Back Pain: Can it be treated with Physical Therapy?

by Christina Lasich, MD Health Professional

Even back pain caused by a spondylolisthesis and lumbar stenosis can be treated with physical therapy. Because spondylolisthesis and lumbar stenosis can cause nerve damage, surgery is the natural knee-jerk treatment option that people think about. Of course, surgical spinal fusion is the best option to stabilize the spine if the nerves are severely damaged and in jeopardy of further damage. But, what about a low grade spondylolisthesis and mild stenosis? Can surgery be avoided? Absolutely, the body is able to compensate for the misalignment of the passive, spinal structures with optimal functioning of the active, stabilizing muscles. That's right; bones, ligaments, and cartilage are passive structures that sometimes fail; thus, the muscles and nerves which actively control the muscles can compensate for the problem. The spine has two systems, the passive and the active system, which can balance each other out. This redundancy allows for one system to compensate for problems in the other system.
The human body is full of redundancy and safety nets. Physical therapy and rehabilitation seeks to restore balance through this checks-and-balance system.

Steve recently learned that he has a spondylolisthesis. Instead of surgery, his doctor said that he should try rehabilitating his spine through physical therapy. Steve used to be very athletic, but work leaves him too tired to have any type of exercise program. However, Steve knows that if he does not get this back pain under control, he will not be able to work. He agrees to invest some time into a physical therapy program.

In order to activate and strengthen muscles, one needs an exercise program. The best exercise program is one that you are going to do every day. Learning an exercise program is done in many types of settings like group classes, personal trainers, videos, or a gym. The problem with these self-help programs is that they are designed for uninjured people. On the other hand, physical therapists specialize in rehabilitating those with injuries. One-on-one, individualized care is best rehabilitation plan for treating a sensitive spine injury. However, not all physical therapists are created equally. Picking the right physical therapist is extremely important. The best physical therapists have been through residency training programs and are fellows of the AAOMPT . The worst physical therapists primarily rely on physical therapy aids (poorly skilled clinic helpers), ultrasound and massage. Only the best should treat a sensitive back from stenosis and spondylolisthesis, otherwise physical therapy can be a waste of time.

Unfortunately, physical therapy can also be prohibitively expensive. In these cases, surgery can still be avoided by doing some homework-a home exercise program. If you find a doctor who understands basic physical therapy principals, that doctor should be able to guide a home exercise program. Furthermore, there are also some books that are great resources for rehabilitating a spine.
For someone with lumbar stenosis or spondylolisthesis, the best book is called "Spinal Stabilization" by Rick Jemmett, PT (available at The exercises in this book start at the most basic level like standing on one leg and progress to Olympic level exercises like kneeling on an exercise ball. Each exercise provides a basic building block that improves muscle strength and endurance. With a highly, functioning muscle system, the spine can benefit from the built-in back brace that these muscles can provide. But, none of this rehabilitation training will work without a time investment.

The body does not change overnight. Marathon runners do not start off running marathons. Professional athletes do not start out with professional-level talents. Every athlete has devoted serious amounts of time to training. You may not have aspirations of running marathons and playing professional sports; however, "Life is an athletic event that you need to train for" says Jack LaLanne . He is so right Rehabilitating your back is your Olympic event.

After the first three months of physical therapy, Steve is finally gaining control over his back pain. He has learned to activate and use his abdominal muscles to stabilize his spine throughout the day. He exercises at least twice daily. His pain is less intense. The flare-ups are less frequent and do not last as long. Overall, he is starting to feel hopeful. But, he knows that this exercise program is really just the beginning to a lifelong commitment to staying fit.


The best exercise program is the one you are going to do every day. When you are just starting a training program, once per day is not enough. Building strength requires exercise throughout the day. Once the desired level of fitness is obtained, maintaining strength can be a once per day endeavor. However, the work does not stop here. Maintaining strength requires a lifelong commitment. This investment must be cultivated and maintained. Only then can the benefits of physical therapy be realized. Ultimately, spine rehabilitation does work. Exercise is an underutilized form of treatment for back pain according to many experts. The results from exercise can be as good (or better) as those gained from surgery. In fact, when comparing those people with spinal fusions to those who went through a spinal rehabilitation program, both groups of people are doing equally well five years after a low back injury. Surgery may give some immediate benefits over a physical therapy program, especially in the face of serious spinal problems. However, the long term results of surgery are usually no better than a good rehabilitation approach in most mild to moderate cases of back pain. Even those who have back pain due to a spondylolisthesis and lumbar stenosis can have a very active and happy life as long as there is a commitment to staying very fit-survival of the fittest.

For more information about exercising with low back pain and to view my video "Dr. Lasich Exercises with Dogs", please visit my blog at .

Christina Lasich, MD
Meet Our Writer
Christina Lasich, MD

Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.