Living Well with Stenosis: 7 Tips for Lumbar Spinal Stenosis
Updated: Mar 3, 2019
The following information was presented in a lecture at the Golden Future 50+ Expo in Pasadena, California on May 13th, 2017:
My name is Terri Night. I’ve been a physical therapist since 1988—so, coming up I’ll be going on 30 years. Boy, did that fly by! In my career, I’ve worked all up and down the West Coast, including the Cedars Sinai Institute of Spinal Disorders, and with some of the best spine surgeons in the country.
Like the many of you, I have my own “back” story. When I was 25, I had what I like to call my "jackass injury." I was taking classes in a Brazilian martial art called Capoeira, and was in the best shape of my life. I was walking down the sidewalk one day and, for some reason, thought it would be a good idea to take a running, leaping kick. I planned to do this kick as I sailed past a speed-limit sign, and (a la Singing in the Rain meets Rush Hour II) grab the sign pole and twirl around. This turned out to not be such a good idea. As I flew past the sign, I grabbed the pole at the last second and a sharp jolt stabbed into the base of my spine. It was my L5-S1 disc. After that, I could hardly walk for months. Even though I was a PT and knew a thing or two about rehabilitation, it took me quite some time to recover from this injury.
By the time I was 37, I was diagnosed with degenerative disc disease, and a few years later, I began noticing that my legs felt very heavy at the end of going for a run. This wasn’t the usual “my legs are tired from running” sort of heaviness. Those of you with spinal stenosis might know exactly the feeling I’m describing. Soon, I started getting it even when I walked long distances. I began using trekking poles to help myself walk farther.
I wrote my book Rehab Your Own Spinal Stenosis after working with many people who felt scared and confused after being told they had this disorder. I wanted to let people know that it’s possible to get better and to do it without surgery. I also wrote it to help myself in my own journey with managing spinal stenosis.
I had originally planned to go over the “23 Tips for Spinal Stenosis” that are listed at the end of my book, but I think that is a little overly ambitious for a 20-minute talk, so instead I’m going to review what I think are 7 really good general tips for managing spinal stenosis.
But what is spinal stenosis anyway? Spinal stenosis is the narrowing of the spinal canal, which the spinal cord runs through. You can also have narrowing in the nerve openings of the spine, but the symptoms are a little different for this. Some of the classic symptoms of lumbar (low back) stenosis are difficulty standing upright and difficulty standing or walking long distances. People with lumbar stenosis find themselves stooping over to create more space for their spinal cord. In some cases, even walking across your house to go to the bathroom is impossible without stooping over or using a walker. This is because the message from your spinal cord is not getting to your legs to make them work properly.
What causes it? Well, I go over this more extensively in my book, but it is usually a combination of bony changes, disc protrusions, unhealthy ligaments, swelling, and poor circulation. Many of the things on this list can be improved by better health and regular aerobic exercise.
Tip #1: Stay Informed
It’s important to stay informed because there’s a lot of false information and myths out there. People think they’re automatically going to wind-up paralyzed, etc… I have a blog post here that talks about 7 Common Myths of Spinal Stenosis, but a few of them are:
That spinal stenosis always gets worse. (Yes, it’s usually a degenerative disorder, but it doesn’t always get worse). It can get better. Even an MRI can look better than it looked in previous years.
That spinal stenosis is rapidly progressing. (Actually, when it progresses at all, it’s usually a very slowly progressing disorder). This is great news! It means you have time to work on your health and possibly start feeling better. I’ve seen this happen with my patients. I’ve seen this happen with myself. Last night, I was on a Facebook Spinal Stenosis Support Group Page. A woman posted that she’d been suffering with stenosis for seven years, but that in the past few months (after making an effort to exercise regularly), she felt…better. “What’s going on?” she wrote. “Is this even possible?” Yes, it’s possible. You can feel better.
That you should FORCE yourself to stand and walk upright. When you are stooping over, it’s to create space in your spinal canal so that your legs don’t give out. (Now, I’m not telling people they shouldn’t try to stand up straight—of course, you should, as much as you can comfortably—but you shouldn’t force yourself to or let anyone else force you or guilt-trip you about it.) My advice is to take a rest when you feel yourself start to stoop—or use exercises different from walking to get your aerobic workout. Or use trekking poles or a cane to help you stay upright longer.
Tip #2 Work on Decreasing Inflammation
Swelling and inflammation exacerbates pain and can take up space in the spinal canal. It can also contribute to poor health in your tissues. In my book, I devote a whole section to this topic. Today, I’d like to recommend trying ice to the low back for 10 minutes, three times per day for five consecutive days (with permission from your physician). Both heat and ice work equally to reduce inflammation, but I prefer ice because it interrupts the pain signal. I’d like to also recommend avoiding repetitive motions through extreme ranges (study and change how you move when you do the simplest things, even doing dishes), and being able to take breaks in life. Some people are just unable to take breaks or say no. This is as important of a health improvement as any other. I also recommend asking your doctor about anti-inflammatory diet foods and spices such as turmeric—as well as foods that can cause inflammation. Of course, we want to avoid those. Regular exercise also increases inflammation-fighting substances in your tissues. Yes, exercise can actually fight inflammation!
Tip #3 Use Strategic Exercise
Current research indicates that regular aerobic exercise is one of the most important factors in determining whether a person with spinal stenosis can live relatively symptom-free. (Some people say there’s a specific muscle that you can strengthen and that’s all you have to do—but there is no clinical evidence of that. Aerobic exercise is still the best exercise we have.) The American Heart Association recommends 150 minutes per week of moderate aerobic exercise to promote good cardiovascular health. Strategic exercise means that we use what we know about stenosis to strategize the best way to get that 150 minutes per week.
