Lumbar Spinal Stenosis

According to the American Academy Of Orthopedic Surgeons 8-11% of the population have spinal stenosis with the largest prevalence in baby boomers over the age of 50. Not everyone who has stenosis will have significant symptoms impacting their function and the condition progresses slowly over time. For people who do experience symptoms, the disease can have a significant impact on their quality of life. This article will help you to understand this condition and give you some tried and tested strategies for managing your spinal stenosis.

What is spinal stenosis?

Lumbar spinal stenosis is a narrowing of the spinal canal causing pressure on the nerve roots that travel through the canal and exit the spine in the lumbar region. The term ‘spinal stenosis’ is actually more a description of physical changes in the spine than a useful diagnosis because not everyone who shows spinal stenosis on imaging has symptoms that require management. People who have symptomatic spinal stenosis have what is called neurogenic claudication (more on that later).

How does spinal stenosis develop?

The spinal column can become narrow for two main reasons. The first is related to the physical changes that the spine undergoes as a result of osteoarthritis and wear and tear on lumbar discs, and the second has more to do with the shape of your spine at birth.

Degenerative Spinal Stenosis

Degenerative spinal stenosis is the most common type, and refers to changes that take place in the spine as a result of wear and tear or arthritis. As the spine ages ligaments that line the spinal column thicken, discs lose height and may bulge into the spinal column and the z-joints develop bony spurs that can further press on neural elements. These factors combine to create a smaller space for the nerves to travel through the column. In advanced cases, a vertebrae can become unstable, causing slippage or malalignment with the adjacent vertebrae. This condition is called spondylolisthesis and it is also a contributor to spinal stenosis.

Congenital Spinal Stenosis

Congenital spinal stenosis is less common. It refers to a group of patients who have anatomic anomalies which result in a narrower spinal column. Each case of congenital spinal stenosis is unique and thus requires a customized solution that may include physical therapy, medications and/or surgical intervention.

What are the Symptoms of Spinal Stenosis (neurogenic claudication)

It is important to note again that simply having spinal stenosis on an MRI examination is not meaningful unless it is accompanied by symptoms that are related to that finding. The most common and recognizable symptom related to spinal stenosis is neurogenic claudication. This describes a pattern of symptoms that can include back pain, but more importantly include leg pain, numbness, weakness or tingling that is made worse when standing and walking but relieved by bending forward or sitting down. People who suffer from neurogenic claudication typically describe being able to walk a specific distance before having to sit to relieve their symptoms. After sitting for several minutes, they can often walk again for a similar distance before needing to rest again.

What treatments are available?

Treatment for neurogenic claudication related to spinal stenosis depends upon the severity of symptoms and how much it is impacting the individual’s quality of life.

Some common treatments are:

NSAID’s - Physicians may prescribe anti-inflammatory medications
Injections - Some patients are offered cortisone injections into their spine in an attempt to reduce inflammation at the site of the stenosis.
Other Medications - Some patients find relief from pain with neural membrane-stabilizing medications. Any medication strategy should be discussed and monitored by your primary care physician.
Physical Therapy - The main goals of physiotherapy are to help reduce symptoms, and improve mobility of the hips. In some cases strengthening of the muscles surrounding the spine can be helpful as well.
Surgery - For some patients surgery is necessary to manage neurogenic claudication. The type of surgery depends on findings from the patient's clinical examination and imaging findings. It may include decompression, fusion or a combination of the two.

What exercises can I try to help manage my symptoms?

For patients with spinal stenosis and symptoms of neurogenic claudication, the best approach is to undergo a detailed assessment by an experienced physical therapist. However, there are some exercises that can safely be tried prior to this step. Additionally, if you record how your symptoms respond to these exercises, it will help to inform a future physical therapy assessment.

Frequent Spinal Flexion

When the lumbar spine flexes (or bends forward) the space in the spinal column increases. Conversely, when the spine extends (bends backward) the space decreases. A common strategy for people suffering from neurogenic claudication is to do gentle spinal flexion exercises frequently throughout their day. These exercises can be performed in sitting or lying and involve gently pulling your knees toward your chest. If this exercise is right for you, it should not cause any leg symptoms, and if you are experiencing leg symptoms, adopting this position should relieve them.

Hip Extension Mobility

People who have had long-standing spinal problems often adopt a slightly stooped forward posture. Standing and walking in this way can lead the hip flexor muscles to shorten. When these muscles shorten they maintain the pelvis in an anteriorly tilted position resulting in more spinal extension (backward bend) when standing. Slowly stretching these muscles out helps to normalize the position of the pelvis and reduces the amount of spinal extension when standing and walking. Reduced extension means more space for your nerves. Stretching muscles takes persistence. You can expect it to take 8 weeks or more to see a significant difference.

Other flexion based symptom management strategies

The following are a few more strategies that patients use throughout their day to help manage the symptoms of spinal stenosis.

Half wall or chair flexion

Shopping cart posture

There is no question that spinal stenosis with neurogenic claudication can be a frustrating problem to suffer from. But with the right strategies in place it can be managed. Make an appointment to be assessed by an experienced physical therapist and talk to your doctor about some of the strategies outlined here to see what will work best for you.