Is Spinal Stenosis
Causing Your Lower Back Pain?

Spinal stenosis is a condition that can cause both lower back pain and sciatica symptoms. Understanding this condition can help you regain control of your symptoms and put you back in the drivers’ seat.



What is Spinal Stenosis?

Spinal stenosis is a condition of the spine in which the space where the lumbar nerves and/or spinal cord becomes narrowed. It is often associated with a decrease in disc height and is therefore more common in people over the age of 50. As we age, the discs lose their natural hydration and become thinner. This reduction in disc height results in narrowing of the region in which the lumbar nerves exit the spine, called the lateral foramina. Narrowing of this region of the spine is thus termed lateral foraminal stenosis.

In addition to the decrease in disc height, bony changes of the lumbar vertebrae themselves and thickening of lumbar ligaments can all add to this narrowing effect. These changes also occur within the central canal, the region that is occupied by the spinal cord. Narrowing of this space is called central canal stenosis. Both lateral foraminal and central canal stenosis can cause significant pain and functional limitation.


spinal stenosis


Signs and Symptoms of Stenosis

The most common symptoms of stenosis are neurological in nature and often described as sciatica symptoms. Primary complaints include pain, numbness, tingling, burning, and weakness in one or both of the legs. It is not uncommon for people to experience little or no lower back pain.

Symptoms related to stenosis are most often aggravated by standing and walking. When in an upright position, both the central canal and lateral foramina become narrowed allowing for compression or pinching of the nerves to occur. Because of this mechanical compression, people will often walk or stand in a slightly flexed forward position. When advised to stand or walk more upright, symptoms in the legs are reproduced.

Commonly people indicate they experience pain, tingling, or weakness with walking but as soon as they sit down, these symptoms go away. Sitting and bending allows the spine to “open up” reducing the compression of the nerves and reducing the leg and/or low back pain. This same reason explains why walking up hill can also be less painful as the spine is in a more flexed position then when walking on flat ground.


Typical Treatment Protocol

It is not uncommon for doctors to prescribe anti-inflammatory medication for stenosis. The goal of the medication is to help reduce any local inflammation that could be adding to the nerve compression.

In significant cases when oral medication has not been effective, epidural injections may also be recommended. Up to three epidurals can be given over a one year period of time.

Utilizing ice therapy can also have a similar effect, reducing local inflammation. Ice your lower back 10 to 15 minutes; three or more times a day. To maximize the effect of the ice, place your spine in a more flexed position such as with sitting or in a 90-90 position while lying on your back.

90-90 position


It is important that if at any time you are experiencing bowel or bladder changes, or pins/needles in your groin region, that you contact your doctor immediately. This is a medical emergency and must be treated immediately.


Physical Therapy

Being that walking is generally painful; many find it difficult to exercise. A great choice is to use a recumbent stationary bike. This exercise keeps the lower back in a flexed position while allowing you to get needed exercise for your legs.

Maintaining flexibility of the lower back and legs is important in the treatment of spinal stenosis. Incorporate leg and lower back stretches into your overall fitness routine.

Weakness in the legs can also occur secondary to the pinching of the nerves associated with this spinal stenosis. Performing leg strengthening exercises should also be incorporated into a treatment routine to avoid gradual leg weakening.

Click here for more detailed information regarding spinal stenosis exercises.


Surgery

Spinal surgery of any kind should be avoided if possible. Surgery should only be considered when conservative treatment has failed and significant symptoms and limited function continue. Typical conservative care includes oral anti-inflammatory medication, epidurals, ice therapy, and physical therapy. If these conservative treatments are not effective, a spinal fusion or laminectomy may be the surgical recommendation.


Summary

• Spinal stenosis is the narrowing of the space where the spinal cord (central) or nerve roots (lateral) are located.

• Symptoms including lower back or leg pain are aggravated with standing and walking and relieved with bending.

• Anti-inflammatory medication, ice, stretching, and stationary bike exercises are typical treatment choices.

• Changes to bowel or bladder function or tingling/numbness in the groin region are signs of a medical emergency.

• Surgery should only be considered if conservative treatment has failed.

• Utilize the following stenosis exercise recommendations to reduce pain and improve function: spinal stenosis exercises.

Spinal stenosis can be painful and limiting but there are things you can do to take back control. Follow the recommendations to help limit your pain and help you maintain your leg function.



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