Some healthcare providers give a blanket instruction to just “get out and walk” with no guidance on what to do if your legs start giving out or your pain becomes so severe you just can't tolerate it. In my book, I review a variety of strategies to get past this. Walking is important for sure, but when you can’t walk, you can add things like a recumbent bike, water exercise, a rowing machine, weight-lifting, and shuttle walking. You can also increase your walking distance (and aerobic workout) by using trekking poles to help take pressure off the spine.
Too many people are told by their physicians to get out and walk—and, what do they do? They force themselves to start walking an hour a day, or something outrageous like that. These are people who may not have even walked more than five minutes on most days, and they push themselves way too hard too fast. So strategic exercise is also making sure you ease in to things slowly.
Is anyone wondering what aerobic exercise has to do with spinal stenosis? What does that have to do with a narrowed spinal canal? Well, it has a lot to do with it, because circulation is key to reducing spinal stenosis symptoms. If you have unhealthy ligaments due to poor circulation, they take up more space in the spinal canal. Your discs have a very tiny circulation system, and when you’re in poor aerobic health, this system essentially dries up. Your spinal cord also has a blood supply too, of course. In short, improving circulation to your spine is the most crucial thing you can do!
Tip #4 Improve Health and Wellness
One study on spinal stenosis showed that 6% of a symptom-free group of people had severe spinal stenosis on their MRI’s. I don’t know about you, but I want to know what those people are doing! By and large, they have a low number of health problems. They are non-smokers, light drinkers, manage stress well, they have a healthy body weight, they have a healthy attitude about pain, and so on. Some health conditions that contribute to spinal stenosis symptoms include: diabetes, obesity, sleep apnea, smoking, alcoholism, and poorly managed stress. Improving health and wellness is a huge factor in stenosis.
Tip #5 Do Breathing Exercises
Recent studies show a strong connection between breathing disorders and back pain, possibly even stronger than being out of shape and obesity! Working on your breathing reduces stress and increases circulation to the spine. Our main breathing muscle, the diaphragm, is actually attached to the lumbar spine. Ask a physical therapist to teach you how to practice diaphragmatic breathing. You can also just look it up on youtube or practice in yoga, meditation, or Tai Chi classes. Qi Gong is also an excellent practice for breathing.
Tip #6 Train Your Brain
Did you know chronic pain can change your brain? It’s true. When we have an acute pain, such as stepping on a nail, that information is usually processed by a certain part of our brain. This enables us to react to a dangerous threat—we are stepping on a nail, we want to react fast and keep our foot from stepping down any further. We will want to put a bandage on to prevent infection, etc… When we have chronic unrelenting pain, it moves to a different part of our brain, a part of the brain that also processes emotions and stress. Emotions and stress can then affect the severity of our pain. Additionally, when we have chronic pain, our brains can start creating our pain for us, even without any reason for it being there. An excellent example of this is when amputees have “phantom limb” pain—pain in an arm or leg that is no longer even there.
One study indicated that in back pain patients, learning about how pain works in the brain is more helpful for reducing symptoms than teaching people about spinal anatomy and why their back hurts. (Yes, scaring people with their terrible MRI reports
may not be helpful for their symptoms!)
I’d like to refer you to an excellent book on this topic called The Brain That Changes Itself by Norman Doidge. The entire book is fascinating, but the chapter on pain may be especially helpful. This book can also lead you in the right direction for training your brain to reduce the severity of your pain. It is possible.
Tip #7 Do Tai Chi
This tip is a new one for me. I took my first Tai Chi class in 2016. At the time, to keep my legs from feeling weak, I was using trekking poles when I took long walks. After two months of doing only 5-15 minutes of Tai Chi per day, I didn’t need the trekking poles anymore. I was shocked. Now, I try to incorporate some Tai Chi into all of my patients’ home exercise programs. I love that it incorporates so many aspects of health: strength, breathing, balance, meditation, and stress management. I can also say with confidence that it’s something anyone can do. If you can’t stand to do it, you can do it sitting. If you can’t sit, you can do it lying down. If you can’t even move at all, you can still benefit from visualizing the movements.
Tai Chi is a type of moving meditation using slow, controlled movements. For stenosis, I highly recommend the Tai Chi for Rehabilitation program by Dr Paul Lam. There are a number of teachers in several states, or you can purchase a video on-line. Many senior centers offer Tai Chi classes as well.
Conclusion: When I was working on my book, I interviewed a noted spine surgeon in Seattle and asked him, "What would you like me to tell people who are looking for help with spinal stenosis?"
"Circulation," he replied. "Tell them it's about circulation. They have to get healthy. They have to walk and exercise."
"And tell them this too," he added. "We don't treat MRI results. We treat people. We treat their symptoms."
This brings to mind a 2006 study out of the University of Michigan that looked at 150 people age 55 to 80. They were all given MRIs, and then clinicians had to figure out which ones had symptoms--based on the MRIs. The study showed no relationship between MRI and clinical diagnosis. The conclusion was that "MRI does not determine if stenosis is a cause of pain." This is really good news for people who want to get better, but think their MRI is evidence that it is just impossible. I don't want to discourage people who need surgery from getting surgery. In certain cases, surgery is absolutely necessary. But if your symptoms are manageable and not putting you at risk, there is definitely hope for improvement.
Note: DO NOT TRY TO DIAGNOSE YOURSELF.Always consult a physician regarding any symptoms of back pain or stenosis.