12 Tips For Runners


For your body

  1. It’s always best to go to a specialty running store and go through their fitting process. As I always tell my patients, a good running store can “get you into the stadium but they can’t find your seat.” Meaning, never go somewhere that shows you only one pair.  You should always have 3-4 different pairs to try.
  2. Proper fitting of running gear is key, make sure your shoes are the correct size. Most people’s running shoes tend to be a half to full size larger than their street shoes to account for the foot spread during your run.
  3. The shoes you wear can make a world of difference. As we age the shape and size of our feet changes.  The pressure distributing fat pads on the bottom of our feet can degrade.  Ask to try a more “cushioned” version of your go-to shoe.
  4.  For your performance
  1. Perform a Dynamic Warm-Up before every run. Every run.  Do light static stretching after your run to reduce soreness.
  2. Pay attention to your intensity/mileage. Mild-moderate muscle discomfort during runs, especially with hills, and mild-moderate delayed soreness after runs is acceptable.  Actual pain during or after runs is not.
  3. Plan for rest days and active recovery days. If you don’t give your body time to recover and are always breaking it down through running without time to recoup, it will most likely lead to injury and signs of overtraining such as general fatigue.
  4. Cross training is key. Running is amazing but adding time for yoga, swimming, cycling, and weight lifting will increase your injury resistance.  This in turn will help your performance and avoid overuse injuries such as tendonitis.
  5. When training, NEVER change more than one variable per run. Meaning, don’t add speed AND hills or Distance AND speed on the same day.

For your mind

  1. Running releases endorphins, your “feel good” chemicals, meaning you feel happier and     satisfied after runs.
  2. Think about occasionally signing up for a race to keep you motivated and focused.
  3. Joining a running club can be great to meet new friends and people to join the fun
  4. My favorite plan for running is what I call an “Adventure Run.”  Get away from your normal route and explore a new trail or route.

There are a million reasons to take up or keep running.  Some run for fun, some for fitness and others for adventure.  Remember that the slowest mile is still a mile and laps everyone on their couch!


If you have specific running questions or any aches, pains, or injuries please contact us and let us help you Advance Beyond Expectations.


Written by:  Joshua C. Anderson PTA, CKTP, CCI, Cert. ASTYM

Health Insurance:  Not The Only Option?


In the world of medicine, there is no topic more frustrating, aggravating, and confusing as health insurance.  Every insurance company has more than one plan option and this information is rarely laid out in a way that is easy to understand.  Knowing what plan you have and what is actually covered is the first step in navigating the waters of health insurance coverage.  No matter where you stand on the political, cultural, or economical spectrum, dealing with and understanding health insurance is in the your best interest.

What can you do as a patient to ensure your best shot at the fullest coverage?  The health insurance market seems to offer a greater variety of plans today than it has in the past.  While this means a little more homework on your part, it also means that you can find a plan that suits your particular needs.  The first thing you should always do is check to see if your plan covers some level of physical therapy.  If your plan doesn’t cover physical therapy or if you have a large deductible, then a therapy provider who offers a reduced cash rate for services would be a smart choice for treating pain or movement dysfunction.  You would also not need a referral script and can simply schedule your own appointment.  This literally bypasses insurance authorizations, denials, appeals, etc. and puts you in control of your own healthcare!

Of course this approach works even if you don’t have insurance.  Reduced cash rate physical therapy visits for an evaluation will undoubtedly be one of the least expensive choices you can make when it comes to receiving skilled healthcare.

If you do have usable insurance benefits, you may run into some authorization “speed bumps” in the process.  Insurance companies often ask for documentation and notes from your Physician and Physical Therapist.  Be sure to work with healthcare provider offices willing to help through the process of referrals, authorizations, appeals.  This includes them communicating with other provider offices to make sure the right paperwork has been done and sending chart notes when needed.

If you are planning on surgery and know that you will need physical therapy, check with the potential providers to find out which coverages are accepted.  This could be the difference between in-network and out-of-network coverage and result in dramatic differences in cost to you.

