Physical Therapy is Equal to Surgery for Spinal Stenosis

Thinking of going under the knife for lumbar spinal stenosis (LSS)?

According to a new study, you can have equal success skipping surgery and going straight to physical therapy.

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"Surgery is a riskier procedure, with about a 15% complication rate, and half of those are life-threatening," said Anthony Delitto, PT, PhD, FAPTA, in a Reuters article about the study ("Physical therapy may be as good as surgery for common back problem" – April 6, 2015). "It isn't a life-risking procedure to do physical therapy," at least give it a chance. 

Delitto led the study, published in the April 2015 issue of Annals of Internal Medicine, which is the first to directly compare a single, evidence-based physical therapy regimen with decompression surgery among patients who agree to be randomly assigned to either approach. Previous studies have focused on comparing surgical and (mostly unspecified) "nonsurgical" elements, and allowed some patients to self-select their treatment groups.  Make sure your physical therapist has the right training and post graduate training in spine treatment ideally a certified manual therapist.

In an editorial that accompanies the study, it was concluded of the 2 treatment approaches, "These data suggest that patients with LSS should be offered a rigorous, standardized [physical therapy] regimen. Those who do not improve and ultimately consider surgery, should be informed that the benefits of surgery are likely to diminish over time."

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Physical Therapy: A Good First Choice Before Surgery for Rotator Cuff Tears

Why get surgery if you don’t need it? Those who experience nontraumatic rotator cuff tears, for example, would do just as well with "conservative treatment" such as physical therapy.

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That's according to a study published in Bone and Joint Journal ("Treatment of nontraumatic rotator cuff tears: A randomized controlled trial with one-year clinical results" – January 2014), which found that patients who received physical therapy alone for rotator cuff tears showed similar rates of physical improvement and patient satisfaction to those who received arthroscopic surgery or open surgical repair, combined with physical therapy.

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Physical Therapy: A Good First Choice Before Surgery for Meniscal Tears and Knee Osteoarthritis

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Before you undergo expensive or invasive surgery, try physical therapy! For many conditions, including meniscal tears and knee osteoarthritis, rotator cuff tears, spinal stenosis, and degenerative disk disease, research has shown that treatment by a specialized physical therapist has been found to be as effective as surgery. Read below…

Mild meniscal tears and moderate knee osteoarthritis send some people under the knife, when all they really need is physical therapy.

A recent study in the New England Journal of Medicine found no significant difference between individuals who received surgery and those who received physical therapy alone, thus avoiding the unnecessarily invasive procedure and related costs.

Dr. Edward Laskowski, codirector of the Mayo Clinic Sports Medicine Center, told Men's Journal that physical therapy might prove equally effective for other knee injuries, including MCL, PCL, and cartilage tears (Try Physical Therapy Before Surgery - April 29, 2013).

"If you have good range of motion, physical therapy may very well settle down the symptoms over time," Laskowski said.

 

 

Things you should know about pain

1. Pain is output from the brain. While we used to believe that pain originated within the tissues of our body, we now understand that pain does not exist until the brain determines it does. The brain uses pain to advise you of tissue that it suspects may be in danger. This process acts as a means of communication between the brain and the tissues of the body, to serve as a defense against possible injury or disease.

2. The degree of injury does not always equal the degree of pain. Research has demonstrated that we all experience pain in individual ways. While some of us experience major injuries with little pain, others experience minor injuries with a lot of pain (think of a paper cut).

3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding may not be the cause of your pain. A study performed on individuals 60 years or older who had no symptoms of low back pain found that 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc, upon diagnostic imaging.

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4. Psychological factors, such as depression and anxiety, can make your pain worse. Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed prior to a total knee replacement were related to a patient's experience of long-term pain following the operation.

5. Your social environment may influence your perception of pain. Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be generated when an individual is in an environment or situation that the brain interprets as unsafe. It is a fundamental form of self-protection.

6. Understanding pain through education may reduce your need for care. A large study conducted with military personnel demonstrated that those who were given a 45-minute educational session about pain sought care for low back pain less than their counterparts.

Ask your physical therapist about safer ways to manage pain!

Adapted from article by Joseph Brence, PT, DPT, FAAOMPT, COMT, DAC

7 Staggering Statistics About America's Opioid Epidemic

America's opioid epidemic is being felt nationwide.

Recent guidelines and consensus studies from The Centers for Disease Control and Prevention (CDC),  the American College of Physicians, and the National Academies (Health and Medicine Division) encourage health care providers to pursue safer alternatives, like physical therapy, for most non-cancer-related pain management. Choosing physical therapy is a safe and effective alternative to manage and treat pain, and can help you avoid the risks and side effects of opioids.

Statics from the CDC, the Substance Abuse and Mental Health Services Administration, the Agency for Healthcare Research and Quality, and the Henry J. Kaiser Family Foundation reveal the gravity of the problem.

1. In 2016, health care providers across the US wrote more than 214 million prescriptions for opioid pain medication, a rate that demonstrated 66.5 prescriptions per 100 people. Some counties had rates 7 times higher than that.

2. As many as 1 in 4 people who receive prescription opioids long-term for noncancer pain in primary care settings struggle with addiction.

3. From 1999 to 2015, more than 183,000 people have died in the US from overdoses related to prescription opioids.

4. While opioid abuse is down in younger Americans, it has risen among older adults. For adults aged 50 years and older, opioid abuse doubled from 1% to 2%.

5. Every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.

6. Veterans are twice as likely to die from accidental opioid overdoses as non-veterans.

7. Opioid-related hospitalizations among women in the US increased by 75% between 2005 and 2014.

Do you know someone in pain? Encourage them to talk to her or his physician or physical therapist about safe ways to manage pain.

The American Physical Therapy Association’s #ChoosePT campaign raises awareness about the risks of opioids and the safe alternative of physical therapy for chronic pain management.

References

  1. The Henry J. Kaiser Family Foundation. Published December 9, 2016. Accessed January 30, 2017.
  2. Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:514–530. Article Summary in PubMed.
  3. National Academies of Sciences, Engineering and Medicine. Accessed September 20, 2017.
  4. Centers for Disease Control and Prevention. Accessed August 23, 2017.
  5. Substance Abuse and Mental Health Services Administration. Accessed August 24, 2017.
  6. Agency for Healthcare Research and Quality. Accessed August 24, 2017.
  7. Bohnert AS, Ilgen MA, Galea S, McCarthy JF, Blow FC. Accidental poisoning mortality among patients in the Department of Veterans Affairs Health System. Med Care. 2011;49(4):393–396. Article Summary in PubMed.