their patients, but haven’t had the information they need to make those decisions.
On top of that, both the US Centers for Disease Control & Prevention and the American College of Physicians advocate for non- pharmacological pain management as primary intervention strategies for patients with musculoskeletal pain [1]. This means that, in addition to trying to help patients manage their pain without surgery, providers have also experienced push-back on one of the more common conservative treatment options: pain medication. I’m sure you’ve heard of the opioid epidemic. That situation leaves providers and patients at a loss for what treatment option to choose.
Fortunately, early implementation of Physical Therapy intervention appears to offer effective clinical outcomes as well as a reduced overall opioid use among patients experiencing chronic musculoskeletal pain [1]. In fact, some evidence suggests that patients with moderate pain who undergo a conservative PT treatment can experience up to 50% pain relief in less than 3 months [4].
What the Research Shows
Physical therapy & other conservative treatments not only have been shown to be an effective treatment option for low back pain and lumbar spinal stenosis, but they have also been linked to lower rates of long-term opioid use. Basically, physical therapy potentially reduces the risk of the negative effects of opioid use to treat pain.
Check out this quote from a recent article on the topic:
“Early physical therapy appears to be associated with subsequent reductions in longer-term opioid use and lower-intensity opioid use for all of the musculoskeletal pain regions examined.” [1]
Now, that basically means that early PT treatment for low back pain decreases the risk of patients using opioid pain medication for the long-term. In fact, this study looked at more than just low back pain. it also addressed other areas of the body like neck & shoulder pain [1].
That being said, let’s look at some of the details about physical therapy treatment techniques (like exercise) for low back pain and lumbar spinal stenosis.
How effective is physical therapy when compared to other, more invasive treatment options?
Physical therapy has been shown to be as effective as surgery for lumbar spinal stenosis [2][3]. Per the research: “Surgical decompression yielded similar effects to a PT regimen among patients with LSS who were surgical candidates. Patients and health care providers should engage in shared decision-making conversations that include full disclosure of evidence involving surgical and nonsurgical treatments for LSS.” [2]
Basically, in this research study, the participants (people with lumbar spinal stenosis) were randomly divided into two groups. One group received surgery. The other group got assigned to the physical therapy treatment program. The results? Both groups experienced similar outcomes. They both experienced a decrease in their symptoms and pain. But, the physical therapy treatment group experienced those results without the additional risk of anesthesia & surgery.
The research seems to show that symptoms associated with spinal stenosis usually respond favorably to non-operative treatment techniques such as Physical Therapy. In fact, conservative management is successful in most patients and is recommended as an initial treatment approach [4].
What might Physical Therapy Treatment for Lumbar Spinal Stenosis include ?
Physical therapy treatment may include: flexion-based exercise programs, manual therapy, isometric stretching, static & dynamic postural retraining, ambulation & gait improvement, education, and aquatic therapy programs. Ideally, the clinician will take a biopsychosocial approach and will tailor the treatment plan to each patient. This ensures that the treatment will have a higher chance of being effective.
Summary
The ultimate goal of treatment should be to both reduce the symptoms (pain, limited motion, etc.) and also provide the patient with the right tools and techniques for them to self-manage the symptoms going forward. One thing we know from working with patients experiencing chronic pain and other conditions that result in persistent pain and symptoms: relapses happen.
Sometimes, you go months or even years without any symptoms or pain. Then, seemingly out of nowhere, the pain comes back. In instances like that, it’s important to be in a position to address those symptoms effectively. So if you’re experiencing low back pain associated with lumbar spinal stenosis, and you’re considering non-surgical treatment options, make sure you find a clinician that understands this cycle and can give you the tools & strategies you’ll need to manage that pain for the long term.
References
[1] Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain. JAMA Netw Open.2018;1(8):e185909. doi:10.1001/jamanetworkopen.2018.5909
[2] 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 Apr 7;162(7):465-73. doi: 10.7326/M14-1420. PMID: 25844995; PMCID: PMC6252248.
[3] Wise, J. (2015). Physical therapy is as effective as surgery for lumbar spinal stenosis, study finds. BMJ: British Medical Journal, 350. https://www.jstor.org/stable/26520635
[4] Lee, S. Y., Kim, T. H., Oh, J. K., Lee, S. J., & Park, M. S. (2015). Lumbar Stenosis: A Recent Update by Review of Literature. Asian spine journal, 9(5), 818–828. https://doi.org/10.4184/asj.2015.9.5.818