You pay hard-earned money for your insurance coverage.  We understand the frustrations you feel when things don’t seem right.  Take time to understand your policy and your coverage.  As always, we encourage you to talk to us and let our billing team help out.  We navigate these rough seas every day and are here to help you.

Choose Your Own Physical Therapist 

So you just received a Physical Therapy referral from your healthcare provider. There is a lot of misinformation out there on just how much you, as the patient, may dictate where and what providers you see.  A prescription for Physical Therapy is just like a prescription for anti-inflammatories, you can fill it wherever you choose.  Just because your doctor may have given you a referral for their “in house” Physical Therapy does not mean you MUST go there.  That would be like your doctor telling you that you can only fill your prescription at a CVS pharmacy.  

A lot of people also think that their insurance controls which healthcare providers they can see.  If you have an insurance plan with a low deductible and the provider is in your network, then it may make sense to go to them.  Ahh, but only if you are also getting the best care.  If you have a high deductible, have a community health plan (bronze plan, Medicaid), or are not insured then it might still make sense to see a Physical Therapy provider who can customize your treatment to meet your needs at a reduced cash rate.

 In regards to your own health and well-being, you are your own best advocate.  Don’t waste your precious time at a big box P.T. clinic that uses cookie cutter treatments and you only spend 15 minutes with a licensed provider.  Come see us at Advance Physical Therapy & Sports Rehabilitation where you know you’ll get the best care, the most cutting edge treatments and get back to doing what you love faster!  Call or message us for more information.  We want to help you advance  beyond your expectations!    

Pre-Operative Physical Therapy

Pre-operative PT
Physical Therapy is often only considered after an orthopedic surgery. However, there is mounting evidence pointing to the benefit of pre-operative Physical Therapy. In the case of an impending total knee replacement, recent studies have shown as little as 1 or 2 visits decrease post-operative care by 29%, or a cost savings to the patient of more than $1000.00 per individual. Preparing the area around the damaged tissue prior to surgical intervention leads to faster recover times, better muscle recruitment, less pain, fewer visits, and a faster return to your life. Pre-operative therapy allows us to better understand the movement patterns or injuries which produced the need for surgery in the first place.
Some orthopedic surgeries that may benefit from pre-operative Physical Therapy include total knee arthroplasty/replacement, total hip arthroplasty/replacement, anterior cruciate ligament (ACL) repair, rotator cuff repair, labral tear procedures, total shoulder arthroplasty/replacement, and any non-emergency back or neck procedures. The physiological benefits of the therapy include decreasing swelling, increasing circulation, decreasing pain, strengthening surrounding muscles, and beginning the process of tissue remodeling including neuroplasticity to improve function between the brain and the affected area.
Many times patients don’t fully understand the surgical procedure they are about to undergo. Often times visiting a surgeon is a scary proposition. You usually have to wait up to a few months and when you do have the consult, so much information is thrown at you that not all of it may stick. Patients want to know how involved the procedure will be and what to expect from the post-op recovery process. Recovering from an injury and surgery has a psychological component in addition to the obvious physical aspect. As we like to say, “there’s a brain attached to the person,” meaning, your emotional state after surgery and how you are able to process and proceed while in pain is a key to recovery that is often overlooked.
So it would be a good idea to build report with your Physical Therapist and Assistants before the surgery. If you have the opportunity to work with your providers for at least a few sessions, when you return to therapy after the procedure it will put you at ease and allow you to progress more quickly. A lot of Physical Therapy is built on trust. If you can establish trust between you and your Physical Therapist before the surgery then you should expect less stress, less pain, and a better outcome.
Physical therapy before a surgical procedure can be of great benefit to your recovery. Talk with your physician about pre-operative Physical Therapy and feel free to call or email us any questions. We are here for you, before and after your surgery. Let us help you advance beyond expectations!

