Physical Therapy Successful in Treating Back Pain

Lower back pain is an incredibly common complaint, and one of the most frequent reasons for a visit to the doctor. If your pain results from a strained muscle or poor positioning while lifting an object, consider yourself lucky. The discomfort is usually temporary and easy to resolve with rest and applications of ice. However, in many cases, back pain is chronic and brought on by a more serious condition such as a narrowing of the spinal canal causing pressure on the nerves. But take heart if that is the condition affecting you because you may not need to undergo an operation to feel better. According to new research, physical therapy can be just as successful in restoring comfort levels as surgery for these patients.

The study, which took place at the University of Pittsburgh in Pennsylvania, found that chronic lower back pain produced by lumbar spinal stenosis may be treated equally effectively by a physical therapy regimen vs invasive surgery.¹ Mozes, Alan. “Physical Therapy Equals Surgery for Some Back Pain.” WebMD. 7 April 2015. Accessed 15 April 2015. http://www.webmd.com/back-pain/news/20150407/physical-therapy-equals-surgery-for-certain-lower-back-pain-study-says. The subjects were nearly 170 men and women with an average age in their late 60s. All of them were residents of western Pennsylvania who had been diagnosed with lumbar spinal stenosis, a painful condition in which nerves in the lower back are compressed by a narrowing of the spinal column. None of them had previously had surgery to treat the problem, and they had similar limited mobility issues and pain assessments.

Approximately half of the participants were randomly selected to have a decompression procedure that involves the removal of portions of spinal bones and ligaments. They did not have fusion surgery, another common operation to treat this condition that uses screws and rods to hold the spinal bones in the affected area together. The other half of the volunteers were provided with physical therapy sessions twice a week for a period of six weeks.

Follow-ups were performed 10 weeks after the start of the trial, and again after six months and one year to evaluate the mobility of each patient. Then, two years after the surgery or end of physical therapy, the subjects answered a questionnaire that focused on any pain experienced, functionality, disability, lingering symptoms, and expectations. Once the data was compiled, the scientists discovered there were no measurable differences over the long term in the areas of pain relief and function between those who had surgery and those who had physical therapy.

That is not to say that in either group was treatment always completely successful. There were participants in both groups who could not reach a “clinically meaningful level of improvement.” But symptoms began to decrease and relief was noted by the 10-week mark among many of the volunteers–both those receiving physical therapy and those who had surgery. These improvements continued to progress during the follow-ups and were maintained even after two years.

There was, however, a large segment of patients in the physical therapy group who took the researchers up on an offer to switch groups, opting for a surgical approach instead. More than half of them, in fact, did so. While we do not know their reasoning, it may be likely that they wanted what they felt might be a faster way to resolve their pain or a more permanent solution. Ultimately, physical therapy does not change the fact that the spinal canal has narrowed, but it can be very successful in improving the strength and flexibility of surrounding muscles and restoring joint mobility to alleviate the pressure and discomfort.

Surgery, though, would appear to be a hasty decision. After all, the findings show equal pain resolution, mobility improvement, and overall satisfaction from both physical therapy and surgery. Keep in mind that physical therapy does not require anesthesia, being cut into by a scalpel, removal of chunks of bone, or risk that something goes wrong as a surgeon works right alongside your spinal cord. And surgical decompression procedures do carry a high risk of complications, often around seven percent, according to a 2010 study at the University of Virginia Medical Center in Charlottesville.² Smith, JS; et al. “Complication rates of three common spine procedures and rates of thromboembolism following spine surgery based on 108, 419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee.” Spine. 15 November 2010. Accessed 16 April 2015. http://www.ncbi.nlm.nih.gov/pubmed/20581760. Many of these complications, such as nerve or tissue damage and blood clots, are very serious or even potentially fatal.

So if you are diagnosed with lumbar spinal stenosis, consider a course of physical therapy before you sign on for surgery. If you actively participate in the regimen and give it a chance for a few weeks, it would appear that you might have a very good chance of obtaining considerable long-term relief from your symptoms and avoiding surgery altogether.