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Why You Should Try Physical Therapy Before Back Surgery

June 9, 2017

When you guys hear the term physical therapy, what comes to mind first? Please feel free to say it out loud (we can't hear you — or can we? — don't worry, we really can't).

According to Google's definition (you know you use it too), physical therapy is the treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery.

The main goal of physical therapy is to educate patients on the mathematics of stretching and strengthening, which in turn, aids in managing your chronic back pain — eventually accelerating your tissue healing — leading to recovery, but is physical therapy as good as surgery?

Let's examine.

Dr. Anthony Delitto and his colleagues set out to see if they could physically (pun intended) examine the benefits of physical therapy and if it could work as well as at easing symptoms versus an operation.

"Surgery is a riskier procedure, with about a 15 percent complication rate, and half of those are life-threatening," reported Delitto, chairman of physical therapy in the School of Health and Rehabilitation Sciences at the University of Pittsburgh. "It isn't a life-risking procedure to do physical therapy."

Lumbar spinal stenosis, a compression of open spaces in the lower spinal column, can lead to pinched nerves, tingling, weakness and numbness in the back and the lower extremities. Can you say OUCH?!

This condition becomes more common as you age, and an estimated 2.4 million Americans may have it by 2021, according to the American Academy of Orthopedic Surgeons.

Over a five-year period, Dr. Anthony Delitto and his colleagues asked a total of 481 patients to participate. These patients previously consented to a form of back or spinal surgery. The testers asked the patients if they would be willing to join a study where they would be randomly chosen to proceed with the operation or receive physical therapy. (Dr. Delitto and his colleagues would choose for them if they would be the surgery group or the physical therapy one.)

Most declined not wanting to be assigned to the nonsurgical group, but 169 patients did agree to participate.

The result: 87 patients had surgery and 82 were assigned physical therapy.

The study's initiation had patients who were at least 50 years old. They had to be able to walk at least a quarter-mile without difficulty and have no underlying medical conditions — such as dementia, severe vascular disease, cancer, or a prior heart attack — apart from their chronic back pain.

Most of them were only mildly active and were typically obese.

Patients in the surgery group were slightly younger, approximately 67 on average, compared with an average age of about 70 for patients receiving physical therapy.

The physical therapy regimen consisted of twice weekly rehabilitation sessions for six weeks. Participants were allowed to opt out of this regimen in favor of surgery at any point during the study. In a two-year follow-up period, 47 to 57 percent of the participants did just that.

No matter what group they started in, participants achieved similar reduction of pain and other symptoms at two years in.

"The study demonstrates that both surgery and physical therapy are reasonable choices; the person who goes down either path ends up in the same place a year or two later," reported Dr. Jeffrey Katz, director of the Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women's Hospital in Boston, Massachusetts.

Katz wrote an editorial accompanying the study in Annals of Internal Medicine — an academic medical journal published by the American College of Physicians (ACP) and noted that there's still a role for surgery in treating lumbar spinal stenosis. But there's no harm in trying physical therapy first, he added.

Because so many eligible patients opted to not participate in the study, and those who were randomly selected for physical therapy ended up abandoned it to obtain surgery, more research is still needed in a larger sense in order to get a complete picture of the relative benefits for each option, hypothesized Dr. James Weinstein, chief executive of Dartmouth-Hitchcock Medical Center — New Hampshire's only academic health system, who has no medical ties to the study in question.

Still, "surgery should be the last option," added Weinstein, lead author of a 2008 paper in the New England Journal of Medicine that found surgery more effective at curbing symptoms than nonsurgical alternatives.

Despite the small size of the current study and the number of patients who stopped physical therapy early, it still makes sense to try it out before considering going under the knife, asserted Dr. Richard Deyo, a researcher in back pain at Oregon Health and Science University, in an email to Reuters Health.

"If they elect to have surgery at a later time, the results appear to be as good as for patients who choose earlier surgery," Deyo disclosed, who wasn't involved in the study either. "Some patients are inclined toward surgery because the high-tech approach seems more definitive, attractive, and quicker. However, patients should realize they are likely to need physical therapy even after successful surgery, and recovery can be slow."

All in all, it's about personal preference and at the determination by your medical team. Deyo does bring up a great point to close this story. The fact that after most surgeries, you will need to undergo some form of physical therapy, it may be a good idea to start it sooner rather than later.

As the lyrics to the band Creed's song “Are You Ready” says, “Are you ready? For what's to come? Oh, I said are you ready, are you ready? Ten, nine, eight, seven, six, five, four, three, two, one. Countdown to the change in life that's soon to come.”

Initiating any form of physical therapy prior to any form of surgery will certainly make your recovery that much smoother because you will be ready for what is to come.
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