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Physical Therapy In Lieu Of Back Surgery

Originally researched and written by ChoosePT provided by APTA

Summarized below by Richelle Stevenson

According to this global analysis(2) low back pain has been shown to be a major problem throughout the world, significantly impacting women and individuals from 40-80 years old.  One common cause of back pain is Lumbar Spinal Stenosis (LSS).   Essentially this occurs when the vertebral foreman ("tunnels" in the back bones) narrow and begin to compress the spinal cord and nerves.  Many seek relief through surgically opening these vertebral canals and then completing postoperative physical therapy.  Yet as evidence continues to emerge, physicians are now recommending physical therapy in lieu of surgery.   Researchers are investigating the long term outcomes of conservative, non-surgical treatments for conditions such as LSS over both traditional and modern surgical approaches.  

This study from the Annals of Internal Medicine(1)analyzed 147 patients eligible for surgical intervention for LSS.  After 2 years, no statistical difference was determined between participants who completed physical therapy alone and those who underwent a decompression surgery.  In other words, participants who completed physical therapy alone had the same improvement of function and relief of symptoms as those who underwent surgery!  It is important to note that there was some crossover in this study; some participants who initially began with only physical therapy did need a surgical intervention during this study.  Nevertheless, a majority of the patients initially considering surgical repair were able to decrease their pain and improve their ability to move using physical therapy alone.  This is a major reason why some doctors are now beginning to recommend physical therapy over surgery to treat back pain.  

Likewise, this meta-analysis(3) examined multiple studies to determine whether surgery or conservative treatment (physical therapy) had higher success rates overall.  The authors found both the surgical and conservative treatments to have equal results over the course of time.  They were unable to make a conclusive recommendation due to the necessity for further and more thorough research.  Still the authors state, "however, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment. No clear benefits were observed with surgery versus non‐surgical treatment."  With generally equal results overall and no side effects, it's no wonder physicians are beginning to choose physical therapy as the initial treatment for spinal conditions.  

Physical Therapists, Orthopedics and Spine Specialists work together to bring you the best care possible and are continually researching to improve treatments.  For some individuals with back pain, surgery may be the only option to alleviate symptoms.  However, most people suffering with low back pain will benefit remarkably from seeking physical therapy first, and many will not need surgery after therapy.  If you are experiencing back pain it's important to speak to your doctor and contact a physical therapist.  Connecticut is a direct-access state which allows people who are in pain to schedule directly with a physical therapist to address their symptoms.  Here at Magna Physical Therapy we care about your whole health and have extended hours so you can be seen quickly and find relief.

Call us at 860-679-0430 today!


1) Delitto, A., Piva, S. R., Moore, C. G., Fritz, J. M., Wisniewski, S. R., Josbeno, D. A., Welch, W. C. (2015). Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Annals of internal medicine162(7), 465–473. doi:10.7326/M14-1420

2)Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R 2012 A systematic review of the global prevalence of low back pain. Arthritis and Rheumatism 64: 2028–2037

3) Zaina  F, Tomkins‐Lane  C, Carragee  E, Negrini  S. Surgical versus non‐surgical treatment for lumbar spinal stenosis. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD010264. DOI: 10.1002/14651858.CD010264.pub2.

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