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  • Stenosis Findings Point to Need for Patient-Provider Conversation About Physical Therapy as First Treatment

    News of the latest research on physical therapy's effectiveness in easing spinal stenosis symptoms is spreading fast and, with it, the idea that health care providers and patients need to engage in well-informed conversations that include nonsurgical as well as surgical options for the condition.

    Coverage, which has now grown to include the Huffington Post, WebMD, and US News and World Report, focuses on a study of self-reported physical function among 169 participants diagnosed with lumbar spinal stenosis (LSS) and divided into 2 treatment groups—1 that began with surgery and 1 that began with physical therapy.

    Researchers found that not only were 2-year effects similar for the 2 groups (87 who began with surgery and 82 who started with physical therapy), the increase in function followed similar trajectories from baseline on.

    "Physical therapy should be fully considered as an equally effective, less risky, and much less costly first treatment option in patients who are candidates for decompression surgery," said lead author Anthony Delitto, PT, PhD, FAPTA, in an APTA news release.

    That concept—full consideration of physical therapy as an effective first option—depends on information and dialogue between patient and provider, according to APTA President Paul A. Rockar Jr, PT, DPT, MS.

    "Patients and health care providers should engage in shared decision-making conversations that include a full disclosure of evidence involving surgical and nonsurgical treatments for LSS," Rockar said.

    Rockar's comments are echoed in an editorial that accompanied the article. In that editorial, author Jeffrey N. Katz, MD, MSc, writes that "because long-term outcomes are similar for both treatments yet short-term risks may differ, patient preferences should weigh heavily in the decision of whether to have surgery for LSS."

    Comments

    • Shouldn't there be a control group that didn't do PT or surgery to compare the groups to?

      Posted by Jennifer Rosecrance on 4/9/2015 7:55 AM

    • I have stenosis as well as bulging disc, arthritis and degenerative disc desease. I would certainly like to have treatment w/o pain meds. Dr's do not want to do surgery due to various reasons. I live near Columbus Ga. Any suggestions?

      Posted by Judy thrower on 4/9/2015 11:23 PM

    • Judy, Often times imaging findings such as bulging discs, arthritis and DDD do not correlate with symptoms. It is common that all of these findings are seen on images when people are experiencing no pain. Basically, these findings might mean nothing. That is probably why your doctor does not want to do surgery. It would be a shame to have surgery and end up with the same pain that you started with. At this point I would recommend seeking out a physical therapist who might better explain all of the influences that contribute to your pain. With better understanding, you are more likely to be successful reducing your symptoms. In the meantime, I would recommend reading "Why Do I Hurt" by Adriaan Louw.

      Posted by Chris Edmundson on 4/13/2015 4:28 PM

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