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Spinal Stenosis

The basics of spinal stenosis

  • Spinal stenosis is a narrowing of the spinal canal, causing pressure on the nerves or spinal cord. This leads to pain, numbness, weakness or tingling.
  • Depending on the location of the narrowing, pain is felt in different areas of the body. Stenosis in the cervical spine can lead to symptoms in the neck and arms, while stenosis in the lumbar spine can lead to symptoms in the lower back and legs.
  • Risk of spinal stenosis increases over the age of 50.
  • Physical therapy is often a recommended treatment to aid in softening the muscles, reducing pain and strengthening core muscles.
  • In severe cases, a doctor may recommend surgery or spinal injections.

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What is spinal stenosis?

This is the narrowing of the spinal canal which houses the spinal cord. This narrowing reduces the amount of space for the spinal cord and nerves, and the added pressure can lead to pain, weakness and impaired sensation. Up to half a million people in the United States have symptoms of spinal stenosis.

The condition often occurs naturally over time due to aging or as a result of past injury or conditions wearing down the body. As a result, it is most commonly found in those over the age of 50.

Others who are at increased risk include women, individuals with prior spinal injury, people who have osteoarthritis or other conditions affecting the spine, and those who were born with a naturally narrow spinal canal.

Stenosis can occur anywhere in the spine. But it most commonly affects the neck area (cervical spinal stenosis) or the lower back area (lumbar spinal stenosis). Symptoms are typically similar to other age-related conditions, so a careful diagnostic is important to ensure individuals get the treatment they need. This will include a full medical history and discussion of symptoms.

Treatments (see below) vary depending on location, severity and specific symptoms the patient experiences. Physical therapy is frequently a recommended treatment to build strength, improve endurance and lessen pain.

Cervical spinal stenosis (cervical stenosis)

Cervical stenosis is a narrowing of the spinal canal in the neck. This causes numbness, tingling or weakness of the arms and hands. Individuals may or may not have pain in the neck itself. It often creates difficulty in maintaining balance.

Degeneration from the aging process is the primary cause of cervical stenosis. Injury or trauma may also cause the condition. The result is changes in the neck’s structure that alter its function.

Lumbar spinal stenosis (lumbar stenosis)

Lumbar stenosis is narrowing of the spinal canal in the lower back (the lumbar region). This is the most common form of spinal stenosis. It can cause tightness in the thighs, buttocks and legs muscles and causes a forward flexed posture. The pain associated with lumbar stenosis is caused by nerve compression. Symptoms often increase while standing or walking; lying down or sitting typically reduce the pain.

What causes spinal stenosis?

Stenosis usually progresses gradually over a long period of time due to factors such as age and overuse. Some people are born with the condition, which is called congenital spinal stenosis (cervical or lumbar). Spinal osteoarthritis is another degenerative condition that can cause bone spurs resulting in lumbar stenosis.

The following conditions increase the risk of spinal stenosis.

  • Bone overgrowth: Conditions such as osteoarthritis or Paget’s disease can prompt bone spurs or growth in the spine. Osteoarthritis is the most common direct cause of spinal stenosis.
  • Disc issues such as herniated disc: A bulging or herniated disc (ruptured or torn) can protrude into the spinal cord, causing stress on the spine and nerves.
  • Thickened ligaments: Stiffness and thickening of ligaments over time can also cause the condition.
  • Tumor: This abnormal growth within the spinal cord might also be the reason for spinal stenosis; the tumor or inner growth can only be identified through a CT scan or MRI.
  • Spinal injury: Accident or any trauma that has caused the dislocation or fracture of a vertebrae can cause the disease. Any injury or surgery that can cause tissue swelling might also lead to spinal stenosis.

Symptoms

The severity of spinal stenosis varies from individual to individual but may include:

  • Pain in the lower back is one of the most common symptoms.
  • Loss of sensation in the feet.
  • Numbness and tingling feeling in the arm, leg and feet.
  • Weakness in legs.
  • Stiffness of neck muscles.
  • Constant pain while standing.
  • Impairment of sexual function.
  • Difficulty in doing the daily routine tasks that involve motor skills of the hand.
  • Bowel or bladder dysfunction in extreme case situations.
  • Difficulty walking and maintaining balance.

If the individual is suffering from any of the symptoms mentioned above, he or she should not delay in speaking with a doctor. Our therapists can help a patient determine if spinal stenosis is the likely cause of symptoms, but a physician will need to make a formal diagnosis.

Risks of not treating the disease

If untreated, symptoms such as pain or weakness can worsen over time, causing further disability. In severe cases, it can lead to significant and permanent nerve damage including bladder control issues, paralysis and death.

If an individual is experiencing any symptoms, a thorough evaluation and (if diagnosis is confirmed) treatment plan is vital.

Physical therapy for spinal stenosis treatment

The diagnosing physician will often prescribe physical therapy. Physical therapy helps to strengthen the back and core muscles, aid flexibility, reduce pain, and improve balance, stability and normal function. Our physical therapist will likely test muscle strength and joint range of motion to determine the severity of pressure on nerves or the spinal cord.

At Spine & Sport, our team of physical therapists will create an individual exercise program to help patients based on their prognosis, goals and activities. For example, a physical therapist can teach proper posture with walking and educate patients on when it is appropriate to take breaks in order to improve their level of function.

Many patients benefit from physical therapy not only to reduce symptoms of this disease but also to improve balance, muscle endurance and flexibility in the spine. A full exercise program may involve a combination of the following.

  • Movement training. This involves teaching specific movements to help take pressure off the nerve, which can help alleviate pain.
  • Strengthening exercises. Strong muscles help to improve spinal stability and take some of the workload off of the spine itself. This aids in reducing pain and other symptoms associated with stenosis and also helps protect the spine from compressive forces and movement.
  • Stretching and flexibility training. Specific exercises can improve mobility in the joints and muscles of the spine, providing pain relief.

Learn more about physical therapy exercises

If physical therapy does not provide relief, the patient’s doctor may recommend medication in combination with physical therapy or surgery.

Self-care spinal stenosis treatment

If an individual suffers from mild spinal stenosis, the healthcare provider may suggest self-care remedies. Self-care remedies may include:

  • Applying heat. Heat increases the overall loss of blood flow, which helps to relax the muscles and promotes healing
  • Applying cold. If applying heat to the affected area is not favorable, patients should try using cold (an ice pack) for 10-15 minutes. Applying ice helps reduce swelling, inflammation and tenderness.
  • Exercising. Exercise is a common self-treatment to help strengthen the muscles and relieve the pain. Moreover, it can also help improve balance and flexibility, two areas often impacted by spinal stenosis. Patients should speak to a medical professional to determine which exercises are safe for them before beginning an exercise program,

When to see a physician

Patients should seek medical attention if they are experiencing any of the symptoms of spinal stenosis. A physician can help diagnosis the condition, typically with the use of imaging.

In case of severe spinal stenosis, the diagnosing physician may prescribe oral medications, steroid injections and decompression surgery. Milder symptoms are effectively managed through nonsurgical means, such as pain medication, activity modification, physical therapy and injections. If the symptoms of spinal stenosis are difficult to manage, the healthcare provider may suggest surgery, although most individuals with spinal stenosis do not need surgery.

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