Physical Therapy Interventions for lumbar spinal stenosis (LSS)

Physical therapy (PT) is often prescribed for patients with lumbar spinal stenosis (LSS); although not much is known regarding its effectiveness. The authors conducted this study to systematically review randomized controlled trials (RCT), controlled trials and cohort studies that evaluated the effectiveness of PT for LSS. They used electronic databases to January 2012 to search for the studies used. The inclusion criteria were: clinical diagnosis of LSS with confirmatory imaging, evaluation of PT treatment, presence of a comparison group and outcomes of pain, disability, function or quality of life. Outcomes were extracted and when possible pooled using RevMan 5. Ten studies were included: 5 RCTs, 2 controlled trials, 2 mixed design and 1 longitudinal cohort study. Pooled effects of 2 studies uncovered that the addition of a PT modality to exercise had no statistically significant effect on outcome. Pooled effects results of RCTs evaluating surgery versus PT showed that surgery was better than physical therapy for pain and disability at long term (2 years) only. Other results suggested that exercise is significantly better than no exercise, that cycling and body weight supported treadmill walking have comparable effects, and that corsets are better than no corsets. The limitations facing their review include the low quality and small number of studies, as well as the heterogeneity in outcomes and treatments.

The authors could not draw conclusions on which PT treatment is superior for LSS. There was low quality evidence suggesting that modalities have no additional effect to exercise and that surgery leads to better long term (2 years) outcomes for pain and disability, but not walking distance, than PT in individuals with LSS.