What is the role of physical therapy (PT) in treating bone spurs?

Physical Therapy for Bone Spurs

Physical therapy should be offered as a first-line treatment for symptomatic bone spurs, particularly when associated with osteoarthritis, focusing on strengthening exercises, range of motion work, and pain management techniques, with the strongest evidence supporting its use in patients with higher baseline pain and functional limitations. 1

Evidence-Based Role of Physical Therapy

Physical therapy serves multiple therapeutic mechanisms in bone spur management:

• Neuromuscular improvement through enhanced proprioception, muscle strength, and joint stability around affected areas 2
• Intra-articular benefits including prevention of further cartilage degeneration and anti-inflammatory effects 2
• Pain modulation through bio-psychosocial effects and serial physical stimuli 3

Treatment Approach and Patient Selection

Target patients with higher pain severity and poorer functional status at baseline, as they demonstrate significantly greater benefit from therapeutic exercise (short-term pain reduction of -6.36 points on 0-100 scale) compared to those with milder symptoms. 1

Core Exercise Components

The recommended physical therapy program should include:

• Strengthening exercises (isometric and isotonic) targeting muscles around the affected joint, with effect size of 0.32 for pain relief 2
• Range of motion exercises to maintain joint mobility and prevent stiffness 2
• Aerobic exercises (walking, cycling, swimming) showing moderate efficacy with effect size of 0.52 for pain reduction 2
• Stretching exercises to address muscle tightness and improve flexibility 2

Specific Applications by Location

Heel Spurs (Calcaneal Spurs)

• Ultrasound therapy represents the most commonly used and effective physical intervention for symptomatic calcaneal spurs 4
• Combined ultrasound and laser therapy demonstrates higher efficiency than exclusive laser therapy 4
• Extracorporeal shock wave therapy (ESWT) confirms effectiveness with no significant side effects 4
• Cryoultrasound therapy (combining cryotherapy and ultrasound) proves more effective than either modality alone 4

Joint-Related Bone Spurs (Hip/Knee)

For bone spurs associated with hip or knee osteoarthritis:

• Hip-focused exercises should target abductors, adductors, flexors, and extensors of the hip joint 2
• Knee-focused exercises should emphasize quadriceps, posterior thigh muscles, triceps surae, and hip stabilizers 2
• Comprehensive physical therapy may include manual therapy, functional training, energy conservation techniques, and pain management strategies 1

Treatment Duration and Expectations

Physical therapy demonstrates small but positive effects, with benefits most pronounced in the short term (12 weeks) and declining over medium (6 months) and long-term (12 months) follow-up. 1

• Short-term pain reduction: -6.36 points (95% CI -8.45 to -4.27) on 0-100 scale 1
• Medium-term pain reduction: -3.77 points (95% CI -5.97 to -1.57) 1
• Long-term pain reduction: -3.43 points (95% CI -5.18 to -1.69) 1

Critical Implementation Points

Transition to home exercise programs after initial supervised therapy rather than indefinite ongoing treatment, as continuous therapy beyond evidence-based visit thresholds lacks justification. 5

Appropriate Therapy Intensity

• Initial phase: Supervised sessions 2-3 times weekly for 8-12 weeks 5
• Maintenance phase: Self-directed home exercise program with periodic reassessment every 6-12 months 5
• Reassessment triggers: New functional deficits or significant decline in established abilities 5

Common Pitfalls to Avoid

Do not use physical therapy as monotherapy for severe, debilitating bone spurs - it should be integrated with other conservative measures including:

• Weight management if overweight 6
• Appropriate analgesics (acetaminophen, NSAIDs) as needed 1
• Orthotic devices for mechanical correction when indicated 7
• Intra-articular corticosteroid injections for persistent knee pain 1

Avoid prolonged passive modalities without active exercise components, as strengthening and functional training provide the most durable benefits. 1, 2

When Physical Therapy Is Insufficient

If patients fail to achieve meaningful improvement after 12 weeks of appropriate physical therapy:

• Consider interventional options such as corticosteroid injections for knee involvement 1
• Evaluate for surgical consultation if mechanical instability or severe deformity present 1
• Reassess diagnosis to ensure bone spurs are the primary pain generator 6