A narrowing of spaces within the spine which puts pressure on nerves and the spinal cord, spinal stenosis is a common cause of pain and disability in older Australians, and a leading reason for spinal surgery.
But over the past decade, a growing body of evidence has challenged a long-standing assumption that surgery is the ‘definitive’ solution.
getback™ Director of Research Professor John Carlson said that decompression surgery was long considered the ‘gold standard’ for spinal stenosis, especially in patients with neurogenic claudication (pain or weakness in the legs and buttocks caused by compressed spinal nerves).
‘Early large studies suggested that surgery could provide faster symptom relief compared to non-surgical care,’ he said.
‘However, there was limited high-quality evidence proving surgery was superior to conservative treatment.’
Comparable outcomes from exercise
Professor Carlson said more recent evidence shows that for many patients, structured exercise therapy delivers outcomes comparable to surgery, without the risks.
‘A landmark randomised, controlled trial comparing surgery with physical therapy found similar improvements in patients’ physical function after two years,’ he said.
‘The outcome from surgery was a +22.4 improvement score, while for physical therapy the outcome was a +19.2 improvement score.’
‘Other high-level evidence found no significant difference in pain and disability outcomes between surgery and exercise.’
Addressing the root causes
Professor Carlson said that spinal stenosis is a functional and neuromuscular issue, as well asa structural problem.
‘Surgery may relieve compression, but it does notrestore muscle strength, improve spinal control, correct movement patterns or enhance mobility.’
‘Exercise therapy directly targets these factors by strengthening stabilising muscles, improving range of motion and enhancing neuromuscular control.’
The sweet spot: exercise and manual therapy
Professor Carlson said that recent meta-analyses completed in 2026 confirmed that multi-modal care – exercise, manual therapy and education – is one of the most effective non-surgical strategies available.
‘At getback our physiotherapy and osteopathy services provide manual therapy where needed, while our exercise therapy supervised by qualified exercise physiologists delivers controlled, safe training programs.’
Asking the right questions
Professor Carlson said that the question is no longer ‘Should we operate?, but rather ‘Have we fully optimised conservative care?’
‘Surgery comes with inherent risks from infection and complications for older patients, while exercise therapy offers minimal risk, lower cost and a scalable treatment pathway.’
‘High-quality exercise therapy, especially when it’s structured, individualised and measurable, should be the first-line treatment.’
‘And importantly, it can be started immediately, without waiting lists.’
The role of technology
Professor Carlson said that technology has played a major role in redefining conservative care for spinal stenosis.
‘Exercise therapy should always be outcome-driven and supported by data.’
‘The getback devices accurately measure a patient’s strength and mobility during each session which allows us to deliver individualised progression driven by objective data.’
‘This means our clinics can deliver hospital-grade rehabilitation without surgery.’
‘Targeted, isolated and progressive exercise is not the alternative anymore, it’s the foundation.’
