Best Treatment For Back Pain: Experts Consider Physical Therapy vs. Surgery


For people who suffer chronic back pain and are considering undergoing surgery, a new study has revealed that physical therapy may very well be a more practical option.

According to research by the University of Pittsburgh, physical therapy offers a less invasive but equally potent procedure compared to surgery in addressing lumbar spinal stenosis (LSS), a common cause of lower backaches and nerve damage among older people.

Lumbar spinal stenosis is the compression of open spaces in the lower region of the spinal column. Symptoms of the condition include a tingling sensation, pinched nerves, and recurrent numbness and weakness of the back and lower extremities. These become more common with age.

According to the American Academy of Orthopedic Surgeons, an estimated 2.4 million Americans may develop LSS by 2021.

Dr. Anthony Delitto, study author and chair of physical therapy at the University of Pittsburgh's School of Health and Rehabilitation Sciences, explained that between the two procedures, surgery is considered "riskier" with a 15 percent chance of developing complications, half of which are life-threatening.

Delitto and his colleagues asked 481 patients who consented to surgery if they would be willing to participate in research where they would be selected randomly to continue with the operation or receive physical therapy instead.

Of the total number of patients, 169 agreed to participate in the study: 87 of which were assigned to push through with the surgery while 82 were assigned to undergo physical therapy.

At the beginning of the experiment, the patients were at least 50 years old and able to walk at least a quarter of a mile without difficulty. They also did not have a prior history of medical conditions, such as vascular disease, heart ailments, dementia or cancer. Most of the participants were typically obese and had mildly active to sedentary lifestyles.

Patients in the surgery group were slightly younger, with an average age of about 67 years compared to the patients in the physical therapy group who were mostly around 70 years old.

A regimen was set for the physical therapy group. It included a rehabilitation session twice a week during a six-week period.

If at any point in the study, the participants felt the need to switch groups, they were allowed to choose to discontinue the regimen and opt for surgery. In follow-up sessions conducted within two years, 47 of the patients, or 57 percent, in the physical therapy group decided to switch and undergo surgery instead.

By the end of the study, the participants experienced a similar decrease in pain and other complications after two years regardless of their group. There were no noticeable differences between the groups in how the pain that they typically experience subsided. The researchers also noted how the participants regained function in their lower extremities, including their backs, buttocks and legs.

"The idea we had was to really test the two approaches head to head," Delitto said.

"Both groups improved, and they improved to the same degree. Now, embedded in that, there are patients who did well in surgery, and patients who failed in surgery. There are patients who did well in PT, and there are patients who failed with PT. But when we looked across the board at all of those groups, their success and failure rates were about the same," added Delitto.

Dr. Jeffrey Katz, director of the Orthopedic and Arthritis Center for Outcomes Research at Boston's Brigham and Women's Hospital and author of the accompanying editorial of the study, said the research presents surgery and physical therapy as equally viable choices. Patients still get the same result at the end of either procedure.

Dartmouth-Hitchcock's chief executive Dr. James Weinstein, who was not involved in the study, pointed out that since many of the qualified patients chose not to participate in the study - and many of the randomly selected participants for physical therapy opted out to get surgery - further research may still be needed to get a more complete understanding of the relative advantages of each option.

"Surgery should be the last option," stated Weinstein, lead author of a paper published in the New England Journal of Medicine, which discussed the effectiveness of surgery at curbing symptoms compared with nonsurgical procedures.

The results of the University of Pittsburgh study titled "Surgery Versus Physical Therapy for Treating Lumbar Spinal Stenosis" were published in the Annals of Internal Medicine.

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