Your spine specialist may refer you to a physical therapy or rehabiliation to help improve your ability to function despite painful cervical (neck) or lumbar (low back) spinal stenosis. It is common for patients to undergo an organized program of physical therapy during nonoperative treatment. Physical therapy, or a rehabilitation program may also be prescribed by your spine surgeon as an important part of your surgical aftercare.

Physical therapy or spinal rehabiliation includes two types of treatments: passive and active.

• Passive therapy are treatments the physical therapist administers
• Active therapy includes stretches and exercises.

Passive treatments may include:

Deep tissue massage: This hands-on technique targets acute and chronic muscle tension. The therapist uses direct pressure and friction to release tightness and tension in the soft tissues (ligaments, tendons, muscles) of the neck or back. This type of massage can help reduce inflammation and pain.

Hot and cold therapies:

• Application of heat draws more blood to the targeted area of the spine. Increased blood flow delivers more oxygen and nutrients, and carries away cellular debris. This is essential to healing and can help reduce inflammation, muscle spasms, and pain.
• Cold therapies are applied to areas that are visibly swollen or internally inflammed, and work quickly to reduce symptoms.
• Hot and cold therapies may be applied alternatively to maximize benefits.

Transcutaneous electrical nerve stimulation (TENS): In the physical therapy setting, TENS is a stand-alone machine connected to leads that attach by means of patches to the neck or back. The amount of stimulation delivered is adjustable. This therapy delivers a mild and soothing electrical current that may increase your body's production of endorphins; the body's natural pain relievers. Small TENS units are available for home use. However, whether large or small, a TENS unit can be a helpful therapy. But keep in mind that TENS is not recommended for chronic pain. In a study from the American Academy of Neurology found that TENS units are not effective at treating chronic low back pain.¹

Ultrasound: Ultrasound works by delivering sound waves deep beneath the skin. The therapist applies a gel to enable the ultrasound wand to move friction-free over the painful area of the neck or back. Ultrasound creates a gentle heat that increases blood circulation and can help reduce muscle cramping or spasms, swelling, stiffness, and pain. 

Active Therapy
Your physical therapist understands that no two patients with cervical (neck) or lumbar (low back) spinal stenosis are the same. Each patient comes to PT with different abilities and needs. Some patients are new to active therapy, or haven't been able to exercise in a long time and need time to adjust to exercise. Therefore, the physical therapist customizes the patient's active therapy program. 

Benefits of active physical therapy may include:

• Learn how to safely stretch and exercise
• Become more flexible; make it easier to move (eg, walk, climb stairs)
• Regain strength; become physically stronger
• Build strong abdominal muscles; your body's core center of strength
• Produce endorphins: your body's natural pain relievers
• Improved posture
• Be more sure-footed, which can help prevent falls

Throughout your physical therapy program, your therapist keeps a record of your progress and challenges, which is shared with your doctor.