The Efficacy of Physical Therapy and Physical Therapy Plus Calcitonin in the Treatment of Lumbar Spinal Stenosis

Abstract

Conservative treatment is effective in LSS patients with mild or occasionally moderate pain. 6 Daily life style adjustments, back training, exercise programs to stretch, strengthening the lumbar region, and general conditioning exercises both prescribed alone or together with physical therapy yield good clinical results. 8-10Original Article DOI 10.3349/ymj.2009.50.5.683 pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 50 (5) Purpose: The aim of our study was to compare the efficacy of physical therapy alone and in combination with calcitonin in patients with neurogenic claudication (NC). Materials and Methods: In this single blind, and randomized study, patients with lumbar spinal canal stenosis who were diagnosed by clinical findings and MRI and having NC were included. Patients were observed for 8 weeks and evaluated before and after treatment. Patients were randomized between the salmon calcitonin 200 U/day + physical therapy (n = 23) (Group 1) and paracetamol 1,500 mg/day + physical therapy (n = 22) (Group 2) treatment groups. Both groups received the same physical therapy (interferential current + hot pack + short wave diathermy) and exercise protocol. The association of various clinical and functional parameters was assessed statistically by using paired and unpaired t test, chi square test and McNemar's test. p < 0.05 indicated statistical significant. Results: Mean age of the patients in Group 1 was 57.6 ± 11.2 and in Group 2 54.5 ± 10.6 years. Before treatment, there were no significant differences between groups with respect to age, body mass index, spinal axial diameter, Visual Analogue Scale (VAS), spinal mobility, functional status and walking distance (p > 0.05). After 8 weeks of treatment, both groups benefited significantly with respect to VAS, functional status and walking distance (p < 0.001). There was no statistically significant difference between groups (p > 0.05). Conclusion: In 45 patients with lumbar spinal stenosis who received 8 weeks of treatment, concomitant use of calcitonin with physical therapy and exercise did not have any benefical effect on the patient's pain, functional status, lumbar mobility and walking distance.

The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review

“…Strengthening exercises were included in nine of the exercise intervention arms [10,25-28]. Specific details of these exercises were not included in any of the studies.…”

“…Eight separate instances from four studies reported an improvement (range 16-29%) in the first 3-months [24-26,28]. At 6-months, only one instance was reported (18%) [10], three at 12-months (13-20%) [10,25] and one at 24-months (16%) [10].…”

The Efficacy of Intramuscular Calcitonin Injection in the Management of Lumbar Spinal Stenosis

“…However, it should be noted that despite these promising results, in this study the definite effects of calcitonin on some of the significant confounding variables, including infrared heating, ultrasonic diathermy, and active lumbar exercises, are unclear. Sahin et al [ 10 ] randomized 45 patients between the intranasal calcitonin 200 U/day and paracetamol 1,500 mg/day treatment groups. Both groups received the same physical therapy including interferential current, hot pack, short wave diathermy, and exercise protocol.…”

“…One of the possible reasons for the difference observed between our study and those that used intranasal formulation of calcitonin may be the lower bioavailability of the nasal formulation of calcitonin in comparison to the intramuscular injection formulation (only around 3%, ranging from 0.3% to 30.6%) [ 12 ], and therefore when a lesser amount of calcitonin was absorbed into the systemic circulation, less benefits of calcitonin were observed. It should also be noted that although the studies conducted by Podichetty et al [ 11 ], Tafazal et al [ 12 ], and Sahin et al [ 10 ] were randomized control trials, it is not clear whether the randomization method was adequate or not; it is also not clear whether the treatment allocation was blinded or not. Therefore, these studies may have a potential bias and also a type II error, and thus, an insufficient sample size to detect the difference between the groups.…”

“…Some authors suggest that it may have a direct analgesic effect through the release of β-endorphin [ 5 , 9 ]. Despite these promising results, some of the published data demonstrated that there may be no advantageous effects of prescribing calcitonin in LSS [ 10 , 11 , 12 , 13 ]. A very recent systematic review found that there is a very low quality evidence that calcitonin is no better than placebo or paracetamol regardless of the mode of administration [ 14 ].…”