Article by:
Joshua C. Anderson, PTA, CKTP, CCI, Cert. ASTYM
Edited by:
Bradford L. Bentley, DPT, OCS, CSCS, MDT, CMP, Cert. ASTYM

How to Avoid Office Injuries: The Slow Burn, Not the Fast Fall

When most people think of injuries, something traumatic or sudden comes to mind. However, in our Physical Therapy practice we see just as many patients with work related conditions as we do from construction sites. Most people do not view their work at their desk and computer as putting the same level of strain on their bodies as building something or lifting heavy objects. The truth of the matter is that while most injuries at construction sites tend to be sudden, office injuries typically arise from repetitive motions or positions sustained for many hours every workday. Repetitive strain or cumulative micro-trauma can develop over long periods of time, often with a gradual onset. This can make tracking down the exact mechanism of the injury a bit more difficult. We specialize in getting to the root of the problem, not just chasing symptoms. Many times office patients present with pain in their wrists or forearms. While it is necessary to examine the area of symptoms, it is even more important to check and see if this is actually coming from the neck/cervical spine. The same goes for sciatica like symptoms into the leg which people often get from prolonged sitting while at work. These symptoms can be produced by the low back/lumbar spine. Looking at a patient’s symptom presentation in a more holistic manner guides treatment for these conditions and allows for the best outcomes. Here are some common office injuries and tips on how you can keep yourself healthy and happy:
If your posture is bad, there is a likelihood of developing multiple sources of pain. Your neck may begin to get sore. You may feel tightness in your shoulders and pain in your elbows and wrists. You could experience sciatica and even numbness in your feet and toes. These are all signs and symptoms of issues that when addressed with your Physical Therapist may resolve quickly. However, the longer a pain cycle continues the longer it takes to break that cycle and return to a pain-free life. Pain in your neck and shoulders will likely either start due to, or will result in muscle tension. When muscles are strained over time, they don’t have the opportunity to relax, and will eventually become tense and painful as a response. As muscles tense up they don’t get the proper blood flow and lymphatic drainage which then makes them even more likely to become painful! These conditions can result in tension headaches and spasms which can lower productivity. If your neck and shoulders begin to hurt, take a moment and sit up tall with your shoulders relaxed down and gently pulled back.
One of the best ways to keep your posture correct is to ensure that your elbows, hips, knees, and ankles are at 90° angles. Your feet should be resting on the ground or on a footrest. If you are a bit vertically impaired in height, your feet may dangle when the rest of you is lined up with your keyboard and desk at the right height. So having a footrest is an excellent way of maintaining good posture and taking pressure off your lower body while working at your desk. Consider adding a keyboard tray if needed in order to modify your workstation so that you can be in the optimal 90 degree angle posture. Be sure the keyboard tray also has a spot for the mouse at the same level as well. Reaching out to use the mouse can lead to repetitive strain and injury so keep your elbow in close to that 90 degree angle when using it. This may take some getting used-to but will quickly be added as one of your many good habits. If you have the option at work to have an ergonomic assessment for your workstation, take advantage of it.
Many office injuries and conditions are avoidable by paying attention to what your body is telling you, as well as learning the proper relief techniques to use throughout your day. If you feel uncomfortable or out of position, you probably are! You should re-evaluate your working environment and position. Take a picture or a video of how you work and bring it in with you. We will give you some creative ideas to help you be comfortable and productive. Use time in your physical therapy sessions to practice and get comfortable with your new routine. You’ll likely end up in a better position both physically and mentally which will go a long way towards a long and happy life. We look forward to helping you relieve your pain and improve your life.

Joshua C. Anderson, PTA, CKTP, CCI, Cert. ASTYM
Brad L. Bentley, DPT, OCS, CSCS, Cert. MDT, CMP, Cert. ASTYM
Advance Physical Therapy & Sports Rehabilitation, Inc.
Burien, WA

