Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis

Spine (Phila Pa 1976). 2009 May 1;34(10):985-9. doi: 10.1097/BRS.0b013e31819c0a6b.


Study design: Randomized single-blind controlled trial.

Objective: We aimed to compare the effects of epidural steroid injections and physical therapy program on pain and function in patients with lumbar spinal stenosis (LSS).

Summary of background data: LSS is one of the most common degenerative spinal disorders among elderly population. Initial treatment of this disabling painful condition is usually conservative including analgesics, nonsteroidal anti-inflammatory drugs, exercise, physical therapy, or epidural steroid injections. Owing to lack of sufficient data concerning the effectiveness of conservative treatment in LSS, we aimed to compare the effectiveness of epidural steroid injections and physical therapy program in a randomized controlled manner.

Methods: A total of 29 patients diagnosed as LSS were randomized into 3 groups. Group 1 (n = 10) received an inpatient physical therapy program for 2 weeks, group 2 (n = 10) received epidural steroid injections, and group 3 (n = 9) served as the controls. All study patients additionally received diclofenac and a home-based exercise program. The patients were evaluated at baseline, 2 weeks, 1 month, 3 months, and 6 months after treatment by finger floor distance, treadmill walk test, sit-to-stand test, weight carrying test, Roland Morris Disability Index, and Nottingham Health Profile.

Results: Both epidural steroid and physical therapy groups have demonstrated significant improvement in pain and functional parameters and no significant difference was noted between the 2 treatment groups. Significant improvements were also noted in the control group. Pain and functional assessment scores (RMDI, NHP physical activity subscore) were significantly more improved in group 2 compared with controls at the second week.

Conclusion: Epidural steroid injections and physical therapy both seem to be effective in LSS patients up to 6 months of follow-up.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Activities of Daily Living
  • Aged
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Diclofenac / administration & dosage
  • Exercise Therapy / methods
  • Exercise Therapy / statistics & numerical data
  • Female
  • Humans
  • Injections, Epidural / statistics & numerical data
  • Low Back Pain / etiology
  • Low Back Pain / physiopathology
  • Low Back Pain / therapy*
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / drug effects*
  • Lumbar Vertebrae / pathology
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Physical Fitness / physiology
  • Physical Therapy Modalities / statistics & numerical data*
  • Radiography
  • Single-Blind Method
  • Spinal Stenosis / complications
  • Spinal Stenosis / physiopathology
  • Spinal Stenosis / therapy*
  • Steroids / administration & dosage*
  • Treatment Outcome


  • Anti-Inflammatory Agents
  • Anti-Inflammatory Agents, Non-Steroidal
  • Steroids
  • Diclofenac