How To Move Without Pain

What is Spinal Stenosis?

by Meghan Griech, PT, DPT, cert MDT, CKTP

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Spinal stenosis is a slow and progressive narrowing of the space where the spinal cord is located. Often this begins without any symptoms and therefore people often don’t even know that its occurring, unless symptoms begin or an x-ray is taken. This narrowing is most often found in adults that are greater than 50 years old. Spinal stenosis is generally caused by normal wear-and-tear changes in the spine related to osteoarthritis. Symptoms are variable and can range from nothing at all, to having a significant impact of daily life.  

According to research completed in 2020, approximately 250,000-500,000 US residents have symptoms of spinal stenosis. This represents about 1 per 1000 persons older than 65 years and about 5 of every 1000 persons older than 50 years.  This essentially means spinal stenosis is a prevalent occurrence in a person’s lifetime. Learning ways to recognize and then relieve symptoms on your own is one of the best ways to manage spinal stenosis symptoms

X-rays assist in the diagnosis of spinal stenosis because the images of the bones can reveal or confirm the narrowing of the spinal canal. MRI (magnetic resonance imaging) is often also ordered since this type of test reveals the healthy or injury of the connective tissues ie; the muscles, ligaments, discs, and can also display neural irritation. 

The limitation to any imaging is that it can display the joint structures and possible changes yet that doesn’t mean that is where the pain or symptoms are specifically coming from that a person might feel. A common misconception is that the worse an image looks (i.e. higher degree of degenerative changes) the worse the symptoms will be.  This is often not the case, and imaging has been shown time and again to not be predictive of someone’s level of disability. 

Stenosis of the spine can occur anywhere within the spinal column yet cervical (neck) and lumbar (low back) ​​are the most common places for stenosis to occur. ​​It is also possible to have more than one area of stenosis at the same time. 

How does Spinal Stenosis form?

The vertebrae of the spine run from your neck to your lower back producing the spinal column of your body. The bones of your spine form a spinal canal, which is a tunnel from the brain to the ending for the spinal cord to be protected within. Some are born with more narrow canals than others. More often over time the spinal canal narrows and causes momentary pressure on the spinal cord which in turn causes pain, tingling, or other symptoms within our neck, back arms, or legs.

There are multiple causes of spinal stenosis which may include:

  • Overgrowth of bone. Osteoarthritis that develops from wear and tear on the spinal bones can prompt the formation of bone spurs/extra bone growth, which can grow into the spinal canal. 
    • Paget’s disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.
  • Discal Changes: The discs are cushions between the vertebrae that act as shock absorbers that will change as we age (due to normal wear and tear and decreasing hydration levels). Cracks or fissures in a disc’s exterior may allow some of the soft inner material to escape and irritate the spinal cord or nerves.
  • Thickened ligaments. The tough fibrous ligaments of the spine are cord-like and help hold the bones of your spine together.  As we age, they can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal if they develop a ‘wrinkle’ that takes up space and adds pressure to the spine.
  • Tumors. Abnormal growths can form inside the spinal cord, spinal canal, within the membranes that cover the spinal cord, or in the space between the spinal cord and vertebrae. These growths take up space at their specific location which can lead to spinal stenosis like symptoms
  • Spinal injuries. Traumatic injuries, like a car accident or serious fall, can cause fractures of one or more vertebrae, leading to swelling that can put pressure on the spinal cord or nerves causing spinal stenosis-like symptoms.

Common Stenosis Symptoms: 

Cervical Stenosis (neck)

  • Neck pain
  • Numbness or tingling in a hand, arm, foot, or leg
  • Weakness in a hand, arm, foot, or leg
  • In severe cases, problems with walking and balance
  • In severe cases, bowel or bladder dysfunction (urinary urgency and incontinence)

Lumbar Stenosis (low back)

  • Back pain, that increases with attempts to stand up taller or extend backward
  • Numbness or tingling in a foot (feet) or leg(s)
  • Weakness in a foot or leg
  • Pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit

One of the most common complaints of someone with spinal stenosis is the inability to walk long distances without pain or discomfort occurring in both of the legs, usually at the same time when they are not leaning on something for support.  This same type of symptom can occur with someone who has vascular (blood flow) changes of their legs, yet the difference is that person would also have the same complaint with seated activities, like biking where someone with spinal stenosis would most likely not have the symptoms during biking. 

Pain also occurs or increases with attempts to try and stand up taller or lean back into extension. Others may experience pain, tingling, numbness, and muscle weakness. Symptoms can worsen over time and relieve almost immediately when you sit.

Knowing when spinal stenosis symptoms occur and how they will change with activity is important to understanding what exercises and stretches are best to do. Since walking tends to be painful or irritating for people with spinal stenosis, the tendency is to sit more often.

Yet increased sitting is also an increase in inactivity which can turn into a progressive weakness, changes in balance, and difficulty doing everyday tasks, like walking, getting into and out of the car, standing up from the couch, or getting out of bed.

Understanding the posture or positions that cause spinal stenosis symptoms to begin or increase is important to understand what you can do and what you need to limit. Maintaining strength and mobility is important to continuing to be able to live an active lifestyle. 

Beginning Stage of Managing Spinal Stenosis

There is no single right way to ‘treat’ this condition, but any activity that increases the symptoms should be modified to reduce further symptoms. 

Any activity that is started should have one of three goals in mind. 

  • Improve flexibility: Stretching exercises can help with pain and make it easier to hold and move your neck and spine in healthier ways.
  • Strengthen your muscles: Strengthening the muscles around your neck or low back/hips help to increase stability and strength for improved endurance and activity tolerance. 
  • Increase your Activity: Any aerobic exercise, ones that get your heart pumping and breathing rates up, release chemicals called endorphins that can ease the pain, improve heart strength, muscle endurance, and in turn improve overall activity tolerance and endurance to everyday activity. 

Increasing activity through exercise, along with good eating habits, can help you slim down if you’re overweight. This will help to improve your overall health. Choosing foods that build bone mass, strengthen connective tissue, and reduce inflammation can help you preserve your joints and reduce inflammation for an active life.

*Disclaimer: All information in this article is intended for instruction and informational purposes. The author(s) are not responsible for any harm or injury that may result.  This information is used to supplement not replace any advice you were provided from your doctor or another medical health professional.  No guarantees of specific results are expressly made or implied with this article.

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