An estimated 400,000 Americans over the age of 60 struggle with back pain caused by lumbar spinal stenosis, a narrowing of the spinal canal. For many patients, surgery is not the only option, and a new study shows other treatments may be just as effective for long-term relief of chronic pain.

Seventy-five-year-old Stephanie Paul is committed to staying active. But until recently, pain in her back, on a scale of 1 to 10, was nearly unbearable.

“There were many times when it was an eight. It was just on the lower back. It was just an ache,” Paul said

Paul had lumbar spinal stenosis. As she got older, her spinal canal narrowed and put pressure on nerve roots causing cramping in their legs.

“Generally, a city block or less will bring it on, and then they sit and the pain goes right away,” Anthony Delitto, PT, PhD, chair of Physical Therapy at the University of Pittsburgh and UPMC told Ivanhoe.

Physical therapy or surgery can relieve the pressure. In a first-of-its kind trial, University of Pittsburgh researchers studied which approach is best.

One-hundred-sixty-nine patients considering surgery agreed to be randomly assigned into groups. Half had surgery, the other half had physical therapy, two sessions a week for six weeks. Therapy included cardio and bending exercises.

“Almost half of the people were able to avoid surgery at the end point,” Delitto explained.

For Paul, physical therapy has made a huge difference.

“I said to my husband, when I leave here I feel like I can take on the world” she said, starting with the walking trails near her hometown.

Researchers say the results suggest doctors and patients should exhaust all non-surgical options before moving to surgery. Also, researchers found one of the biggest deterrents to physical therapy was cost. For most patients, especially those on Medicare, co-pays of $25 or $30 per visit added up.