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Spinal Stenosis: Therapy vs. Surgery

Has your back pain made walking, standing, and enjoying your hobbies difficult? You are not alone. Low back pain is a common complaint and is experienced by 80% of individuals at some point in their lifetime (1).  As a physical therapist, it’s not uncommon to hear my patients say, “I cannot walk for more than five minutes, but if I sit down the pain goes away.” Pain with standing and walking are classic signs of “lumbar spinal stenosis.”

What is spinal stenosis?

Lumbar spine stenosis is a common cause of low back pain in the older population. 47% of individuals between 60 to 69 years of age have mild to moderate stenosis and 19.7% have severe stenosis (2).  Lumbar stenosis is a cause of low back pain that is often misunderstood by patients. Degenerative disc disease, degenerative joint disease, and arthritis are commonly associated terms with spinal stenosis. Simply put, spinal stenosis is the narrowing of the spinal canal.

As we age the discs (shock absorbers and cushions) of our spine can lose fluid. Dehydration causes the disc height and flexibility to decrease; resulting in narrowing of the spine. This is also one reason why we lose several inches, shrinking as we age. Losing inches is not the only consequence of degenerative spinal changes. Decreased space in the spine can compress the nerves in our back. Nerve root compression presents as pain, numbness, tingling, or even weakness in the back, hips, or down the legs.

back, pain, standing, walking

While standing, gravity will naturally cause the space between the vertebrae to decrease. For some, pain is nearly instant. Others may be able to tolerate standing for over an hour before pain sets in. Why does sitting provide nearly instant relief? Sitting will flex the spine forward, opening space in the spine. It’s worth noting:  the diagnosis of spinal stenosis does not mean a life sentence of sitting.


What are your options?

Patients are always asking about their options when it comes to spinal rehabilitation. There are several choices when addressing lumbar spinal stenosis; including physical therapy, pain management, injections, or surgery. In certain circumstances, patients are surgical candidates due to potential damage to the spinal cord; however, most patients do not fall under that category. For most cases research shows that physical therapy is just as effective as surgery. One study revealed that physical therapy reduced symptoms and improved function after just ten weeks (3). More importantly, those improvements remained after two years.

So what does this all mean? Movement is medicine.  Physical therapy should be the first treatment for lumbar spinal stenosis. Increasing flexibility, improving core strength, altering body mechanics, and increasing mobility are all important when battling spinal stenosis.

A few words of caution….Therapy requires hard work and patience. It is important to understand building strength and changing how your body moves takes commitment. However, that effort can prevent a costly, invasive surgery or reliance on pain medication. Movement is medicine!

1. Manchikanti L. Epidemiology of Low Back Pain. Pain Physician. 2000;3(2):167-192.
2. Kalichman L, Cole R, Kim DH, et al. Spinal stenosis prevalence and association with symptoms: the Framingham study. Spine. 2009;9:545-550.
3. Delitto A, Piva SR, Moore CG, et al. Surgery Versus Nonsurgical Treatment of Lumbar Spine Stenosis. Ann Intern Med. 2015; 162: 465-473.



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