Posts tagged spinal stenosis
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.

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No Correlation Found Between MRI Findings And Spinal Stenosis Symptoms
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Lumbar stenosis is a spinal condition where nerves are compressed by the bony canals in our spine.  When symptomatic, this condition can lead to leg pain, numbness, pins and needles, and weakness in one or both legs of older adults.  Physical Therapy has been shown as effective as surgery for this condition and should be utilized in the majority of patient cases as a first line treatment.   

Interestingly, most of as we age accumulate changes in our spine including disc herniations, disc tears, and spinal stenosis yet we remain symptom free.  MRI s in asymptomatic people continue to shown these changes due to the high sensitivity of this testing, but we given the high risk of false positives we must ask if these changes directly correlate with our symptoms.  A recent review article in the journal Spine authors analyzed the available evidence to determine if MRI findings correlated with back or leg symptoms (Burgstaller et al. 2016).  The authors reported that they "were not able to prove any correlation MRI findings and severity of pain".  This highlights the growing evidence behind the limitations of MRI findings to determine a patient's symptoms, function, or prognosis.  

Individuals with spinal stenosis are encouraged to utilize Physical Therapy to help reduce their symptoms and improve their function, and most importantly put their MRI findings into perspective.


Lumbar Injections for Back and Leg Pain
lumbar epidural injections, back and leg pain

The use of lumbar corticosteroid injections is often utilized for patients with back and leg pain (radicular pain) and/or leg numbness, pins and needles, or nerve root weakness (radiculopathy).  In an older adult these symptoms may be due to a narrowing of the canals in which the lumbar nerve roots exit (lumbar stenosis).  These injections are costly and not without risk including a number of cases of infection in 2013-2014.  A recent review of the available literature published this month in the Annals of Internal Medicine found limited effectiveness of these treatments compared to placebo trials for both lumbar radiculopathy and stenosis.  Chou et al. and colleagues reported injections for radiculopathy may offer a small, short-term effect but long term effectiveness is limited.  In patients with lumbar stenosis the evidence reported little to no effectiveness on pain or function.  Physical Therapy is the first line intervention for patients with these conditions. 

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