What is Spinal Stenosis?
Spinal stenosis is a narrowing of the spinal canal and foramen, which results in “choking” of the spinal cord and/or nerve roots.
Stenosis usually involves the narrowing of:
- The spinal canal in the centre of the column of bones (spinal column) through which your spinal cord and nerve roots pass.
- The spinal foramen openings between your spinal vertebrae through which peripheral nerves leave the spine and go to other parts of the body.
What Causes a Spinal Stenosis?
Spinal stenosis most often results from a gradual, degenerative ageing process of your spine. As you age, the ligaments of your spine may thicken and calcify and start to compromise the adjacent tunnels. Your bones and joints also tend to enlarge due to increased bone stress and cause bone spurs, encroach on the spine’s space. Your spinal discs, between the vertebrae, become dehydrated with age and lose their height. This disc narrowing can deteriorate quicker with injury, e.g. disc bulges or degenerative disc disease.
Osteoarthritis of your spine (spondylosis) is the most common form of spinal arthritis and is more likely to occur in middle-aged and older people. It is a chronic, degenerative process. It results from everyday wear and tear of the spine joints and is often accompanied by overgrowth of bone, the formation of bone spurs, which can cause spinal stenosis.
Spinal stenosis is most common in men and women over 50 years of age and is related to degenerative changes in the spine. However, it may occur in younger people born with a narrowing of the spinal canal or who suffer an injury to the spine.
What are the Symptoms of Spinal Stenosis?
Most commonly, spinal stenosis sufferers experience numbness, muscle weakness, diminished reflexes cramping or general pain in the arms or legs. The exact symptoms depend upon which part of your spine is stenotic and how advanced is your stenosis.
The most common stenosis regions of your spine are your lumbar spine (low back) and your cervical spine (neck), but any spinal region can suffer stenosis.
In lumbar spinal stenosis, the spinal nerve roots in the lower back are compressed. This can produce pain, tingling, weakness or numbness that radiates from the low back and into the buttocks and legs, especially with activity.
Cervical stenosis may cause similar symptoms affecting your arms and potentially your legs too!
If the narrowed space within the spine is pushing on a nerve root, you may feel pain radiating down the nerve, e.g. sciatica. However, unlike patients with sciatica due to slipped disc, this sciatica is relieved by sitting down in stenotic patients.
Classically, in stenosis patients, sitting or bending forward to flex the spine should relieve your symptoms. The flexed position “opens up” the spinal column and therefore enlarges the spaces between the vertebrae. Patients will often walk with a slight stoop forward or look downwards because keeping the lower back ‘flexed’ (bent forward) relieves their symptoms.
With this adaptive posture, the lower back is often stiff, and tightness develops in the hip flexor muscles at the front of the hips. Standing, walking or bending backwards often makes stenosis-related symptoms worse because this position causes narrowing of the nerves’ space.
Walking up a hill may be fine because leaning forwards opens up space around the nerves.
The space in the spine may narrow without actually producing any symptoms of stenosis. Only when the narrowing causes the compression of the spinal cord, nerves and nerve roots there may be an onset of stenosis symptoms.
Your neck or back may not even be painful. In severe spinal stenosis, you may experience constant or worsening back pain, numbness or pins and needles in the genital region, weakness in both legs, and or disturbances in bladder or bowel function. If this is the case, you require urgent medical attention!
How is Spinal Stenosis Diagnosed?
Your physiotherapist or doctor may diagnose you with spinal stenosis based on your symptom behaviour alone. However, the extent of your stenosis is best determined via a CT scan, MRI or myelography.
MRI Spinal Stenosis
Spinal Stenosis Treatment
PHASE I – Pain Relief & Protection
Managing your pain is usually the main reason that you seek treatment for stenosis. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.
Managing your inflammation. Inflammation is the main short-term reason for why you have suddenly developed stenosis symptoms. It best reduced via ice therapy and techniques or exercises that de-load the inflammed structures.
Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, unloading taping techniques, soft tissue massage and temporary use of a back brace.
Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen.
PHASE II – Restoring Normal ROM, Strength
As your pain and inflammation settle, your physiotherapist will turn their attention to restoring your normal joint alignment and range of motion, muscle length and resting tension, muscle strength and endurance.
Your physiotherapist will commence you on a lower abdominal and core stability program to facilitate your important muscles that dynamically control and stabilise your spine.
