Lumbar Spinal Stenosis
Lumbar spinal stenosis is the medical term used to describe a condition where a segment or segments of the spine are narrow. While there are many forms of spinal stenosis, this article will concentrate on the two most common types. Lumbar spinal stenosis is described as central or lateral. Central stenosis is narrowing around the spinal canal (Fig 1), whereas lateral canal stenosis is narrowing where the nerves exit the spine at the intervertebral foramen (Fig 1). Stenosis becomes common as we age and our spine undergoes wear and tear, termed 'degeneration'. The Degenerative changes are termed "degenerative disc disease', "facet joint arthritis', etc. Degenerative changes are a normal process of aging and our body can typically adapt to these changes. However, if the body's natural adaptation becomes overloaded with extra stress and strain, in combination with these degenerative changes, then the nerves can become irritated. These degenerative changes have the effect of reducing the space that the nerves have to exit the spine i.e. there is a narrower tunnel.
The typical symptom of lumbar stenosis are an increase in leg pain (either one or both legs) and / or pins and needles while walking or standing. Walking and standing reduce the space that the nerve has to exit the spine. The combination of the normal narrowing and the degenerative changes can, over time, create the nerve irritation. Walking with a flexed spine, sitting or bending forward will ease the symptoms, as these positions increase the space for the nerve(s). Symptoms will usually, but not always, develop gradually and are almost always associated with a history of lower back pain.
It is important to properly diagnose lumbar spinal stenosis as other conditions, like vascular claudication, should be ruled out. An examination will consist of taking your history and a physical examination of both the spine and nervous system.
The goal of treatment is to improve spinal mobility and open the space for the nerve(s). While it is impossible to reverse the degenerative changes of the spine, lumbar spinal stenosis symptoms will typically improve with Manual Physical Therapy treatment. Treatment can include:
- Manual Therapy including joint mobilization and soft tissue mobilization.
- IMS dry needling - needling the muscles of the spine to relieve muscle spasm that will limit spinal mobility.
- Lumbar Traction - to open the space for the nerve.
- Electrical Stimulation - for pain relief and muscle relaxation.
- Specific Therapeutic Exercise - to improve mobility and strength of the spine, pelvis and hips.
- Education - on activity modification, aerobic exercise and posture.
If your symptoms are not improving with Manual Physical Therapy then you should follow-up with your family doctor for other options i.e. medication, injections, surgical consultation, etc.