The People's Perspective on Medicine

Physical Therapy Eases Low Back Pain as Well as Surgery

Trying physical therapy before surgery for lumbar spinal stenosis often eases low back pain and may make surgery unnecessary.
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Lumbar spinal stenosis, a condition in which narrowing of the spinal column crowds the spinal cord causing serious pain, is frequently treated with spinal surgery. Spinal stenosis is not unusual as people age, but the surgery has a 15 percent complication rate in older individuals.

Now a study of 169 patients shows that physical therapy is just as effective as surgery at easing the low back pain caused by lumbar spinal stenosis. It is far safer, however.

Physical Therapy: Now or Later?

All of the patients had been planning to have surgery, but agreed to be randomly assigned to get surgery promptly or to try physical therapy. They were all at least 50 years old and had no heart disease, dementia or cancers.

Those assigned to physical therapy had twice weekly sessions for six weeks. During the two years of the study, just over half of those who started with physical therapy opted to follow up with surgery. Both groups had similar levels of pain reduction and other symptoms at the end of the two years.

Patients who have had back surgery almost always need physical therapy afterwards to recover. It makes just as much sense to try it first to relieve back pain and possibly be able to skip the surgery altogether.

Annals of Internal Medicine, online April 6, 2015

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    About the Author
    Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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    Finding a good PT makes all the difference in the world for my LBP, after a minor surgery on the disc. Mine does trigger point dry needling which is miraculous. I am a fraidy cat about needles bit this is worth it!

    Looks like – every DC takes responsibility to scan the net for any support for PT and disavow PT while singing praise for chiropractic.

    Honestly, there are several factors leading to differing results from surgery, chiropractic (not medicine) and physical therapy. Singularly, despite much oversight by training accreditation and licensing, all providers/practitioners are not equally effective. Overwhelmingly, composite data over-generalizes to a wildly heterogeneous population (varied individuals).

    Likely, chiropractic was left out of the equation as respect for the practice has fallen dramatically in recent decades. Find a DC and you will find someone who has had to supplement their practice by nutritional advice and selling supplements. Chiropractic as a singular method may not be so much snake oil as under the cloak of over-the-counter product (not requiring a prescription). Most PTs now have the skills for spinal joint manipulation AND physical therapy wears the imprimatur of medicine and medical insurance.

    I am in agreement with your conclusive statement:
    “It makes just as much sense to try it first to relieve back pain and possibly be able to skip the surgery altogether.”

    Thousands of people go to the doctor with back pain each year. It is one of the most common medical problems for visits. Each spine is different. A study of 169 people touting physical therapy for restenosis has little value.

    It always amazes me that chiropractors are left out of the equation when talking about back pain. I have lower back scoliosis and it started to bother me about 17 years ago. I went to a chiropractor – several sessions the first few weeks and then gradually an adjustment once a month. I’ve had only two really bad episodes in all those years and a neurologist suggested steroid shots. So far, I’ve only had 5 total in all those years. I credit my chiropractor for the healthy life I’ve had in spite of occasional pain. I had physical therapy once (a 6-week session) which did nothing to help. Prednisone, which the physical therapist recommended, did not help. I truly believe that keeping one’s back (lower, upper and neck) adjusted is key!

    In 2009, I suffered a sciatic attack and saw an orthopedic surgeon. I was diagnosed with arthritis, degenerative disk disease, scoliosis, and lumbar stenosis. I was told that given the extent of the damage (too many disks and too many nerves involved), I was not a candidate for surgery. I went for physical therapy (12 sessions, I think) and was told by the physical therapist who studied my MRI that I was lucky to have found an honest surgeon, that surgery would not help me and would likely make me worse. I added the PT exercises to my routine and have been doing them every day since. Along with various “alternatives” (foods, herbs, spices, vitamins, minerals, etc.) and Topricin (a homeopathic cream that has helped me with this and other joint issues), I am doing far better (without surgery, without NSAIDs, without steroids, etc.) than friends who have turned to allopathic treatments. I am a huge fan of physical therapy and have relied on it for several other problems since.

    * Be nice, and don't over share. View comment policy^