Researchers have discovered the importance of your back and abdominal core muscle recruitment patterns. A normal order of deep, then intermediate and finally superficial muscle firing patterns is normally required for pain-free backs. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.
Your physiotherapist may recommend a stretching program or a remedial massage to address your tight or shortened muscles.
Please ask your physio for their advice.
PHASE III – Restoring Full Function
As your back’s dynamic control improves, your physiotherapist will turn their attention to restoring your normal pelvic and spine alignment and its range of motion during more stressful body positions and postures. They’ll also work on your outer core and leg muscle power.
Depending on your chosen work, sport or activities of daily living, your physiotherapist will aim to restore your function to safely allow you to return to your desired activities.
Everyone has different demands for their body that will determine what specific treatment goals you need to achieve. For some, it is simply to walk around the block. Others may wish to run a marathon.
Your physiotherapist will tailor your back rehabilitation to help you achieve your own functional goals.
PHASE IV – Preventing a Recurrence
Back pain does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal and core muscle exercises. You should continue a version of these exercises routinely a few times per week. Your physiotherapist will assist you in identifying the best exercises for you to continue indefinitely.
In addition to your muscle control, your physiotherapist will assess your spine and pelvis biomechanics and correct any defects. It may be as simple as providing you with adjacent muscle exercises or some foot orthotics to address any biomechanical faults in the legs or feet.
General exercise is an important component to successfully preventing a recurrence. Your physiotherapist may recommend pilates, yoga, swimming, walking, hydrotherapy or a gym program to assist you in the long-term.
Fine tuning and maintenance of your back stability and function are best achieved by addressing any deficits and learning self-management techniques. Your physiotherapist will guide you.
What is Your Prognosis for Spinal Stenosis?
The success of treatment for stenosis is very good. A well-respected scientific study reported a 95% improvement in stenotic symptoms at 12 months. Surgery did provide with the quickest relief with a small risk of complications eg infection. A physiotherapist guided exercise protocol provided similar outcomes to surgery within a few months. But, both groups had a similar patient perceived improvement at 12 months. If you are interested in the spinal stenosis exercise protocol, please consult your PhysioWorks physiotherapist to see if you are a suitable candidate.
Other Treatment Options
If your stenosis symptoms persist, you could consider an epidural corticosteroid injection. While these injections can seldom be considered curative, they can alleviate the pain in about 50% of cases in the short-term.There are a number of complications and risks and therefore options should be discussed with your doctor.
Epidural injections appear to work most effectively when undertaken in conjunction with an active rehabilitation exercise program designed by your physiotherapist.
Spinal Stenosis Surgery
Surgery may be considered in patients where conservative treatment has been unable to prevent worsening symptoms. Surgery is usually only considered when the patient has severe constant pain that is making everyday tasks impossible and they have failed conservative exercise-based physiotherapy.
Surgery is more effective in those people who have leg pain from spinal stenosis. The results of surgery can be mixed and there tends to be a poorer outcome in patients who have diabetes, hip pain or pain that is predominantly in the back. Surgery will also be considered immediately if you experience numbness or pins and needles in the genital region; weakness in both legs; and or disturbances in bladder or bowel function. You will be referred to a spinal surgeon for their expert opinion.
The type of surgical intervention will be based on your specific pathology. The most common surgical procedure is a laminectomy, where a section of your vertebrae is removed to open the stenotic bone tunnel.
Common Lower Back Pain Causes
The following conditions may cause lower back pain.
- Back Cramps
- Back Muscle Pain
- Core Stability Deficiency
- DOMS - Delayed Onset Muscle Soreness
- Side Strain
- Back Stress Fracture
- Scheuermann's Disease
- Spinal Stenosis
- Stress Fracture Spine (Cricket Bowlers)
Back Joint Injuries
Youth Spinal Pain
Teenager Neck & Back Pain
Teenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control.
The competitive athlete and most individuals who exercise regularly or maintain fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports. Your physiotherapist can assist in the resolution of any deficits in this area.
Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions.
Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist with a particular interest in these types of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.
Common Adolescent Spinal Injuries
Lower Back (Lumbar Spine)
Midback (Thoracic Spine)
Neck (Cervical Spine)
For specific advice regarding youth neck or back pain, please seek the professional advice of your trusted spinal physiotherapist or doctor.