Treatments for Lumbar Radiculopathy

Julie Fritz, PhD, PT, ATC, leads a team of investigators from the University of Utah and Intermountain Health Care (link to ihc.com) investigating the outcomes of physical therapy interventions for patients with low back pain and radiculopathy. Patients with low back pain and radiculopathy (or sciatica) often experience prolonged disability, and about 20 percent require surgery due to intractable symptoms.

Physical therapists and other health care providers use a variety of interventions for patients with lumbar radiculopathy, however most do not have published evidence for their effectiveness. Traction, exercise (particularly lumbar extension exercises), and epidural injections are among the most commonly used interventions, yet the research to date on the effectiveness of these interventions has been equivocal. The research projects in this area are focused on examining the outcomes of these interventions and comparing their relative effectiveness.

Current Projects

Comparison of Physical Therapy Interventions for Patients with Low Back Pain and Signs of Lumbar Radiculopathy

We are conducting a randomized clinical trial comparing the outcomes of several different interventions used by physical therapists for the treatment of patients with low back pain and signs of radiculopathy. The interventions are mechanical pelvic traction, extension exercises and stabilization exercises. Outcomes include pain, disability, fear avoidance beliefs, and additional health care utilization assessed six weeks and one year after baseline. This study is a collaborative project between the University of Utah, Intermountain Health Care, and is supported by the Saunders Group.

Effectiveness of Epidural Steroid Injections, With or Without Physical Therapy, for Patients with Low Back Pain and Radiculopathy

Epidural steroid injection is a non-operative treatment often recommended for patients with LBP and sciatica. One large survey of spine centers in the United States reported a recommendation for steroid injection in 13% of patients with low back pain and sciatica. The effectiveness of epidural steroid injections has been a matter of debate, with some studies reporting a benefit, while others do not. Another non-operative treatment frequently used for patients with low back pain and sciatica is physical therapy.

Anecdotal reports and case studies suggest good outcomes with various forms of exercise, however well-designed research studies of these interventions are lacking. This project is a pilot study comparing the effectiveness of epidural steroid injection with or without concurrent physical therapy for patients with low back pain and sciatica due to lumbar disc herniation. Primary outcomes are pain and disability assessed 8 weeks and 6 months after baseline. This study is a collaborative effort between the Division of Physical Medicine and Rehabilitation and the Department of Physical Therapy and Athletic Training at the University of Utah.

Collaborators

•  
  
  • Stuart Willick, MD
  • Associate Professor
  • University of Utah
  • Division of Physical Medicine & Rehabilitation
  • Musculoskeletal Medicine Fellowship Director
  • Salt Lake City, Utah

Key Publications

• Fritz JM, Delitto A, Vignovic M. Inter-rater reliability of judgments of centralization and status change during movement testing in patients with low back pain. Arch Phys Med Rehabil 2000;81:57-61.
• Fritz JM, George S. The use of a classification approach to identify subgroups of patients with acute low back pain: Inter-rater reliability and short-term treatment outcomes. Spine 2000;25:106-14.