Physical Therapy as a First Line Treatment of Opioid Addiction and Chronic Pain

Physical Therapy as a First Line Treatment of Opioid Addiction and Chronic Pain
It is estimated that 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin [1]. That number is on the rise. Where do people get the drugs? For 1 in 5 people it is prescription medications which are prescribed by a medical provider for valid reasons. For over 54% of people, the drugs are given to them by friends or relatives. This means they were not prescribed these medications and are highly likely to lack education about what these drugs will do to their system. Prescription opiates are powerful drugs that can help alleviate the brain’s perception of pain. But they are also the same drugs that come from the same plants that used to create heroine, perhaps the most addictive substance on the planet.
The Centers for Disease Control and Prevention (CDC) issued new guidelines in March 2016 for the prescription of opioids. It states they are appropriate for certain cases such as cancer treatment, palliative and end-of-life care, and in acute care situations if properly dosed. The CDC recommendation also includes the use of non-opioid interventions including Physical Therapy.
Every day our Physical Therapy clinic works with people who are on strong pain medications after an injury, accident, or surgery. In the short term, this is fine, but we sometimes see people who have become dependent on and even addicted to those meds. This can happen for several possible reasons. Sometimes it’s associated with the depression that comes after an injury, especially an auto or work injury. Sometimes it’s because of a probable genetic predisposition. Other times it is because their medical provider may have prescribed too much medication. Whatever the case may be, whenever there is a significant episode of pain and opioids are prescribed there is a chance for possible dependency.
Prescription medication addiction has finally started to get some considerable attention. In March 2016 and May 2016 the New York Times ran editorial pieces about the negative impact of prescription medication on society. Recognizing that the opioid epidemic is a leading cause of death in the United States, Congress and local governments are starting to take action. Massachusetts has passed a new law regulating the duration someone can be prescribed an opiate. This may help prevent some people from dependency but does not offer an alternative for those you do become dependent. One possible course of action is the use of non-pharmacological Physical Therapy treatments designed to desensitize the nervous system, literally modifying the neural tissues of the brain and peripheral nervous system. Desensitization techniques are an important first step toward reducing pain and dependency on prescription meds, but we often also find specific joint or muscle lesions which when treated provide additional relief and can restore normal function. The next phase of Physical Therapy would be to gradually and carefully reintegrate normal movement patterns once the pain levels have reduced. Based on the experience in our practice, about 1 in 3 chronic pain patients are able to achieve full resolution of their symptoms. Another 1 in 3 have a significant reduction of symptoms and improvement in function. This is consistent with the CDC recommendation to consider the use of Physical Therapy to manage chronic pain and reduce or eliminate opioid dependence.

Headaches can be a real pain in the neck

Physical Therapy and Headaches

For millions of Americans, headaches and migraines are a recurring fact of life.  But they don’t have to be and Advance Physical Therapy is here to help.  Knowing what type of headache you suffer from and what is the cause of it will direct your therapy.   Hint: it’s not always in the head!  The main types of headaches that affect most Americans are cervicogenic, tension, and migraine.  Each of these have different symptoms, origins, and therapy options.

Cervicogenic headaches are actually generated by a dysfunction of the neck and since the nerves from the upper neck share the same transmission pathways with some of the nerves from the head, the brain will sometimes feel the pain in the head or facial area.  They are one of the more common types of headaches and are often misdiagnosed as “tension” or “migraine” headaches. These may occur due to improper posture, sleeping in a bad position, a car accident or other activity that leads to an imbalance in your cervical spinal joints and musculature.  This imbalance may be the cause of your headaches and could account for why medication only provides temporary relief or only mild relief of symptoms.  Sitting at a desk working for hours on a computer can lead to cervicogenic headaches from the muscles becoming overworked and eventually the upper cervical spinal joints becoming stiff.  There may be concurrent neck, shoulder area, or arm symptoms that go along with the headaches.  A classic presentation for this type of headache is the pain starting in the base of the skull at the upper neck and moving to the front of the forehead.  Resolution or modulation of the headache during a physical therapy session in which the cervical spine is evaluated and treated confirms a cervicogenic component to the headache.

Tension headaches are another common form of headaches and can have a negative impact on daily function, work productivity, and even mood.  One study (found here) reported that people who suffer from tension headaches miss 9 days of work per year on average because the pain becomes so debilitating.  The cause of these headaches may be difficult to diagnose, but with the right questions and evaluation techniques it becomes easier to treat and manage.  Probable causes are poor posture, emotional stress, overuse strain, squinting due to poor vision or use of bifocals, and jaw muscle dysfunction.  As with cervicogenic headaches, you can’t medicate your way out of this one.  A comprehensive physical therapy approach that evaluates and treats the affected areas coupled with patient education on how to improve posture, modify work stations if possible, and change habits will often provide resolution or long term relief of tension headaches.

