Spinal Stenosis

October 27, 2017 at 10:49 AM

WHAT IS SPINAL STENOSIS? 

As you get older your spine changes.  This often leads to degeneration of the vertebrae (Osteoarthritis), discs, muscles and ligaments.   These changes can cause narrowing in the spine, which can irritate or pinch the spinal nerves.   “Stenosis” comes from the Greek word meaning “narrowing”.

Spinal stenosis may occur in the central spinal canal or may affect the area where the nerve root exits on one side (foraminal, lateral recess or far lateral stenosis).

Central stenosis will cause symptoms in both legs; whereas stenosis on one side can affect just one leg in a single nerve root distribution.

WHAT ARE THE COMMON SIGNS AND SYMPTOMS?

Spinal stenosis commonly affects people over 60 years of age.  People often have pain that is worse in their legs than in their back. Symptoms may also include numbness, tingling or burning in the legs.  Symptoms are generally aggravated by walking and standing and eased with sitting or leaning forward to flex the spine.

Vascular problems can also cause leg pain whilst walking, therefore it is advised that you should seek medical advice to confirm your diagnosis.  

ACTIVITY MODIFICATION

Avoid any aggravating activities such as arching your lower back or standing for long periods.  Exercise in flexed positions, such as cycling leaning forwards on the handlebars or flexing forward while walking eg. by pushing a trolley.  Sit and lean forward or stand and flex your lower back for relief as required while walking.  Avoid sitting up really straight, you may be more comfortable in a reclined chair.

Spinal stenosis often impacts people’s sex lives.  To increase comfort during sex, maintain a position where your lower back is flexed. Below are some examples of modified positions:

  • The modified missionary position:  If you prefer to lie on your back try placing a few pillows under your knees or pull your knees up to your chest, this will flex your lumbar spine.

  • Spooning: You can also lie in a foetal position and get your partner to lie beside you.  You will need to be passive in this position.

MANAGEMENT

Management options include exercise-based treatment, activity modification, anti-inflammatory medication, an epidural cortisone injection and surgery. 

Some people can successfully manage their symptoms with conservative management alone and this is usually the first choice of treatment.  Try these recommended exercises or speak to your physiotherapist for more information or exercises to meet your individual requirements.

Epidural cortisone injections may provide temporary pain relief and are best for people with symptoms only arising from only one nerve root.

Whether you require surgery will depend on the severity and duration of your symptoms.  Surgery is generally reserved for people who have such a degree of pain and physical disability that they are unable to continue completing their daily tasks, such as walking to get the groceries.  Surgery aims to increase your activity tolerance to allow you to do more with less pain. 

HOME EXERCISES

You can try the exercises below to see if they alleviate some of your symptoms. All exercises should be pain-free and you should feel better after completing the exercises. If you feel any pain during the exercises please stop them and discuss this with your therapist. 

Your physiotherapist can instruct you on how to correctly perform these exercises. They may also adjust some exercises as required to meet your individual needs.  

FLEXION IN LYING

While Lying on your back, hold your knees and gently pull them up towards your chest.

 

POSTERIOR PELVIC TILTS

Lie on your back on a firm surface with knees comfortably bent.  Then flatten back against the floor while contracting abdominal muscles as if pulling belly button toward ribs.  

 

CHILDS POSE 

While in a crawling position, slowly lower your buttocks towards your feet until a stretch is felt along your back and/or buttocks. 

 

SUPERMAN

While in a crawling position, slowly raise up an arm out in front of you.  Keep your trunk as still as possible.

 

BRACE MARCHING

While lying on your back with your knees bent, slowly raise up one foot a few inches and then set it back down.  Next, perform on your other leg.  Tighten your stomach muscles to keep your spine from moving.