Spinal stenosis is the narrowing within the vertebrae of the spinal column that results in too much pressure on the spinal cord (central stenosis) or nerves (lateral stenosis). Spinal stenosis may occur in the neck or in the low back.
The most common causes of spinal stenosis are related to the aging process in the spine. Osteoarthritis is a deterioration of the cartilage between joints. In response to this damage, the body often forms additional bone (called “bone spurs”) to try to support the area. These bone spurs might cause pressure on the nerves at the point where the nerves exit the spinal canal.
Normal aging can result in a flattening of the disks that provide space between each set of vertebrae. This narrowed space allows less room for the nerve to exit from the spinal cord.
Spinal injuries, diseases of the bone (such as Paget disease), spinal tumors, and thickening of certain spinal ligaments also may lead to spinal stenosis.
In most cases, symptoms of spinal stenosis can be effectively managed with physical therapy. Only the most severe cases of spinal stenosis need surgery or spinal injections.
Spinal stenosis may cause symptoms such as pain, numbness, tingling, or weakness in your arms and shoulders, legs, or trunk. Depending on where in the spine stenosis is occurring, it could problems with bowel or bladder function.
If you have spinal stenosis in the neck (cervical spinal stenosis), you may have weakness, numbness, and pain in one or both arms and often in the legs, depending on which nerves are affected. You may or may not have pain in the neck itself.
If you have spinal stenosis in the low back (lumbar spinal stenosis), you may have pain, numbness, and weakness in the low back and one or both legs, but not in the arms. Your symptoms may get worse with walking and improve with sitting.
In our physical therapy office, the first recommendation that we usually make is to take a short break from the aggravating activity. This allows for an environment for the inflammation to settle down and irritated nerves to heal. While taking a break usually helps with pain, we know for our patients to get back to the activities that they enjoy, we have to address the root of what is exacerbating stenosis.
In many cases, lumbar stenosis is correlated with poor mobility of the hip muscles and the lumbar spine. Cervical stenosis can be correlated with poor mobility of the lats and thoracic spine. This can be combined with weakness of the core, lower back, and gluteal muscles. In addition, if there are technique/form errors with exercise, this may lead to faulty spine mechanics. However, the only way to know what is contributing to pain and injury is to perform a complete assessment.
When pain and stiffness is found via our assessment, our approach includes manual mobilization to alleviate pain and improve mobility. Improvements can be made very quickly if the right regions are targeted. If weakness is found, we teach activation exercises to help our clients better engage muscles that are not firing well. Deep neck flexor exercises are crucial for those that suffer with a cervical stenosis dysfunction. Abdominal and lumbar flexion exercises are important in the case of lumbar spine stenosis.
Once pain is controlled and muscles engage better, our next step is teaching our patients to develop stability of the hips and spine with resistance exercise. We slow begin to reintroduce movements and exercises that were once painful. We teach proper technique with all loaded movements (e.g. push, pull, hinge, squat, lunge).
When addressed with a through physical therapy assessment and plan of care, spinal stenosis can be addressed conservatively. However, ignoring symptoms and continuing with repetitive activity with poor mechanics can develop into a more serious issue. If you feel like you may be developing spinal stenosis, the physical therapists at Movement Solutions would be glad to provide a thorough assessment and give you a diagnosis for your condition. We are available for a free 15-minute phone consultation to talk about how your pain is affecting you and discuss your treatment options. If you prefer an in person consultation, we offer a limited number of free Discovery Visits at our office. This type of appointment of for those who are considering booking an evaluation. It is an opportunity to ask questions, obtain clarity about your condition, and develop confidence that we can help. If you’re in pain and unsure about what your next steps should be, call us at (864) 558-7346 and ask how we can help.