Medical management: Medical treatment can be conservative or surgical and an accurate diagnosis of the disease is necessary for determining appropriate treatment. Where an MRI shows active inflammatory changes or oedema, localised injections can be tried. If injections do not improve the patient's symptoms, surgical treatment is then recommended.
Non-surgical treatment consists of localised injections of analgesics or NSAIDS. which can be given bi-weekly. During this treatment period, extension movements of the lumbar spine should be avoided. After local anesthesia of the skin and subcutaneous tissues, the injection is given the painful interspinous ligaments between the affected spinous processes' under fluoroscopic control.
Suggested surgical therapies include: excision of the bursa, partial or total removal of the spinous process, or an osteotomy
Physical therapy management: The main goal is the reduction of pain as well as hyperlordosis and to improve spinal function. Once the pain is managed, physical therapy management can begin, involving education, strengthening and stretching of the abdominal and spinal muscles.
When the abdominal muscles are weak, the hip flexors are mainly responsible in shaping the lumbar spine. Furthermore the rectus femoris muscle is a continuation of the hip flexor complex so it is important to stretch these muscles.
Motion of the gluteus maximus muscle during the flexion-extension cycle is decreased in patients with chronic low back pain, which is why strengthening of this muscle should be part of the physical management program.
Physical therapy is also suggested to be helpful for reducing the neuromuscular damage that is provoked by the disease and other treatments such as, heat therapy.