Alternative to Surgery

Question:

How much more effective is physical therapy than surgery in treating spinal stenosis? Is there any research supporting this?

Answer: By Alison Lichy, PT, DPT, NCS

Spinal stenosis is the narrowing of the spinal canal and causes compression on the spinal cord and nerves.  There are many causes of spinal stenosis and the symptoms, severity, and location within the spine can vary from patient to patient. Each case must be evaluated and managed individually to determine the best treatment –  surgery, physical therapy, or a combination.

Both physical therapy and surgical interventions have shown benefit in treating spinal stenosis, though surgical versus non-surgical treatment effectiveness has not been demonstrated in research studies.  The goal of surgery is to take the pressure off the spinal cord and may be performed with or without fusion (permanently joining the vertebral bone above and below) or instrumentation (insertion of plates, screws, or wires) to stabilize the spine.  The goal of physical therapy is also to decompress and stabilize the spine through use of manual therapy, strengthening, stretching, muscle retraining and postural education. 

Physical therapy can also be helpful prior to surgery and following surgery to decrease pain, increase mobility, increase strength, increase postural control, and decrease the reoccurrence of stenosis.  You should discuss your treatment options with your physician and physical therapist.

Biographical Information

Physical therapist and American Physical Therapy Association (APTA) member Alison M. Lichy, PT, DPT, NCS, is the current president of the District of Columbia Chapter of APTA. Dr Lichy is the owner of Neurological Physical Therapy PLLC in Alexandria, Virginia, an outpatient physical therapy clinic specializing in treatment of neurological disorders. A researcher associated with the National Rehabilitation Hospital in Washington, DC, Dr Lichy is a research investigator for the National Capital Spinal Cord Injury Model System (addressing assistive technology disparities); the Rehabilitation Research Training Center (addressing secondary complications following a spinal cord injury and use of electrical stimulation and Lokomat® in treatment protocols); and the Assistive Technology Research Center (addressing bracing in the ambulatory spinal cord injured population). An active member of APTA, Dr Lichy is an APTA Board Certified Specialist in Neurological Physical Therapy and previously served as APTA membership chair, secretary, and chief delegate.