Migraine headaches can be the worst of all.  Symptoms include changes in vision, extreme sensitivity to noise, light sensitivity, nausea, vomiting, and severe pain.  If you have never suffered from a true migraine, count yourself lucky.  Migraines are not just “really bad tension headaches” they are unto themselves their own class of pain.  Migraines are often produced by vascular dysfunction which can also cause muscle tension around the head/eyes compounding the debilitating effects.  These types of headaches should respond to medications such as triptans.  Patients who do not respond as well to medications may benefit from a physical therapy evaluation to determine if the headaches have a significant mechanical component such as muscle tension which could be treated by the physical therapist.  Many times we see patients for an unrelated issue and they state having migraine-like symptoms, but after discussing further and evaluating them it is evident that they are in fact moderate to severe cervicogenic or tension headaches, not a true chemically-mediated migraine.  For these patients we can usually help them find relief within a few visits.  Patient education and the right treatment is the key to decreasing headaches and achieving long-term resolution.  If you do have a full migraine brewing, finding a calm dark place, use ice or a cold pack for up to 30 minutes, and lightly massaging the head and neck which may reduce the severity of a migraine.

Determining the type of headache you suffer from is an important step to finding relief.  Those patients who are suspected of having a non-mechanical origin for the headache symptoms most likely would benefit from a consult with a medical doctor for further diagnostics.  Headaches with a sudden severe onset and/or with changes in vision, speech, cognition, hearing, gait, or balance may represent an emergency medical condition and the patient should call 911 immediately for medical assistance.  Chronic, episodic, or recent onset mild-moderate headaches can be evaluated by a doctor of physical therapy with most being treatable in the clinic and through the use of patient education and an individualized home program.  Treatments include the use of joint mobilizations, muscle and fascia release techniques, instrument assisted soft tissue mobilization, posture correction, ergonomic assessment, neuromuscular re-education, pain relieving modalities such as electric stimulation and therapeutic ultrasound, as well as stretching and strengthening exercises.  If you suffer from headaches, come see us and we will perform a thorough clinical evaluation and recommend the right kind of treatment for your specific type of headache.  Determining what is actually causing your headaches and providing long-term relief is the focal point of our sessions.  Most patients achieve resolution of symptoms within 1-2 months after starting a comprehensive course of physical therapy.  Call, e-mail, or post any questions you have and we will be happy to help!


Advance Physical Therapy & Sports Rehabilitation, Inc.

Advance Beyond Expectation[i]


Joshua C. Anderson, PTA, CKTP, CCI, Cert. ASTYM

Brad Bentley, DPT, OCS, CSCS, Cert. MDT, CMP, Cert. ASTYM


[i] Advance Physical Therapy August 2016

My background in running and how you’re already a “runner”

My background in running and how you’re already a “runner”:

By Joshua C. Anderson, PTA, CKTP, CCI, Cert. ASTYM


As a recreational athlete, where do you go for tips, tricks and the most up to date information?  Your answer is, you’re already here.  I will strive to provide you the most up to date information available on a wide range of topics.  In my first post, I am going to be focusing on a topic that is very popular this time of year, running.   A little background on me, I used to HATE running.  When I played baseball, home runs were my favorite because I didn’t have to run.  It wasn’t until I put on, what I called my “college fluff” and had gotten up to 221 pounds that I decided enough was enough and started running.  When I first started, I could literally only run around a city block, then I would have to walk.  At my peak of running and racing I was a 40+ mile a week runner, and during my “season” I would run between one and two races a month of varying distances.  After finding my love of running, that passion flowed into my profession as a Physical Therapist Assistant and I have taken dozens of hours of continuing education in running analysis and training.  As well as countless of hours reading running books, articles and studies.

