Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial

Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline

“…While our findings agreed with the DHA 114 and NASS 74,75 guidelines regarding the common medications assessed, divergence in opinion with these two guidelines 74,75,114 can largely be explained by the use of different eligibility criteria, and the inclusion of recently published evidence on multimodal rehabilitation intervention 4,93,117 and acupuncture 112 upon which we were able to base our recommendations.…”

“…Further, only RCTs with an inception cohort of at least 30 participants per arm at baseline were admissible for non-normal distributions to approximate the normal distribution. 100 Importantly, three recent high to moderate quality RCTs 4,93,117 investigated the effectiveness of various combination of multimodal rehabilitation that have informed our guideline recommendations, but were not available when the NASS 74,75 and DHA 114 guidelines were developed.…”

Back Pain: Chiropractor’s View

“…Recently, two large clinical trials were published that involved chiropractic spinal manipulation and exercises provided to older adults with lumbar spinal stenosis Ammendolia et al 2018). In both of these trials, patients had significant improvements in their walking performance (neurogenic claudication symptoms).…”

Development of a Clinical Decision Aid for Chiropractic Management of Common Conditions Causing Low Back Pain in Veterans: Results of a Consensus Process

“…45 Radicular pain is defined as ectopic nociceptive firing within spinal nerves due to inflammation, mechanical strain, or possible ischemic damage to dorsal root ganglia, resulting in pain perceived in the nerve-supplied territory. 45 Interventions: Education about the condition 13,[25][26][27][28][29]33,34 Neurodynamics (neural mobilization) when tolerated 46 Spinal manipulation (thrust and/or nonthrust as tolerated) 10,14,16,39,47 Directional preference exercises 42 Neurogenic claudication: pain caused by intermittent compression and/or ischemia of a single or multiple nerve roots 48 Interventions: Education about the condition 13,[25][26][27][28][29]33,34 Spinal manipulation (thrust and/or nonthrust as tolerated) [49][50][51] Neurodynamics (neural mobilization) [49][50][51] Muscle stretching 49,51 Lumbar mobilization exercise 49,51 Self-management via a cognitive behavioral approach including goal-setting, graded activity, pacing, relaxation, and body positioning techniques to reduce lumbar lordosis 49,51 Home exercises when tolerated 49,51 Comanage with other providers when needed 52 Central sensitization...…”