Lumbar spinal stenosis: Can positional therapy alleviate pain?

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Applied Evidence

Lumbar spinal stenosis: Can positional therapy alleviate pain?

J Fam Pract. 2008 April;57(4):257-260

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References

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the lack of any comparison group
improvements in ambulation are based on subjective criteria
findings can be generalized only to older patients potentially eligible for surgery,¹¹ those who have not benefited from surgery, or those who are undergoing medical therapies recommended by the North American Spine Society⁴
patients seen in a podiatry office who present for lower extremity symptoms of spinal stenosis may differ from those seen in a family practitioner’s office who present with low back pain.

Nonetheless, this conservative strategy may be applicable to the evaluation and management of lower extremity symptoms of spinal stenosis regardless of presenting symptoms or source of medical care.

FAST TRACK

This conservative strategy may increase ambulation and decrease pain, with minimal risks and costs

Walking limitations and lower extremity pain caused by spinal stenosis are physically and psychologically disabling. Relief can dramatically improve a person’s quality of life. Improved ambulation may also aid in the management of concurrent medical conditions, such as diabetes and cardiovascular disease.

Our hypothesis requires direct testing in randomized trials of sufficient size and duration. Such trials should include longer term and more objective clinical endpoints, such as quality of life measures, complications due to immobility and need for drugs, physical therapy, procedures such as epidural injections, or spinal surgery. Validation of this hypothesis would substantially reduce morbidity and costs, as well as increase the quality of life of patients with lower extremity symptoms of lumbar spinal stenosis. Until such studies are conducted, this conservative strategy may increase ambulation and decrease pain over the short term, with minimal risks and costs. It may also be helpful for those with contraindications (or aversions) to surgery or epidural injections or those who have found these approaches ineffective.

Correspondence
Charles H. Hennekens, MD, Sir Richard Doll Research Professor, College of Biomedical Science, Department of Clinical Science and Medical Education and Center of Excellence, Florida Atlantic University, Building 10–Administration, Division of Research, Room 244D, 777 Glades Road, Boca Raton, FL 33432; chenneke@fau.edu

Lumbar spinal stenosis: Can positional therapy alleviate pain?

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