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Why You Should Try Physical Therapy Before Back Surgery

Published June 9, 2017
| Written By SpineNation Editorial Staff   | Medically Reviewed by Scott Rosner, DC, MS, CCSP

In an American Physical Therapy Association survey, 37 percent of people said they don't seek professional help for back pain. That leaves their option of choosing physical therapy vs surgery for back pain as a pair of stones unturned. Couple those findings with data in a study conducted by the Global Burden of Disease that revealed that 50 percent of working Americans admitted to having back pain symptoms each year. This makes back pain the single leading cause of disability worldwide and is one of the most frequent reasons that people miss work. It becomes clear why we should examine the question: is physical therapy as good as surgery?

In this article:


The Benefits of Physical Therapy

For many people who suffer from back pain, their conditions are typically mild and it resolves over time. When the pain lingers and worsens it may require you seeking professional help. In choosing physical therapy or surgery for back pain, the first step is understanding the purpose physical therapy serves. Physical therapy for back pain aims to strengthen and support the structures surrounding your spine and its related joints, muscles, ligaments, and tendons. These are important in helping people with chronic back pain problems to develop the core strength necessary to perform their daily jobs and other activities. When you see your therapist, the first thing he or she will seek to do is rule out any serious conditions. Should your therapist find something concerning, you’ll be referred to a specialist. If your condition is treatable in physical therapy, your therapist will work with you to create a treatment plan to improve the structures around your spine, relieve pain, and get you active as quickly as possible.

"Most people experience low back pain at some point in their lives, but many people don't realize they can prevent or treat the condition with the help of a physical therapist," said APTA spokesperson Mary Ann Wilmarth, PT, DPT, OCS, chief of physical therapy at Harvard University. "For Americans living with low back pain, everyday tasks can be a challenge, and this survey revealed just how much this condition can affect someone's quality of life."

According to research by Cleveland Clinic, 95 percent of herniated disc patients would not require surgery if they addressed their symptoms with a therapist who could help them with the rehabilitation of the injured area. For the patient with back pain, physical therapy presents itself as proven and cost-effective and, for many people, should be the first treatment option considered. Given that on average 1 in 3 Americans are prescribed opioids to manage (and mask) pain, physical therapy only requires that you work with your body to allow it to strengthen itself and heal from within.

Back & Spine Conditions that Benefit from Therapy

Physical therapists see back pain patients with a wide range of ailments. A good therapist can successfully rehab a patient with acute and chronic back pain conditions such as:


When Therapy Doesn’t Work

Physical therapy, though highly successful for an assortment of back and spine conditions both acute and chronic, is not always effective for every patient. There are a few reasons why physical therapy isn’t serving your spinal condition well.

For physical therapy for back pain to be it's most effective, a patient has to be consistent with attending appointments with their therapist. Skipping sessions or being non-committal in your therapy sessions can lead to lowered returns on investment. If you want physical therapy to benefit your back pain, you have to show up and perform each therapy exercise to the best of your ability. In time, you’ll begin to see results and feel strength return to your affected area.

Another reason that physical therapy may not work for some patients is not following the treatment plan. Your therapist has specifically designed your exercises to target muscles that will increase core strength and improve the areas that support your back. Working the muscles incorrectly, or pushing them too hard in the hopes of a more rapid recovery, can lead to additional injury and setbacks. A major reason physical therapy may not be producing the results you need is that your condition is advanced and requires a consultation with a spinal surgeon.

A study by BMJ Open concluded that though patients undergoing physical therapy for lumbar disc herniation who received conservative treatments like physical therapy felt better, back surgery may be required if physical therapy doesn’t work, or a patient’s back pain is so overwhelming that surgery poses a direct and immediate relief.

Choosing Surgery for Back Pain

Patients who have chosen physical therapy over spine surgery hope that their treatment is effective. Surgery presents a set of circumstances that are disruptive and life-altering. In some cases, though, having to undergo surgery for back pain is unavoidable. When physical therapy over the course of three to six months is ineffective in relieving back pain, your physical therapist is likely to recommend that you see a spine surgery specialist. When you meet with this doctor, the goal is to find a treatment that will relieve your back pain while maintaining range of motion in your spine.

Some conditions, like spinal stenosis, can be difficult to diagnose and hard to treat. While surgery is a rapid results way to handle pain, most doctors still recommend sticking with therapies, but recognize that surgery is sometimes best for long-suffering chronic back pain patient.

“When you get to the point where symptoms are intolerable, you should consider surgery,” spine specialist Thomas Mroz, MD says. “There are a lot of other options to try before you get to that point” This makes surgery a last resort for patients with this back condition but does not rule it out. If you’re considering back surgery, these are among the most common treatments spinal surgeons perform on chronic back pain patients:

  • Discectomy. A procedure by which herniated portions of a patient’s disc is removed to resolve pain.
  • Laminectomy. The bone overlying the spinal canal is removed to relieve pressure from stenosis.
  • Spinal fusion. Two or more spinal bones are fused together to stabilize and relieve pain in an area of the spine caused by degenerative discs.
  • Artificial disc replacementImplanted artificial discs used to replace degenerated discs. Unlike fusion, which limits range of motion, artificial discs preserve the spine’s natural flexibility.



If you’re like most people, you’re going to suffer from back pain at some point in your life. Knowing what treatment options you have at your disposal will be the difference in how you approach it and will determine whether you choose physical therapy or surgery for back pain.

There is no one-size-fits-all approach to lower back pain. Some patients will find relief in physical therapy while others will elect to undergo surgery. Each patient’s decision is based on their level of comfort with the pain they’re experiencing and the amount of optimism they feel about recovering from their back injury. A 2013 study conducted at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, show that the outcomes were similar for many patients whether they chose physical therapy or back surgery. The important part is to not get discouraged and talk to your physical therapist or your doctor to plan the course that will benefit you most.

Updated: February 19, 2020

Information provided within this article is for educational purposes and is not a substitute for medical advice. Those seeking specific medical advice should consult his or her doctor or surgeon. If you need to consult with a specialist, you may be able find a health care provider in our Specialist Finder. SpineNation does not endorse treatments, procedures, products or physicians.

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Contributors and Experts

Dr. Scott Rosner is a Certified Chiropractic Sports Physician through the American Board of Chiropractic Sports Physicians practicing at Weymouth Chiropractic.