Treatment

Despite a long search, no guideline for the treatment of spinal stenosis could be found. Nevertheless, the Orthopaedic Section of the American Physical Therapy Association (APTA) created guidelines with several recommendations for low back pain in general, taking into consideration only the best available evidence. Among others, the guidelines provide treatment options for “LPB subgroup responder categories”, including spinal stenosis. The following section is based on the treatment recommendations of the APTA (2012) for spinal stenosis only.

  • Flexion exercises: Combined with other interventions (manual therapy, strengthening exercises, nerve mobilization procedures, progressive walking), flexion exercises can be used to reduce pain and disability in older patients (weak evidence)
  • Manual therapy: For back-related lower extremity pain (which can be the case in spinal stenosis) manipulative procedures reduces pain and disability, while improving spine (and hip) mobility (strong evidence)

Duong et al (2010) concluded in their review that “published RCTs can provide only limited evidence to formulate recommendations pertaining to the nonsurgical treatment of LSS”. They state that concerning physiotherapy, the evidence is really limited but suggest minimal benefits for passive physiotherapy. The effects of active physiotherapy remains unknown (Duong et al. 2010).

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Patient History

Assessment

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