This article will cover central spinal stenosis (not lateral (foraminal) stenosis.
What is It?
The spine or bodies backbone consists of 31 separate vertebrae. The spinal cord is a bundle of nerves that travel down the entire spinal column. Spinal stenosis occurs when there is narrowing of the spinal canal, limiting movement of the nerves.
Spinal stenosis can occur for multiple reasons, but is primarily due to age related changes, such as arthritis. For this reason, spinal stenosis is more commonly seen in individuals over 50 years of age. Other less common causes of stenosis include spinal fracture, tumors, or other trauma to the spine.
Symptoms of Spinal Stenosis
Since a major cause of spinal stenosis is osteoarthritis, symptoms typically develop gradually over time. Early on, individuals will complain of back pain, stiffness in the legs and thighs, and periodic numbness or tingling. Additionally a loss of sensation may be noted in the thighs or feet. As symptoms progress, gradual weakness or ataxia (incoordination) may be noted while walking. Typically, individuals with spinal stenosis feel better when leaning forward while performing activities. Bending forward creates more space in the spinal canal and decreases pressure on the nerves.
As spinal stenosis progresses, the severity of symptoms typically progress as well. For this reason, it is beneficial to seek medical care when you start noticing symptoms.
Treatment of Spinal Stenosis
While treatment is varied across the country, most individuals with lumbar stenosis should receive conservative management (physical therapy, NSAIDS, injections) prior to more serious medical interventions. A 2015 study by Dr. Delitto and colleagues found that surgery compared to nonsurgical treatment of lumbar spinal stenosis yielded similar long-term results. This profound study has shown that surgery is not necessary (or at least not needed as commonly) if you are suffering from lumbar stenosis.
At Heafner Health, I was recently working with someone diagnosed with moderate central spinal stenosis. During the initial evaluation, the client said, "normally I do not pay out of pocket, but this is my last option before surgery. I have had pain for 6 years without any relief from stem cell or steroid injections." This individual had pain every morning while getting out of bed. His symptoms would naturally lessen throughout the morning, but any prolonged sitting or walking increased his leg symptoms and affected his ability to work. Each evening his sense of stiffness returned, forcing him to take a muscle relaxer and CBD cream. Our sessions focused on a mobility approach, meaning we focused on the mobility of his spine and hips more than anything else. Within 6 sessions, he is no longer having leg pain during the day, and his morning stiffness decreases in minutes! While it is nice to show off our successes, more importantly it speaks to the point that surgery is not necessary. The proper interventions on a motivated patient will work!
While this approach will be different from individual to individual, a good physical therapy routine should consist of trunk strengthening exercises, decreasing pain and nerve symptoms, maximizing endurance, and lower extremity flexibility exercises. For a full review of lumbar spinal stenosis, I highly recommend reading the American Physical Therapy Associations article on Physical Therapists Guide to Lumbar Spinal Stenosis.
-Dr. Jim Heafner PT, DPT, OCS
Owner at Heafner Health Physical Therapy
Delitto A, Piva SR, Moore CG, et al. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 2015;162(7):465-473
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