Physical therapy has been found to be as effective as surgery for low back pain caused by lumbar spinal stenosis in a study published in the Annals of Internal Medicine this past year. Low back pain from lumbar spinal stensois is caused by a narrowing of the vertebral canal from degenerative changes that can occur as we age. The vertebral canal is the central opening running down the center of your spine that your spinal cord and nerves travel through. The canal can be thought of as a pipe and the stenosis is like corrosion in the pipe. The loss of space in the pipe eventually places pressure on the nerve that travel through causing the low back pain. Two common treatments for lumbar spinal stenosis are physical therapy and decompression surgery. The researchers found no difference between groups that were randomly assigned to have physical therapy or decompression surgery.
The clinical diagnosis of low back pain due to lumbar spinal stenosis is generally straight forward. If you have low back pain after a standing still a relatively short period or after walking short distances and if the pain generally clears with sitting you probably have lumbar spinal stenosis. A physical therapist will confirm this through an examination to rule out other causes of your low back pain. Someone with lumbar spinal stenosis typically has poor flexibility of their back and hips along with poor control over weak abdominal muscles.
How does physical therapy work to clear low back pain associated with lumbar spinal stenosis? First you need some background on the structure of your low back and the vertebral canal. A “normal” low back has a forward facing arch in it (concave side facing back). The individual bones, or vertebra, are offset in forming this arch. When there is no spinal stensois / corrosion there is enough excess capacity in the canal to allow the nerves through without any compression. When you have spinal stensois if you are flexible enough in your low back and hips and have good control over strong abdominal muscles you can decrease your low back arch lining up the remaining capacity of your vertebral canal. The flattening of your low back takes pressure off the nerves and clears your low back pain. Physical therapists treatment for low back pain caused by lumbar spinal stenosis includes stretching exercises and manual therapy to improve flexibility or your low back and hips and strengthening exercises to improve abdominal strength and control. This is the same approach used in this study.
It seems equally plausible that surgical decompression to remove the corrosion would be more effective and easier than the physical therapy approach. This was not the case in this study. There are many possible explanations and the one we most commonly encounter in the clinic is scar tissue formation that creates compression and low back pain. In this study many participants decided to stop physical therapy and have the surgery but unfortunately there was no improvement in long term outcomes compared to those that only had physical.
______________________________________________________________________________ Christopher DiPasquale, PhD, PT, OCS, SCS, CHT is a physical therapist at Performance Physical Therapy & Sports Medicine with offices in Hebron and Colchester, Connecticut. He is board certified by the American Board of Physical Therapy Specialties in Orthopedic Physical Therapy and Sports Physical Therapy and a Certified Hand Therapist by the Hand Therapy Certification Committee.