Can physical therapy help you avoid back surgery?
Yes, for many people with chronic low back pain, physical therapy can reduce pain enough that surgery may not be needed. The strongest evidence comes from a 2021 Cochrane review of 249 trials, which found that exercise therapy (a core component of PT) reduced pain by an average of 15.2 points on a 100-point scale compared to no treatment, usual care, or placebo [1]. This difference is considered clinically important, meaning patients actually feel the improvement [1]. The review also found that exercise was more effective than education alone or non-exercise physical therapy for pain relief [1].
However, the same review found that the improvement in physical function (ability to do daily activities) was smaller — only 6.8 points on a 100-point scale — which did not meet the threshold for a clinically meaningful change [1]. This means that while pain may improve, you might not notice a big difference in how well you can move or do your daily tasks. The review also noted that the quality of the evidence was moderate, mainly because many studies could not blind participants to whether they were exercising (which is hard to fake) [1].
A separate 2021 study of 108 patients with chronic low back pain found that those with lower work ability and those who had recently seen a medical specialist for their back pain were more likely to have worse outcomes after 6 months of conservative care (including PT) [3]. This suggests that PT may be less effective for people with more severe or complex back problems, and these patients might still need surgery.
Does physical therapy help after back surgery?
The evidence suggests that physical therapy after back surgery does not lead to better outcomes. A 2023 study of 1,003 patients who had lumbar decompression surgery found that those who attended physical therapy after surgery did not have better pain scores, disability scores, or fewer readmissions or reoperations compared to those who did not attend PT [5]. The same research group studied 1,000+ patients after lumbar fusion surgery and found the same: PT attendance did not improve patient-reported outcomes like pain or disability at 90 days or one year after surgery [4].
These findings are important because many surgeons routinely prescribe PT after back surgery. The authors of the 2023 fusion study concluded that 'physical therapy does not significantly impact patient-reported outcomes after lumbar fusion surgery' and suggested that surgeons should be more selective in recommending PT after surgery [4]. This does not mean PT is useless — it may still help with specific goals like regaining strength or mobility — but it does not appear to reduce the need for additional surgery or improve pain and function more than not doing PT.
What if physical therapy doesn't work?
If physical therapy fails to relieve pain, other non-surgical options exist. For people with failed back surgery syndrome (FBSS) — persistent pain after surgery — spinal cord stimulation (SCS) is an option. A 2022 review found that SCS can reduce pain and disability and improve quality of life in FBSS patients, and that it is cost-effective compared to conventional medical management (including PT) over the long term [2]. The same review noted that SCS is underutilized, with only about 4% of FBSS patients receiving it in one large US study [2].
However, SCS is not a first-line treatment. It is typically recommended only after conventional treatments (including PT) have failed and when the pain has a neuropathic (nerve-related) component [2]. The review also pointed out that while SCS has higher upfront costs, long-term costs are significantly lower — a 68% decrease in the year after implantation compared to conventional management [2].
About These Sources
This answer is built on 5 peer-reviewed studies — published from 2021 to 2023, 1 in Q1 journals, collectively cited 355 times — selected as the most relevant from 8 studies that passed quality screening, drawn from 57 papers retrieved from a database of over 500 million.
Sources used in this answer
Exercise therapy for chronic low back pain
In a 2021 Cochrane review of 249 trials, exercise therapy reduced chronic low back pain by a clinically important 15.2 points on a 100-point scale compared to no treatment, but the improvement in physical function (6.8 points) was not clinically important.
SP61 Cost effectiveness of spinal cord stimulation in chronic low back pain
A 2022 review found that spinal cord stimulation is cost-effective for failed back surgery syndrome, with a 68% reduction in costs in the year after implantation compared to conventional management, and improved pain and quality of life.
Predictors of low back disability in chiropractic and physical therapy settings.
A 2021 study of 108 patients found that lower work ability and recent consultation with a medical specialist for back pain predicted worse disability at 6 months despite conservative care (including PT).
The Impact of Physical Therapy After Lumbar Fusion Surgery
A 2023 retrospective cohort study of over 1,000 patients found that physical therapy attendance after lumbar fusion surgery did not improve patient-reported outcomes (pain, disability) at 90 days or 1 year compared to no PT.
Does physical therapy impact clinical outcomes after lumbar decompression surgery?
A 2023 study of 1,003 patients found that physical therapy after lumbar decompression surgery did not improve patient-reported outcomes or reduce readmissions or reoperations.