I see patients almost every day for the management of lumbar spinal stenosis. Lumbar stenosis is a common degenerative disease that can cause quite a bit of discomfort, interfere with activities of daily living, and in some cases result in significant disability.
First a quick anatomy lesson: The spinal cord travels down your spine in a canal surrounded by 24 bones (vertebra). As the spinal cord descends down your back, pairs of nerves exit through small holes (foramen) between the vertebra. These spinal nerves go to your muscles, organs, etc.
In spinal stenosis a combination of degenerative arthritis, disc bulge/herniation, spinal joint degeneration, and ligament thickening leads to encroachment (stenosis) into either, or both, the spinal canal and the spinal nerve foramen.
Although you can infer that someone has stenosis from their symptoms and an x-ray, the definitive test is an MRI. The report may describe degeneration of the disc and spinal joints, disc bulging, ligament thickening, and narrowing of the spinal canal and neural foramen.
The symptoms of lumbar stenosis are chronic low back pain, unilateral or bilateral buttock/leg pain, leg weakness, and numbness in the legs and feet.
One of the hallmarks of stenosis is something called “neurogenic claudication,” in which the person develops low back and/or leg pain after a period of walking that progressively worsens as you continue to walk.
Symptoms frequently subside when the person stops walking and bends forward. Flexing forward opens the spinal canal and relieves pressure on the nerves and spinal cord. This explains why these patients sometimes walk around stooped forward. Walking with a flexed posture helps to relieve their symptoms. Similarly bending backwards can aggravate symptoms, which is why walking uphill (where you tend to lean back) can sometimes make these patients worse.
Spinal stenosis can be progressive, and while it is the most common reason for spinal surgery in older adults in the U.S., it can usually be managed using conservative care.
In my office I treat spinal stenosis with a combination of manipulation, flexion/distraction, neuromobilization, massage, myofascial release, and individualized rehabilitative exercises.
Occasionally, in patients who have more severe symptoms, I may refer to a pain management practitioner for a spinal injection to get a patient over a hump so they can continue with conservative care.
Do you have any questions about spinal stenosis? If so, let me know.
