What is Lumbar Spinal Stenosis?
The word stenosis is defined as an abnormal narrowing of any opening in the body. The term spinal stenosis relates to the narrowing of either the spinal cord canal or of the nerve openings. Thi
nk of a piece of Swiss cheese. Swiss cheese has holes big enough for spinal nerves to
pass through. Change that cheese to a baby Swiss, suddenly the holes aren’t big enough—and it’s kind of like this in your spine.
(This is not meant in any way to disparage baby Swiss cheese, which is a fine cheese for sandwiches or even just a snack.)
When the holes in the lumbar spine—or lower back area--are narrowed, people can experience:
· low back pain
· feelings of heaviness or pressure in the low back
· weakness or cramping in the legs
· difficulty standing up straight (pain eased by bending forward)
· loss of balance
· pain or weakness relieved by sitting
· pain and weakness increasing with prolonged standing
· (in severe cases) paralysis and loss of bowel or bladder function
If you have moderate to severe stenosis, you may find yourself stooping over to create more space in the spinal canal and nerve openings. Even walking across the house to get to the bathroom may be difficult. The more severe the stenosis, the more likely this is to happen. But it doesn’t always happen, and that’s why there’s hope. While about 10% of patients need surgery to alleviate pressure on the spinal cord or nerves, most people with stenosis do not.
Many things can cause lumbar spinal stenosis: bony changes, disc protrusions, enlarged ligaments, fat, cysts, and swelling. When we say these things “cause” stenosis, what we are really saying is that they are taking up more space within the spinal canal than normal. Since there is a fair amount of extra room for the spinal cord and nerves within the lumbar spinal canal, people can often have stenosis without any symptoms at all. Mild stenosis is considered a normal finding on MRIs, and up to 6% of people without symptoms can have severe lumbar spinal stenosis.
How Spinal Stenosis Differs from Ordinary Low Back Pain
When it comes to treatment for back pain, people are full of advice—but spinal stenosis is different from run-of-the-mill back pain.
First of all, walking is considered the crème-de-la-crème of back exercises. But walking long distances can make spinal stenosis symptoms worse, putting more pressure on (or momentarily reducing circulation to) the spinal cord or nerve roots. I won’t say it’s impossible or even unadvisable to use walking as your primary exercise when you have spinal stenosis, but in many cases, it is not the best first choice. Options include: aquatic exercise, stationary cycling, Tai Chi, or even rowing. (Consult your physical therapist for guidance on beginning any new exercises.)
Ordinary back pain does not give you neurogenic claudication—a fancy name for the annoying leg weakness, numbness, and cramping associated with stenosis.
Ordinary back pain does not generally feel better when you sit down. With spinal stenosis, sitting down often provides immediate relief.
Ordinary back pain most often feels worse with bending. Stenotics can often touch their toes with ease. In fact, bending forward often makes it feel better.
Some common exercises for ordinary low back pain can aggravate spinal stenosis, especially very large twisting or bending backward motions. While not everyone will be aggravated (or helped) by the s
ame exercises, it pays to know what to be careful of when figuring out your exercise plan.
The Good News About Stenosis? People Can and Do Get Better.
In 2006, a study of 32 subjects with spinal stenosis followed for 20 months, showed improvements in spinal anatomy, with almost 20% of those subjects showing an increase in spinal diameter. When stenosis does progress, it is usually very slowly. There is time to work on doing things to reduce your “spinal canal clutter.” Improvements in overall health—getting regular aerobic exercise, managing blood sugar, even managing stress—can help reduce symptoms of lumbar spinal stenosis and prevent the need for surgery.
Safety Tips
DON’T try to diagnose your own spinal stenosis. A physician should help you determine the cause of your particular symptoms.
DON’T force yourself to stand up straight if it makes your legs feel weaker.
DO see a doctor immediately if you have any of the following red flags:
· Disturbance of bowel or bladder control, or numbness in the genital region.
· Sudden severe, unrelenting low back pain.
· Any unusual weight loss or weight
gain.
· Foot is dragging on the floor when you walk (“drop foot”).
· Any rapidly progressing weakness, numbness, or tingling.
Possibly the most important thing to do when you’ve been diagnosed with lumbar spinal stenosis, is to realize this is a very common condition. Only 10% of people with this diagnosis wind-up needing surgery. The more informed and proactive you are about promoting good spinal health, the better your chances of becoming symptom-free.
*Note: Always consult a physician before beginning any new exercise program or treatment plan. This information is not a substitute for evaluation and treatment from a doctor or physical therapist.
Terri Night is author of the internationally distributed best seller Rehab Your Own Spinal Stenosis: strategies to improve the health of your spine (Terrific Books, 2018).
A physical therapist specializing in back pain, back surgery rehab, and chronic pain management, her presentations have been featured at jam-packed senior center auditoriums and health expos. Terri likes to stir a little humor (the health benefits are real!) into everything she doe
s, including her physical therapy practice. For more information visit rehabspinalstenosis.com or rehabspinalstenosis on TikTok.
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