What is the Best Treatment for Spinal Stenosis

As we age many of us will be diagnosed with spinal stenosis.  In most cases the cause is arthritis, the end result of our tissues and bones thickening from a lifetime of stressing the joints and ligaments of our spine.  However just because you have spinal stenosis doesn’t mean that you have to have pain or restrictions.  Whatever the X-ray or MRI tells us, the most important part of this diagnosis is not what your spine looks like but whether it is causing you any pain or restriction in walking.

If this is your diagnosis or if you think you have this condition, then its important to know that the right approach to treatment can make a big difference as to whether you spend your retirement actively walking or sitting to avoid pain.  Unchecked this condition can make walking more painful the older we get.

What are the symptoms of spinal stenosis?

The most dramatic impact of spinal stenosis is in its effect on our capacity to walk.  By the time people get to me, many can only manage to walk a block or two.  The pain or heaviness in our legs is so intense that it’s almost impossible to go on. However what is equally surprising is how quickly the pain goes away.  Five to 10 minutes of sitting and you feel restored, the leg pain is completely gone! You set out to walk again,  only to have the pain come back – however this time it comes on a little sooner and a little stronger. These recurrent bouts of increasing pain can make a pleasant walk feel like a miltary exercise in strategic planning as you choose your route to ensure there are places to sit down along the way.

Spinal stenosis can irritate the joints in the back or the nerves that travel down your legs.  This irritation can cause these symptoms as we stand and walk:

  • Low back pain
  • Numbness
  • Tingling down the leg or in your feet
  • Heaviness in your legs or a sensation of walking through mud
  • A feeling of wearing boots or socks even when your feet are bare

Just as important in the diagnosis is knowing what makes it feels it better.  The symptoms can be relieved when we:

  • Sit
  • Bend forward
  • Lean on a shopping cart

What causes spinal stenosis

Stenosis is the Latin word for narrowing.  The narrowing is usually caused by arthritis[1] as the stresses we place on our spine cause our bones to overgrow and ligaments to thicken.  This narrowing can be located in the central canal, where our spinal cord is located, or where the nerves exit the spine (foramen). The pain is caused when these overgrown structures take up more space and crowd our nerves and blood vessels.  When we sit there is more space for these delicate, but painful structures, resulting in the instant relief that can make us think about giving up walking and learning to knit.

What treatments work for Spinal Stenosis

Spinal stenosis is typically treated first with physiotherapy, massage therapy, exercise and/or medication.  If this isn’t enough the next steps are to consider spinal injections and/or surgery to help you to walk with less pain.  Non-surgical treatments are the most effective if your stenosis is more influenced by dynamic than static factors.

Static factors are changes in your spine which are permanent.  The MRI or X-rays tells much of the story about static stenosis.   Thickened ligaments, bony overgrowth, degenerative discs, osteochondral bars are all permanent spinal changes that only the surgeon can alter.  Decompression, Laminectomy and/or fusion are what address these contributors.  However just because we see these permanent changes, it doesn’t mean that you need surgery.

Dynamic factors are things that influence stenosis which are changeable.   The space in your central spinal canal and in the area where the nerve exits (foramen) can be positively impacted (made bigger) or negatively altered (made smaller) by posture and muscle tightness.  Tightnesses in your leg or back muscles, sway back posture, poor core support are all dynamic stenosis contributors that can be improved with therapy.

Can exercises help my spinal stenosis?

I often explain how therapy works by using a suitcase analogy.  Over my lifetime I have learned to pack much lighter when I go on a plane.  My goal is to fly only with carry-on.  The problem is that I always want to take too much and I can never get the suitcase to close.  Although the suitcase size is static, what I take with me is dynamic.  With careful consideration I reduce the number of things I am taking to not push my suitcase to the limit however my favourite suitcase has a special feature.  It has a zipper that lets me make it just a bit bigger – which is really important to fit in the extra items I always buy when I’m away.

How does this equate to your spine?  Your spine also has a special feature.  Posture is your secret weapon as just by doing a pelvic tilt you can increase the size of your canal to give the nerves more room.  The pelvic tilt has the same effect as  unzipping my suitcase.  It increases space for all those extra items you packed into your spinal canal.  .

Try this simple test to see if exercise will help you

Although we recommend most people try a program of exercises before surgery or injection there is one test that can help to determine if you are a good candidate to correct your problem with exercise.

Aniela’s standing posture video

Stand with your back against the wall and your feet about 6” away.  Place a hand in your low back area.  Gently flatten your back (pelvic tilt).  This position should feel good on your back.  Once you have learned how to hold this posture, practice it in standing (video) and walking.  If you forget to hold it when you walk, remember that the pain is a solid reminder to correct your posture .    If this posture takes away the pain then a program of flexion based exercises and stretches is quite likely to help you.

If this posture change is not enough or causes you more discomfort, you need a full examination by a physiotherapist or other health professional who treats spinal stenosis.

Our Approach to Spinal Stenosis

All of the therapists at The Orthopaedic Therapy Clinic are well-versed in providing therapy to help you reduce the effects of spinal stenosis and regain your independence in walking and standing.  They will also help you to know when other treatments are required i.e. injections, consulting a surgeon.

At the Orthopaedic Therapy Clinic when we conduct our examinations, we look for the dynamic factors which affect your pain.  Once your specific dynamic factors are identified we tailor a program of exercises, hands-on therapy and/or pain relieved modalities i.e. acupuncture, ultrasound, to make changes.  The effect of these changes is measured in your ability to stand and walk more comfortably, so remember to measure these activities at the start of therapy to ensure we can quantify your change i.e. walk 10 minutes and have to stop, walk 2 hours and feel great!

Please contact us if you would like to book an assessment to help determine if you have spinal stenosis or to determine therapy can affect your dynamic factors and help you to walk without pain.   Call 416-925-4687 or email us at physio@orthophysio.com

 

[1] There are two other types of stenosis – congenital and discogenic

Service provided by:

Maureen Dwight RPT, ( Bio ) Clinical Musculoskeletal Specialist, Advanced Practitioner ISAEC

Taylor Sipos, RPT (Bio)

Tiffany Shi, RPT (Bio)

 

To Book an appointment

call 416–925–4687 or email physio@orthophysio.com