Whenever someone suffers an injury to the musculoskeletal system such as muscle strains, sprains, disc prolapse or dislocations, he will have to make some difficult decisions on whether to go for physiotherapy or undergo orthopedic surgery.
One such case is a type of lower back pain, called lumbar spinal stenosis. It is sometimes treated with surgery. But physical therapy works just as well, and comes with fewer unwanted complications compared to surgery.
Stenosis means narrowing. In lumbar spinal stenosis, the space inside the lowest part of the spinal canal has narrowed. This puts pressure on the spinal cord and the nerves extending from the lumbar vertebrae (the five bones between the rib cage and the pelvis that make up the lower part of the spine).
Spinal stenosis usually results from degeneration of discs, ligaments, or any of the joints between the interlocking vertebrae that form the spine (called facet joints). This can cause a painful and potentially disabling narrowing of the spinal canal.
TYPICAL SYMPTOMS OF SPINAL STENOSIS ARE:
- pain in the groin, buttocks, and upper thigh that does not move down the leg (like the pain of sciatica)
- Pain with standing or walking that gets better if you sit or squat
- Pain that feels worse when you lean back and becomes less intense if you lean forward.
Weighing lower back pain treatment options
For most people with lumbar spinal stenosis, there are no hard and fast rules for choosing the right treatment, especially when deciding whether or not to have surgery for lower back pain.
Initially, treatment for lumbar spinal stenosis to relieve lower back pain includes what Physicians call conservative measures like physiotherapy.
Patients with low back pain are often referred for physical therapy for four weeks as an initial conservative (nonsurgical) treatment option before considering other more aggressive treatments, including back surgery. The goals of physical therapy areto build up their muscle strength and endurance, restore function, decrease pain and reduce the swelling and inflammation. Physiotherapy is therefore effective in helping heal any injured joints and muscles.
Common forms of physical therapy include:
- Passive physical therapy (modalities), which includes things done to the patient, such as heat application, ultrasound, ice packs and electrical stimulation. For example, a heating pad may be applied to warm up the muscles prior to doing exercises and stretching, and an ice pack may be used afterward to sooth the muscles and soft tissues.
- Active physical therapy, which focuses on specific exercises, myofascial release and stretching. For most low back pain treatments, active exercise is the focus of the physical therapy program.
- Lumbar Traction, Which helps relieve pressure on the nerves.
SURGERY.Of course, immediate surgery may be needed if there is so much pressure on the nerves that:-
- There is significant pain, weakness, or numbness in your leg or foot
- There is leg pain worse than back pain
- Patient has not improved with physical therapy or medication
- There is difficulty walking or standing that affects your quality of life
- Diagnostic tests (MRI, CT, myelogram) that show stenosis in the central canal or lateral recess.
Physical Therapy Before and After Back Surgery
Unfortunately the success of your surgery does not finish the moment you leave the operating theatre.There is substantial evidence supporting the benefits of physical therapy and exercise both before and after back surgery. The strength and stability that physical therapy provides can significantly shorten a patient’s recovery time after surgery. Physical therapy and exercise is considered an important part of most back pain patients’ treatments, including those undergoing non-surgical and surgical care. This is because patients with low back pain are most likely to recover when the patient is in optimum physical condition. Unless there is a contraindication for physical therapy or a patient requires emergency surgery, most patients are advised to undergo a trial of physical therapy prior to considering back surgery.
For many patients with low back pain, a good physiotherapist can diagnose the patient’s condition and rule out any serious contraindications for physical therapy, such as a fracture or tumor.
Many patients find it most helpful to be monitored by a physical therapist to ensure follow through and avoid problems. Once the initial phase of therapy is complete, those patients who continue to follow an exercise program are often the most successful in managing their low back pain.
Exercise Benefits for Low Back Pain
Lumbar spine (low back) stability is largely dependent on the supporting abdominal (stomach) and low back musculature. The abdominal muscles provide the initial stabilizing support through their ability to generate pressure within the abdomen which is exerted posteriorly on the spine, thus providing an anterior support column (from the front of the spine). The low back muscles stabilize the spine from the back and lead to posterior support. Simply stated, the bony spine and discs are surrounded by ligaments and muscles, and the stronger these specific muscles are, the less stress is placed on the discs and joints of the spine. The patients should therefore develop a strong ‘belt’ of muscles around their spine.
Active exercise plays an important role in helping reduce the patient’s pain and improving subsequent function in patients with low back pain.
An ongoing exercise program also reduces the likelihood and severity of future occurrences of low back pain.
So why are we so addicted to surgery?People like the idea that someone is going to “fix” them. We want a simple solution for what ails us, and believe surgery fits the bill in many cases. It is impressive to know that trying physiotherapy first will result in the same or better results than surgery, since the statistics show us physiotherapy works.
Sometimes surgery is important; however patients who had physiotherapy before and after surgery were better than the patients who only had surgery.
Mayfield Brain & Spine
Written By; Naomi Wausi,
C n P Health Center.