From the Guidelines
The initial management for patients with lumbar arthrosis should focus on a biopsychosocial approach, including patient education, individualized exercise programs, and weight management, as recommended by the most recent guidelines 1. The management of lumbar arthrosis (lumbar osteoarthritis) should prioritize conservative, non-surgical approaches. Key components include:
- Patient education and self-management strategies, which should be offered and reinforced at subsequent clinical encounters, considering available modes of delivery 1.
- An individualized, multicomponent management plan that includes recommended core non-pharmacological approaches, such as exercise programs tailored to the patient's physical function, preferences, and available services 1.
- Exercise programs should include strength, aerobic, flexibility, or neuromotor exercises, with the mode of delivery selected according to local availability and patient preferences 1.
- Education on the importance of maintaining a healthy weight, with support for weight loss in overweight or obese patients, as this can reduce stress on the lumbar spine 1.
- Consideration of assistive devices and adaptations at home and at work to reduce pain and increase participation, although this is more commonly recommended for hip and knee OA, the principle can be applied to lumbar arthrosis as well 1. It is essential to note that while the provided guideline focuses on hip and knee osteoarthritis, the principles of a biopsychosocial approach, patient education, individualized exercise programs, and weight management can be applied to the management of lumbar arthrosis, prioritizing a holistic and conservative management strategy to improve function and quality of life.
From the Research
Initial Management for Lumbar Arthrosis
The initial management for patients with lumbar arthrosis (lumbar osteoarthritis) typically involves conservative, non-surgical approaches.
- Nonoperative Treatment: This includes activity modification, such as reducing periods of standing or walking, oral medications to diminish pain like nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy 2.
- Conservative Management: Studies suggest that a significant portion of patients with lumbar spinal stenosis, a condition often associated with lumbar arthrosis, can experience improvement or no change in symptoms with conservative management 2, 3.
- Physical Therapy and Epidural Steroid Injections: Both have been shown to be effective in improving pain and functional parameters in patients with lumbar spinal stenosis, with no significant difference noted between the two treatments in some studies 3, 4.
- Medications: The use of NSAIDs and COX-2 inhibitors is common, especially for early arthrosis and in older subjects with advanced osteoarthritis. Hyaluronic acid and chondroprotectors are also frequently used in all types of osteoarthritis 5.
- Lifestyle Modifications: Reducing weight, engaging in regular exercise, and avoiding activities that exacerbate the condition are also part of the initial management strategy.
Considerations for Treatment
- The choice of treatment should be based on the individual patient's symptoms, the severity of their condition, and their response to initial therapies.
- Surgical options may be considered for patients who do not improve with conservative management 2, 6.
- The role of epidural steroid injections in long-term management is still being studied, with some evidence suggesting that while they may provide short-term relief, their long-term benefits are less clear 2, 4.