The Hunt for an Effective and Less Costly Solution to Lumbar Spinal Stenosis
Is there a solution that saves money and ensures functional progress in the world of debilitating lower back pain? A study published in the Annals of Internal Medicine reveals that physical therapy is that solution for lumbar spinal stenosis, a form of lower back pain affecting some 400,000 Americans.
Lumbar spinal stenosis often occurs at the hands of age: as we get older, the spine goes through changes that can lead to a degeneration of the vertebrae, discs, muscles and ligaments that comprise the spinal column. As this happens, some patients will be handed a diagnosis of lumbar spinal stenosis and may note pain, numbness and weakness in the low back and legs. Symptoms may worsen when walking and engaging in other low-impact activities but ease a bit when sitting and otherwise at rest.
What to do next? A physical therapist will conduct a thorough evaluation, relying on screening tools and a detailed overview of the patient’s medical history, to ensure an accurate diagnosis. This is particularly important because spinal stenosis presents the same as other age-related conditions. During your first appointment, a physical therapist will likely ask you to:
•Identify the location and nature of your weakness, pain, numbness and other symptoms
•Participate in muscle strength tests to understand the level of pressure on your nerves
•Walk and perform other activities so the PT may observe posture and function
•Have your spine and leg range of motion measured
The American Academy of Orthopedic Surgeons reports that roughly 11% of Americans, mostly those over age 50, have this condition. Many are confronted with the difficult decision of whether or not surgery is the answer to their pain and difficulty ambulating. In the case of spinal stenosis, the most common procedure is decompression surgery or lumbar laminectomy which relieves pressure on the spinal cord or nerves by removing the lamina. This surgery is performed with or without spinal fusion.
Alongside other recent research, the study published in Annals found that conservative care such as physical therapy can achieve just as good as or better results than surgery. Participants in both study groups (surgery and physical therapy) saw benefits beginning 10 weeks after surgery or the start of a physical therapy program. The patients' lower back pain continued to decline and physical function continued to improve during the four months following initial treatment. Two years after the study’s start, the two groups reported no difference in pain or physical function.
In addition to preventing invasive and sometimes life-threatening surgeries, physical therapy can often avoid the need for medications and expensive imaging. Patients are urged to speak with their physicians about seeing a physical therapist first.