Supervised Physical Therapy Superior To Home Exercise Program For Patients With Lumbar Stenosis
Lumbar spinal stenosis is a narrowing of the bony canals in the spine which surround the nerves which supply our lower extremities. The condition is common among aging adults, > 60 years old, and can lead to symptoms such as single or bilateral leg pain, numbness, pins and needles, and/or weakness. Often leg symptoms are more frequent and severe than back symptoms. In our previous blogs we have discussed prior research papers indicating no long term (> 1 year) differences in outcomes between surgery and Physical Therapy for patients with lumbar spinal stenosis. Previous Physical Therapy approaches have focused on lumbar flexion exercises (ex. knees to chest) to create more space for the nerves, but more recent studies have shown benefits of manual therapy, strength training, and body weight supported treadmill walking. A recent research study highlights the importance of Physical Therapy compared to a home exercise program alone.
Minetama and colleagues conducted a randomized controlled trial in the Spine Journal to compare the effectiveness of supervised Physical Therapy compared to a home exercise program for patients with spinal stenosis (2019). Authors randomized 86 patients with neurological claudication (symptoms in legs consistent with lumbar spine compression) to one of the two groups. The Physical Therapy group received treatment twice a week for 6 weeks while the home exercise group received a home program to be performed independently without supervision. Authors assessed function, gait, pain, and activity levels before and after the study. As expected superior outcomes on pain, gait, activity levels, and function were found among the supervised Physical Therapy group compared to those receiving a home exercise program.