When I first began running, I was under the impression that one day, I would be a “runner,” someone who could run like the wind and be one with the road and trail from the first step.  I thought, when my fitness got high enough running would be an effortless symphony of muscles, breathing and zen-like moments.  You’re probably wondering why I am telling you this, why not just list great tips to help you run?  I wanted to give insight into the fact that you’re not alone, running is daunting and takes time to develop a love of it.  When I was at my peak of 40+ miles a week I realized one universal truth in running, THE FIRST MILE SUCKS!  After the first mile is where you find the love.  My realization of this helped me become a better runner and allowed me to stick to my training on days I didn’t feel like running.  In the first mile all of your body systems are transitioning from conservation mode to exertion mode.  For some people it’ll only take a half of a mile, some it might take two but once you get through that initial fight you will find your stride and your step.  The point of this is to realize you’re not alone in your struggle thinking that.  The person who is behind you or the gal who passed you 3 times on your one lap of Green Lake all had the same experience. The first mile sucked.  As time the miles pass and your training progresses, your mental stamina will improve along with your physical stamina.

Now that we have established that the first mile will suck, where to do you go now.  Well, here are my 7 running tips to get you going and keep you going.

  1. SHOES: Finding the right shoe for you is first and foremost. The best way to accomplish this is by going to a running specialty store to be analyzed and fitted.  No one can tell you, “this is the shoe for you!”  However, as I like to tell my patients they can get you into the section of the stadium, but only you can find your seat.  What I mean by this is to know that the shoe specialist can only get you near your perfect fit, not find.
  2. TRAINING PLAN: Just going out running here and there will never get you to your goal.  It doesn’t matter if your goal is to lose weight, become faster or just become happier with the amazing person that is you.  Without a program and plan you’ll eventually fizzle out.  The best way to begin running is to carve out 3-4 days a week, with at least one day of rest in between and stick with that.  Consistency is the key to reaching your goals.
  3. HYDRATION: Pre-hydrate to run better, try for 16-20oz prior to any run under 8miles. In a study in the Journal of Athletic Training, the runners who started a 12K race dehydrated on an 80 degree day finished two and a half minutes slower compared to when they ran it fully hydrated. Try to get a sip or two of water every 15 minutes
  4. NUTRITION: Realize your body is a machine. Yes, your body is the greatest machine in the world.  Food is fuel.  Depending on your overall goal, fitness vs. weight loss, your requirements will be different.
  5. WARM UP/COOL DOWN: This is very important, and quite often the most overlooked aspect for runners.  You want to dynamically warm up prior to the run and lightly statically stretch after.  Some runners find foam rolling helpful for recovery.
  6. LISTEN TO YOUR BODY: Running is truly a mental chess match with your body. You have to get to know your body again and understand what discomfort is okay and what is not.  As you run more and more you’ll discover throughout any given run that you’ll have little tweaks and irritations.  However, by changing either your cadence or foot strike they should subside.  If they do not, take time to walk/rest and if need be stop for the day.  If rest doesn’t solve the problem, call us at Advance Physical Therapy to help fix it and get back out there!
  7. CROSS TRAIN: Most runners think to become a better runner they only need to keep running.  This is very untrue.  Cross training means anything other than running; Yoga, body weight workouts, gym time or stretching at home.  You don’t need a fancy gym for push-ups, planks and side planks, just a little floor space.

I hope this quick overview will help get you started on your path to becoming happier, healthier and finding your love of running. It doesn’t matter if you run a 5 minute mile, or a 20 minute mile, you are already a “runner.”  Each of these tips could be an article all unto themselves, let me know on our Facebook page what you’re most interested in and what topics you want to hear about.  I’ll bring them into my series of blogs, videos and informational tips!



“It is not the mountain we conquer, but ourselves” Sir Edmond Hillary.


Joshua C. Anderson, PTA, CKTP, CCI, Cert. ASTYM

Advance Physical Therapy and Sports Rehabilitation

Burien, Washington

April 4, 2016

Seasons Greetings from Advance Physical Therapy

Clinic Tree

Seasons greetings and happy holidays from Advance Physical Therapy.  As this joyous time of year quickly approaches we wanted to reach out and give thanks to you, our patients.  With so many options for care in our world, it means the world to us that you choose Advance Physical Therapy.  We are currently running a toy drop off location for the Marine Corps Toys For Tots toy drive.  Please help us in helping our community by bringing in any new, unwrapped toys to our clinic and dropping them in our Toys for Tots box.

