What is Spinal Stenosis?
The term “stenosis” refers to narrowing of the spinal canal through which the spinal cord travels. This usually occurs gradually over a long period of time, as the intervertebral discs and the facet joints become degenerative, with associated bony spurs (“osteophytes”) intruding into the spinal canal. The facet joints can also become enlarged with degeneration and associated inflammation. This results in a smaller diameter hole for the spinal cord to travel through, creating the potential for the spinal cord and associated nerves to be pinched.
The ligaments of the spinal column, especially the ligamentum flavum, become stiff, less flexible, and thicker with age, which also contributes to spinal stenosis.
Stenosis may occur in the central spinal canal (central stenosis) where the spinal cord or cauda equina are located, in the tract where the nerve root exits the central canal (lateral recess stenosis), or in the lateral foramen (foraminal stenosis) where the individual nerve roots exit out to the body.
What Are the Symptoms?
The symptoms of spinal stenosis can vary depending on factors including the severity of stenosis, the sensitivity of the nerves and which level/s the stenosis occurs at. Symptoms include:
· Back/buttock/hip pain
· Referred pain down into the thigh/calf/foot
· Pain can be one-sided or can affect both sides simultaneously
· Weakness, cramping, numbness and pins and needles.
· “Claudication”-type pain is common, which refers to pain in the legs which worsens with prolonged standing and walking.
Typically the diameter of the spinal canal is improved in flexed positions (eg. Sitting down, bending forward), so these positions often offer relief.
Positions that promote extension of the spine (eg. Standing, leaning backwards, walking uphill) tend to narrow the spinal canal further, which reduces the space for the spinal nerves. That is why people with stenosis often find standing and walking for long periods difficult, but find sitting brings relief.
How is Spinal Stenosis Treated?
Treatments can vary depending on the severity of symptoms and how much they limit everyday activities. Here are some treatments, depending on your level of pain:
- Non-surgical treatments– For mild to moderate pain, more conservative treatment methods can include medications, physiotherapy, and exercise programs. All patients should trail conservative physiotherapy treatment before surgery.
- Less invasive back surgery– For moderate to severe pain, decompression can be achieved through less invasive surgical procedures like interspinous spacers.
- Traditional back surgery– For moderate to severe pain, decompression or spinal fusion may be considered when more conservative treatments aren’t successful at relieving pain.
Targeted drug delivery – For severe chronic pain from spinal stenosis, targeted drug delivery may be a treatment option when more conservative treatments are not helping to relieve pain
Physiotherapy and Stenosis:
People with stenosis often benefit from physiotherapy to provide relief. The following are some ways in which physiotherapy can help:
- Manual therapy – this can loosen stiff joints and muscles, often allowing better mobility of the vertebrae in the spine, hence reducing the nerve impingement.
- Exercises – people with stenosis often benefit from a stretching/mobility program to loosen their lower backs, especially exercises which flex the spine, encouraging an “opening” of the canal to create more space for the neural tissue.
- Postural advice – too much lordosis, or arching, in the lower back can increase the degree of stenosis, so teaching people to find their “neutral spine” and sometimes even encouraging a flexed posture (ie. a slight slouch) can bring relief.
- Hydrotherapy – exercises based in warm water often give the most relief, as the spine is offloaded and mobility is restored to stiff spinal joints.
Physio Professionals offer weekly classes of hydrotherapy individually tailored for each patient.