What kind of physiotherapy (PT) program works best for lumbar spinal stenosis (LSS)? That's the topic of this study by a group of PTs from around the United States. Spinal stenosis is a narrowing of the spinal canal where the spinal cord is located. Anything that narrows the spinal canal can also put pressure on the spinal nerves as they exit the canal through special holes called the neural foraminae.

Physiotherapy treatment is designed to relax the soft tissues around the openings and to improve the position of the spinal column, thereby taking pressure off the nerves.

In this study, patients with LSS were divided into two separate treatment groups. The first group was treated with flexion exercises, a walking program, and ultrasound (a form of deep heat).

The second group received manual therapy (stretching, joint manipulation, strengthening), flexion exercises, and a walking program. The walking program for the second group was with a body-weight supported (BWS) treadmill. The BWS is a system of cables and trunk harness that unloads weight from the patient while walking.

Both exercise programs lasted for six weeks (twice each week). Results were measured by levels of pain, satisfaction, and function. Patients in both groups were followed for at least one year. Patients in both groups benefitted from nonsurgical care. Patients in the manual physiotherapy, flexion exercises, and BWS walking had the best results.

The authors suggest ongoing studies to compare surgical versus nonsurgical results in LSS patients. Cost, pain reduction, and changes in function should be compared for different kinds of conservative care as well.

Julie M. Whitman, DSc,PT, et al. A Comparison Between Two Physiotherapy Treatment Programs for Patients with Lumbar Spinal Stenosis. In Spine. October 15, 2006. Vol. 31. No. 22. Pp. 2541-2549.