Spinal stenosis: how to reduce pain and increase mobility
I’m always impressed by how active people can be in their later years and what a positive impact this activity level can have on their health and function. As a Physiotherapist, I’m fortunate enough to be given the opportunity to assist these people with maintaining and improving their physical abilities, and a common condition that interferes with day-to-day activities is spinal stenosis.
Spinal stenosis is a condition that affects about 10% of all people over the age of 65. Typically, patients with lumbar spinal stenosis present with pain, numbness or fatigue that radiates down either one or both legs. The symptoms are typically relieved quickly by sitting down or bending forward. Symptoms are believed to be the result of a narrowed spine secondary to changes over a lifetime. This narrowing puts pressure on either the spinal nerves that supply the legs or the blood supply to these nerves. Standing and bending backwards tends to narrow the space where the nerves and blood vessels reside and brings on symptoms. Conversely, when we sit, the spinal canal opens up and takes pressure off the nerves, leading to a quick improvement in leg symptoms.
An x-ray can help confirm the diagnosis but isn’t definitive; approximately 20% of all seniors have stenosis on imaging without experiencing any symptoms.
So, what are your options if you are diagnosed with spinal stenosis and want to improve your function and decrease your pain?
It used to be that surgery was thought to be the only effective treatment for spinal stenosis. Some of the more recent research suggests that spinal stenosis surgery can be effective for a few years but at eight to ten year follow-ups, patients who undergo surgery are no better than those who receive conservative treatment. A more recent clinical trial took patients with lumbar spinal stenosis that had been slated for surgery; half the patients proceeded ahead with surgery while the other half received physiotherapy. At two year follow-up, patients who received physiotherapy did just as well as the surgical patients. These facts are not meant to dissuade people for pursuing from receiving surgery for spinal stenosis but rather to suggest that the first option for a spinal stenosis patient is a thorough course of conservative treatment that includes physiotherapy.
What should your rehabilitation treatment consist of when you attend physiotherapy?
There are a number of different interventions that can be used for spinal stenosis, and they should be custom-designed based on each individual’s presentation. Generally speaking, flexion-based exercises can be used as a tool for pain relief as it helps open up the area where nerves and/or blood supply are compressed. People with spinal stenosis tend to have limited mobility in not only the low back, but also stiffness in the hips, mid-back, knees and ankles. Improving movement in these areas through manual therapy and exercise can help improve spinal stenosis symptoms.
There is also some good research suggesting that cardiovascular exercise can help decrease spinal stenosis symptoms. The problem is that most older adults use walking as a form of exercise and spinal stenosis tends to aggravate symptoms when walking, so patients often come in a de-conditioned state. If this is the case, water based exercise and stationary cycling can be good options. Finally, general strengthening and exercise to improve trunk musculature is beneficial for everyone.
If you are suffering from spinal stenosis, Physiotherapy can help and should be a first line intervention.
By Sean Overin, Physiotherapist