Have you been diagnosed with stenosis or are you wondering if this is something that you've been dealing with? Can you only walk a short distance before you feel like you need to sit down and rest due to pain?
Sometimes, we see patients that were diagnosed with stenosis years ago and they are told that surgery is the only option for a normal healthy life. At this rate, patients begin to just avoid doing the activities they love and their quality of life begins to decrease.
When patients come into the office we make it clear that we cannot change that diagnosis but can help you manage it.
What is Spinal Stenosis?
Spinal stenosis often occurs when there is a narrowing of the spaces within the spine. When these spaces narrow it can put pressure on the nerves that travel through those spaces in the spine. Often the symptoms will be seen in the legs of the patients.
Some of the symptoms include:
As previously described, stenosis is a narrowing of a passageway in the body. In LSS (lumbar spinal stenosis) we are referring to two specific areas that can become narrowed. The neuroforamina where the nerve roots exit the spine is one location and the spinal canal itself is the other. When the neuroforamina is obstructed, we typically present with single sided symptoms. These are commonly due to disc herniations and often described in laymen’s terms as a “pinched nerve.”
Today we will be focusing on a narrowing of the spinal canal which may be more specifically termed “Central Spinal Canal Stenosis” There are numerous causes for the narrowing of these passageways, including severe disc herniations, chronic degenerative changes to the bone, traumas, or infections to name a few. In all of these examples, there is some change to either the soft tissue or bone that has led to the narrowing of the spinal canal.
In the chronic LSS, the changes in your anatomy that may lead to stenosis are more likely to be degenerative changes of the spine such as bone spurs. In many cases “spinal degeneration” is a normal part of aging, often compared to wrinkles of the skin. Often, these “wrinkles” will have no symptomatic significance, but in more severe cases these bony growths can actually begin to narrow or cause “stenosis” where the nerves pass through. When these passages become too narrow, the nerves that pass through them can be impacted. This may lead to numbness, tingling, radiating pain or in more serious cases loss of muscular strength.
What do we do to help manage stenosis?
First, we start with a thorough exam to ensure we are treating the right condition. One of the big differences between spinal stenosis and basic low back pain is the actual stenosis that is occurring within the spine.
When someone is dealing with spinal stenosis they will report an increase in symptoms when standing or walking, but significant relief when they sit down. When dealing with basic low back pain it is actually the opposite.
Central lumbar spinal stenosis is evaluated and diagnosed with a combination of MRI imaging along with a correlating physical exam. A thorough medical history, health history and physical exam can provide guidance to a clinician in determining whether the patient is suffering from LSS or a different pathology that has led to their symptoms.
An MRI may also be performed to determine how stenotic the foramen are however research indicates that the degree of stenosis visualized on an MRI image does not correlate well with the severity of symptoms.
Treatment of Spinal Stenosis
We have a variety of ways to treat those with stenosis and research shows a few styles of treatment are effective in managing spinal stenosis. Manipulation, either manual or with an instrument is helpful when treating spinal stenosis. Often the patient dealing with spinal stenosis will benefit greatly from distraction or decompression techniques that will help open up those spaces in the spine that are narrowing.
We use the technique of flexion distraction which addresses the range of motion in the joints and the flexibility of the nerves to move throughout the motions of lumbar flexion and laterally bending.
We also like to use exercise to help maintain progress while patients are not in the office. We work a lot with the patients in the office with these exercises so that they are comfortable performing them at home.
These exercises increase strength in the spine, as well as mobility. Another crucial aspect when it comes to treating spinal stenosis is core stabilization. When manipulation and exercises are combined, we can show patients how much they are actually capable of doing and that spinal stenosis does not have to be the end of their lifestyle.
You are not your diagnosis! Reach out when you're ready to take your life back and let's start managing your stenosis and getting you back, doing the things that you love.