Also, remember in the holiday season of cooking, cleaning and decorating to stretch, breathe and enjoy the amazing things in your life.


Happy Holidays and good tidings to you and yours.

Physical Therapy as good as Surgery and less risky

Physical therapy as good as surgery and less risky for one type of lower back pain

Howard LeWine, M.D.

POSTED APRIL 09, 2015, 2:30 PM

Howard LeWine, M.D., Chief Medical Editor, Internet Publishing, Harvard Health Publications

One type of lower back pain, called lumbar spinal stenosis, is sometimes treated with surgery. But physical therapy works just as well, and comes with fewer unwanted complications — some of them life-threatening — than surgery, according to a study published yesterday in Annals of Internal Medicine.

Stenosis means narrowing. In lumbar spinal stenosis, the space inside the lowest part of the spinal canal has narrowed. This puts pressure on the spinal cord and the nerves extending from the lumbar vertebrae, the five bones between the rib cage and the pelvis that make up the lower part of the spine.

Spinal stenosis usually results from degeneration of discs, ligaments, or any of the joints between the interlocking vertebrae that form the spine (called facet joints). This can cause a painful and potentially disabling narrowing of the spinal canal.

Typical symptoms of spinal stenosis are:

  • pain in the groin, buttocks, and upper thigh that does not move down the leg (like the pain of sciatica)
  • pain with standing or walking that gets better if you sit or squat
  • pain that feels worse when you lean back and becomes less intense if you lean forward.

An operation known as decompression or laminectomy is sometimes done to ease the pain of lumbar spinal stenosis. It removes structures that are pressing on the nerves and contributing to symptoms. But physical therapy can also help ease this type of lower back pain.

To compare these two treatments, researchers recruited 169 Pittsburgh-area men and women with lumbar spinal stenosis. All agreed to have surgery, and understood that half would get surgery right away, while half would initially participate in a specifically designed physical therapy program.

Participants in both groups saw benefits as early as 10 weeks after surgery or beginning physical therapy. Their pain continued to decline over four months, while their physical function continued to improve. Two years later, there was no difference in pain or physical function between the surgery and physical therapy groups.

Twenty-two participants in the surgery group (25%) experienced surgery-related complications like repeat surgery or a surgery-related infection, while eight of those in the physical therapy group (10%) reported worsening symptoms as a complication.

Weighing treatment options

For most people with lumbar spinal stenosis, there are no hard and fast rules for choosing the right treatment, especially when deciding whether to have back surgery. The results of this study offer some guidance.

Initially, treatment for lumbar spinal stenosis includes what doctors call conservative measures. These include pain relievers, anti-inflammatory medicines, and sometimes corticosteroid spinal injections. If symptoms don’t improve, surgery is often the next step. That makes sense based on the results of earlier studies.

The results of the new Annals study suggest that people with lumbar spinal stenosis should first try a well-designed physical therapy program, says Dr. Jeffrey N. Katz, professor of medicine at Harvard Medical School, in an editorial commenting on the study results. If physical therapy doesn’t work as well as expected, the decision of when to have surgery should be driven by the person’s preferences, says Dr. Katz, who is also the faculty editor of Back Pain: Finding solutions for your aching back, a Special Health Report from Harvard Health Publications.

Of course, immediate surgery may be needed if there is so much pressure on the nerves that

  • muscles around the pelvis or upper legs become weak
  • it becomes difficult to control bladder or bowel function
  • pain can’t be controlled with strong medicine.

When surgery is needed, the operation performed is usually a laminectomy. The surgeon removes the bony plate (lamina) on the back of the vertebra where the stenosis is located. This opens up more space for the spinal nerves. Laminectomy can be performed through a tiny incision and guided by video from a miniature camera.

Sometimes there is so much narrowing that a simple laminectomy won’t do the job. In such cases, a laminectomy with spinal fusion may be needed. In addition to removing one or more bony plates, the surgeon removes discs and other tissues, then stabilizes the spine with cement or hardware.

Laminectomy alone is just as effective as spinal fusion, and so is the preferred option when possible.