Spinal Stenosis: Causes, Symptoms and Treatment.
Spinal stenosis is condition in which the bone channel that carries the spinal nerves narrows. In most patients it is a degenerative condition though it can be congenital. Most cases occur in the lumber spine, in other words the lower back. The narrowing of the spine canal can compress the nerves and the effect of this is to cause radiating pain which is generally experienced down the back of the leg. Muscular weakness and incapacity are also common symptoms.
- Age related degeneration – as we age our ligaments tend to thicken and bone spurs can form on the bones. These can protrude into the canal. The disks between the vertebrae deteriorate, thin and lose their ability to cushion. Also, the facet joints can break down. Each of these processes can cause the can to narrow.
- Osteoarthritis is a degenerative condition in which the cartilage in joints breaks down. Cartilage a flexible material that reduces friction between the bones that form the joint and acts as a shock absorber cushioning the joints.
- Rheumatoid arthritis is an immune response that can be triggered by a range of factors. The immune system starts to attack the joints leading to inflammation, loss of cartilage and canal narrowing.
- Spondylolisthesis or spinal instability can cause the vertebrae to slip, thus narrowing the canal.
- Injury – the canal can be narrowed as the result of injury, for instance dislocation of the spine and burst fractures causing bone fragments to penetrate the canal.
- Tumours in soft tissue can cause inflammation or may grow into the canal
The most common symptom is pain in the lower back and pain that radiates into the top of the legs. The narrowing canal can pinch the nerves that control the leg muscles and sensations in the legs. This can make it painful to walk, cause numbness, and result in falls.
Spinal stenosis is just one of the conditions that causes back pain; there are many others such as scoliosis and spondylosis. This can make it difficult to diagnose, though problems that include the lower back and the legs are more often caused by spinal stenosis. To confirm the condition, MRI and CT scans are often needed.
As the condition is degenerative, there is currently no wonder cure, though much can be done to reduce and manage the pain. There are three approaches to treatment. These are pharmaceutical, injections, surgical, and physical therapies:
- Pharmaceutical – Nonsteroidal anti–inflammatory drugs (NSAIDs) and pain killers can often bring relief. These include over the counter drubs such as ibuprofen, aspirin and paracetamol along with a wide range of prescription drugs.
- Injections of corticoid steroids into the spine can be effective in reducing acute pain as can anaesthetic injections to the affected nerve.
- Surgical – surgical procedures can be used to relieve pressure on the nerves and to realign the spine. Decompressive laminectomy is used to increase the space in the canal the procedure is often combined with vertebrae fusion.
- Physical therapy and prescribed exercises are used to strengthen the muscles and increase endurance while maintaining motion. Many people find aerobic exercises particularly beneficial. We look at physical exercises for spinal stenosis in the next section and compare their benefits with those provided by surgery.
Physical therapy and exercise in the treatment of spinal stenosis
Pilates and other exercises designed to strengthen the core can be particularly effective. It is important to use the right Pilates exercises. Flexion Pilates exercises such as spine stretch forward and leg stretches are generally recommended, but you should discuss this with your Pilates instructor who will develop the most appropriate exercises routine for your specific circumstances.
Physiotherapy for spinal stenosis is used to reduce pain, improve function and build muscle strength. A physiotherapist should work with you to devise a regime tailored to your specific condition. Typically, a treatment plan might include the following:
- Stretching and other exercises designed to reduce the stress on your joints and build muscle strength
- Posture correction advice to help you improve your posture
- Massage and other manual therapies to restore and maintain motion
- Heat treatment to improve blood circulation to your back muscles
- Cycling and walking exercises can be highly beneficial for some people
- Swimming and other aquatic exercises help you gain and maintain fitness without putting any pressure on your spine
Physical therapy as effective as surgery
Physical therapy can be as effective as surgery in the treatment of spinal stenosis. A study carried out on a group of 169 symptomatic lumbar spinal stenosis patients (Delitto, et al., 2015) in which 87 underwent surgical depression and 82 received physical therapy demonstrated that physical therapy was as effective as surgical intervention.
Another recent study on the long term effects of surgery (Kääriäinen, et al., 2015) that included a two year follow up showed that while Impaired lumbar proprioception improves shortly following decompressive surgery it tends to deteriorate over time. Furthermore, feed-forward and feed back muscle function wasn’t improved by surgery.
Although it is a painful and potentially debilitating condition, spinal stenosis can be effectively managed by a combination of treatments. While surgery might be required in some instances, physical therapies can be equally effective and their benefits longer lasting.
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Delitto, A., Piva, S., Moore, C., Fritz, J., Wisniewski, S., & Josbeno, D. (2015, April 7). Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis: A Randomized Trial. Annals of Internal Medicine, 162(7).
Kääriäinen, T., Taimela, S., Aalto, T., Kröger, H., Herno, A., Turunen, V., . . . Airaksinen, O. (2015). The effect of decompressive surgery on lumbar paraspinal and biceps brachii muscle function and movement perception in lumbar spinal stenosis: a 2-year follow-up. European Spine Journal, 1-6.