It is estimated that as many as 80% of us will experience some form of back or neck pain at some point in our lifetimes. Spinal stenosis can be one cause of back and neck pain. It affects your vertebrae (the bones of your back), narrowing the openings within those bones where the spinal cord and nerves pass through.
Spinal stenosis is a narrowing within the vertebrae of the spinal column that results in too much pressure on the spinal cord (central stenosis) or nerves (lateral stenosis). Spinal stenosis may occur in the neck or in the low back.
The most common causes of spinal stenosis are related to the aging process in the spine:
In most cases, symptoms of spinal stenosis can be effectively managed with physical therapy and other conservative treatments. Only the most severe cases of spinal stenosis need surgery or spinal injections.
Spinal stenosis may cause symptoms such as:
If you have spinal stenosis in the neck (cervical spinal stenosis), you may have weakness, numbness, and pain in one or both arms and often in the legs, depending on which nerves are affected. You may or may not have pain in the neck itself.
If you have spinal stenosis in the low back (lumbar spinal stenosis), you may have pain, numbness, and weakness in the low back and one or both legs, but not in the arms. Your symptoms may get worse with walking and improve with sitting.
Because the symptoms of spinal stenosis are often similar to those of other age-related conditions, a careful diagnosis is important. Your physical therapist will conduct a thorough evaluation, including a review of your medical history, and will use screening tools to determine the likelihood of spinal stenosis. Your physical therapist may:
If you have muscle weakness, loss of sensation, or severe pain, diagnostic tests such as an X-ray or MRI may be needed. Physical therapists work closely with physicians and other healthcare providers to ensure that an accurate diagnosis is made and the appropriate treatment is provided.
Research shows that in all but the most extreme cases of spinal stenosis (usually involving muscle weakness or high levels of pain), conservative care, such as physical therapy, achieves better results than surgery.
Your physical therapist’s overall purpose is to help you continue to participate in your daily activities and life roles. He or she will design a treatment program based on both the findings of the evaluation and your personal goals. The treatment program likely will be a combination of exercises.
Your physical therapist will design a specialized treatment program to meet your unique needs and goals. Your program may include:
Gentle Movement. Your physical therapist may teach you specific movements to help take pressure off the nerve root, which can help alleviate pain.
Stretching and Range-of-Motion Exercises. You may learn specific exercises to improve mobility in the joints and muscles of your spine and your extremities. Improving motion in a joint is often the key to pain relief.
Strengthening Exercises. Strong trunk (abdomen and back) muscles provide support for your spinal joints, and strong arm and leg muscles help take some of the workload off your spinal joints.
Aerobic Exercise. You may learn aerobic exercise movements to increase your tolerance for activities that might have been affected by the spinal stenosis, such as walking.
This might sound like a lot of exercise, but don’t worry: research shows that the more exercise you can handle, the quicker you’ll get rid of your pain and other symptoms!
Your physical therapist may decide to use a combination of other treatments as well, including:
Manual Therapy. Your physical therapist may conduct manual (hands-on) therapy such as massage to improve the mobility of stiff joints that may be contributing to your symptoms.
Use of Equipment. Your physical therapist may prescribe the use of rehabilitation equipment—such as a special harness device that attaches to a treadmill to help reduce pressure on the spinal nerves during walking.
Postural Education. You may learn to relieve pressure on the nerves by making simple changes in how you stand, walk, and sit.
Spinal stenosis usually is a natural result of aging. Research has not yet shown us a way to prevent it. However, we do know that you can make choices that lessen the impact of spinal stenosis on your life and even slow its progression.
Your physical therapist can help you develop a fitness program that takes into account your spinal stenosis. There are some exercises that are better than others for people with spinal stenosis, and your physical therapist can educate you about what exercises and activities you should avoid. For instance, because walking is usually more painful than sitting, bicycling may be a better way for you to get regular physical activity. All low back pain is different and unique to each individual. Your physical therapist will design a specialized exercise program for you based on your movement exam, your health profile, and your goals.