What is Spinal Stenosis and How Is It Treated?
Constant lower back pain with associated pain and numbness in your legs are signs that you should not ignore. Spinal stenosis is one of many conditions that can cause these symptoms and can be very painful and debilitating, so it is always a good idea to speak to your healthcare provider to rule out this condition.
What is spinal stenosis?
Narrowing of your spinal canal is termed spinal stenosis. The spinal canal is a small tunnel formed by your vertebrae through which your spinal cord and nerve roots run. If stenosis progresses, it can lead to pinching of the nerve roots and / or the spinal cord, resulting in pain, numbness and weakness into the legs. Depending on where the region of narrowing, you may experience these symptoms in the neck, lower back, legs, shoulders or arms. A common sign of lumbar spinal stenosis is an increase in pain if you are walking downstairs compared to upstairs. This is because walking upstairs requires your torso to bend forwards and opens the passageways compressing the nerves. In comparison, bending backwards compresses these passageways further.
What are the causes of spinal stenosis?
The most common cause of spinal stenosis is due to gradual wear and tear of the vertebral joints, which is also known as osteoarthritis. In osteoarthritic spinal stenosis, the bones start to flatten and change, building bone spurs that can narrow the room in the spinal canal. This is also known as acquired spinal stenosis. Females over 50 years of age are at the highest risk of developing spinal narrowing, and it would be highly recommended to meet your physical therapist or physician to get an evaluation including diagnostic tests if needed. in some cases, spinal stenosis can be a secondary cause to another injury or condition. Disk herniations are another common cause spinal stenosis, as the disk material can push back in to the canal and encroach the spinal cord. For some people, spinal stenosis can be something they are born with. A small percentage of the population have a condition called congenital stenosis, wherein they are born with a small spinal canal. Other less likely causes of spinal stenosis could include previous spinal injury, past surgical treatment of the spine, rheumatoid arthritis or spinal tumour.
What are the symptoms of spinal stenosis?
Depending on the location of the narrowing of your spinal canal, you may exhibit symptoms of either cervical stenosis or lumbar stenosis
If you have foraminal stenosis of the spinal canal in the neck region, also known as cervical stenosis, the commonly occurring symptoms would include:
Numbness (paresthesias) and tingling sensation in your hand, arm, foot or leg due to involvement of the spinal nerves
Feeling of weakness in your hand, arm, foot or leg
Difficulty walking and with balancing
Neck pain
For those who have stenosis of the spinal canal in the lumbar region known as lumbar stenosis, the commonly occurring symptoms would include:
Numbness (paresthesias) and tingling sensation in your foot or leg
Feeling of weakness in your foot or leg
Feeling of cramping in the legs if you stand or walk for longer duration of time, which is relieved on bending forward or sitting
Back pain
In severe cases, urinary and bowel incontinence
How do we diagnose spinal stenosis?
Your physician or physical therapist will gather more information about your symptoms through history taking questions and then perform a complete physical examination to look for signs of spinal stenosis, which include but are not limited to abnormal sensations or loss of sensation, weakness and altered reflexes.
The most important physical symptom in diagnosing spinal stenosis is neurogenic claudication, which is having low back, hip, and leg pain that is exacerbated by walking or standing and relieved by sitting, crouching, or leaning forward. If you are suffering from lumbar spinal stenosis you may find it quite uncomfortable to walk upright but find it a lot easier to ride a bike or walk while leaning on a support. This is because your lower back is flexed, which thereby reduces pressure on the lumbar spinal nerves.
Diagnostic tests include:
Cervical and lumbar spine x-rays, which may reveal spurs (bony growths) pushing the spinal nerves and causing narrowing of the spinal canal
Cervical and lumbar CT and MRI
Bone dexa scan, a myelogram and an electromyography
What is the best treatment for spinal stenosis?
For any of the above mentioned physical symptoms, it is always advisable to book an appointment with your pain management specialist, a neurologist or physical therapist. Treatment can include pain medicine, physical therapy, modalities and in some cases surgical intervention may be necessary.
Medicines may include nonsteroidal anti-inflammatories or corticosteroid injections to help reduce your pain and swelling.
Physical therapy sessions should focus on exercises to strengthen your neck and back, especially the hip adductors and abductors and the hamstrings if dealing with lumbar stenosis. Your physiotherapy will include learning about what positions to avoid and which can provide you with relief. A comprehensive physical therapy program can improve your balance and your ability to perform activities like bending, moving and walking and also control your pain.
Surgery is usually indicated when the symptoms are too severe and too debilitating. It is always advised to try conservative treatment prior to surgery due to its risks.
Spinal Decompression for spinal stenosis is becoming a more popular treatment, and has shown great results especially for those suffering from foraminal stenosis or stenosis as a result of disk herniation.
Acupuncture and massage have also been shown to help provide symptomatic relief for patients.
What is the prognosis for spinal stenosis?
A majority of the population with spinal stenosis will respond to medicine and home-therapy but you should be prepared to make modifications to your physical activity. It is always advised to consult your physical therapist as they can help provide the necessary approach to combat your symptoms. Lifestyle management and incorporating regular stretching and strengthening exercises help in alleviating the pain and associated symptoms of spinal stenosis. However, it is important to note that any development of neurological signs like bladder and bowel disturbances is considered a medical emergency and you should go to the hospital immediately. Overall the prognosis for spinal stenosis is case dependent and should be monitored by your healthcare provider.
What can be done for spinal stenosis?
Having spinal stenosis can be a very frustrating and tough condition to deal with. However, if you have been diagnosed with this condition there are certain things you should do to help improve overall outcomes. Below we list a few things you can do to improve your quality of life:
Movement – Exercising regularly is essential and incorporate an exercise regimen after having consulted your physical therapist, with the focus on gentle, flexion-based exercises. As you begin to feel stronger and confident, increase the exercise routine from 30 minutes every alternate day to 30 minutes every day. You may add swimming a couple of times a week as well.
Activity modification – Avoid lifting heavy objects or walking long distances, as this may aggravate the pain.
Medication - Consult your physician about pain medication and its dosage and regarding alternative therapies like acupuncture and massages
Reduce body weight - Those of us that are overweight and obese put an incredible amount of stress on our lumbar spine which results in some of the boney changes causing spinal stenosis. Lowering your weight to a healthy and more managable figure will help reduce the pain and progression of the condition
Cane or Walker - In some cases, if the condition has progressed to the manner in which it is too painful to stnad upright, a cane or walker can provide stability and make walking around easier. Talk to your doctor to see if its right for you
Conclusion
Spinal stenosis is a condition that can severly impact all the things we love to do, but with the right modifications, we can continue to enjoy most things. Understanding what spinal stenosis is helps us understand why certain body positions are more relieving than others and use them to help better our day. Conservative therapy such as physiotherapy and massage have shown great value to helping increase the quality of life and helping us return to the things we enjoy.