Your spinal cord has a vast amount of nerves that run through a tunnel formed by your vertebrae. The tunnel is called the spinal canal. Lumbar spinal stenosis is a narrowing of the spinal canal in the lower part of your back. Stenosis, which means narrowing, can cause pressure in your spinal cord or the nerves that go from your spinal cord to your muscles. Commonly, lumbar spinal stenosis happens when spondylosis causes one or more of the following changes in the spine, such as:
- Dehydration located in the facet joints – This results in the collapse of the inner soft and decreasing the space available for the spinal nerves.
- Alterations within the facet joints – the small, stabilizing joints located between and behind vertebrae, which tend to get larger as they degenerate, compressing nearby spinal nerve roots.
- Thickening of spinal ligaments – From inside the vertebral canal, leading to compressive forces on the spinal cord and spinal nerves.
When spinal stenosis affects the spinal nerves as they run through the foramina (bone opening on each side of the lower spine), the condition is referred to as foraminal stenosis. Narrowing of the spine that encroaches on the spinal canal is also possible and is called central canal stenosis. Foraminal and central canal stenosis can occur at the same time, causing overlapping symptoms.
When lumbar spinal stenosis occurs in conjunction with stenosis at a different level, such as in the cervical spine or thoracic spine, it is then called tandem stenosis. Depending on the location of the stenosis, various neural elements, such as the spinal nerve roots, spinal cord, and / or the cauda equina, may get compressed, leading to a wide combination of symptoms.
Causes & Symptoms
Lumbar spinal stenosis has various causes. What they share in common is that they change the structure of the spine, causing a narrowing of the space around your spinal cord and nerves roots that exit through the spine. The spinal cord and / or nerve roots become compressed or pinched, which causes symptoms, such as low back pain and sciatica.
Some common causes of lumbar spinal stenosis include:
- Bone overgrowth – Osteoarthritis is the wear-and-tear condition that breaks down the cartilage in your joints, including your spine. Cartilage is the protective covering of joints. Therefore, as the cartilage wears away, the bones begin to rub against each other. Your body responds by growing new bone. Bone spurs, or an overgrowth of bone, commonly occurs. Bone spurs on the vertebrae extend into the spinal canal, narrowing the space and pinching nerves in the spine. Paget’s disease of the bone can also cause an overgrowth of bone in the spine, compressing the nerves.
- Herniated disc – Between each vertebrae is a flat, round cushioning pad that acts as shock absorbers along the spine. Age-related drying out and flattening of vertebral discs and cracking in the outer edge of the discs cause the gel-like center of these discs to break through a weak or torn outer layer. The bulging disc then presses on the nerves near the disc.
- Thickened ligaments – Ligaments are the fiber bands that hold the spine together. Arthritis can cause ligaments to thicken over time and bulge into the spinal canal space.
- Spinal cord cysts / tumors – Growths within the spinal cord or between the spinal cord and vertebrae can narrow the space and put pressure on the spinal cord and its nerves.
- Spinal injuries – Broken or dislocated bones and inflammation from damage occurring near the spine can narrow the canal space and put pressure on spinal nerves.
- Congenital spinal stenosis – This is a condition in which a person is born with a small spinal canal. Another congenital spinal deformity that can put a patient at risk for spinal stenosis is scoliosis.
Depending on the type, the signs and symptoms of lumbar spinal stenosis may be localized to specific areas in one leg or affect both legs at the same time. If the sciatic nerve roots are compressed, the symptoms are called sciatica and usually affect the lower back, buttock, thigh, leg, and possibly the foot. Compression of a lumbar spinal nerve as it enters, courses through, or exits the intervertebral foramen may cause some combination of the following symptoms and signs, including the following:
- Loss of sensation – Such as numbness, pins-and-needles, and / or tingling in one or more parts of the thigh, leg, and foot.
- Radicular pain – This originates at the source in the lumbar spine and travels along the path of the affected nerve. Radicular pain is typically characterized by sharp pain, dull and aching pain, cramping, and pain when standing for a long period of time.
- Weakness – Located in the leg muscles, making it difficult to move the leg and / or foot in different directions.
- Stiffness – Which is commonly located in the lower back.
- Foot drop – This occurs if the spinal nerve root is compressed and results in the inability to lift the front part of the foot.
When the spinal cord and / or the cauda equina nerves are compressed due to the narrowing of the internal portion of the vertebral foramen, one or more of the following symptoms may occur, typically following a symmetrical pattern in both legs:
- Abnormal sensation – such as tingling and a pins-and-needles feeling in both legs.
- Weakness – resulting in an inability to move or lift the legs.
- Gait problems – that usually involve an unsteady, wide-based walking pattern.
- Difficulty balancing – due to the sensation of not being sure-footed.
- Neurogenic claudication – This is a term that describes the set of symptoms characterized by burning pain and cramping in the buttocks, thighs, and calves while standing for long periods of time, and walking. Most patients experience neurogenic claudication as a feeling of heaviness and tiredness in the legs and difficulty in lifting / moving the legs while walking.
Who gets Lumbar Spinal Stenosis?
Elders who are aged 50 and older are more prone to developing lumbar spinal stenosis. The cumulative effects of repetitive trauma and wearing down of spinal tissues can lead to joint inflammation, spinal disc breakdown, and bony overgrowth that all may encroach on spinal canals. Other risk factors for lumbar spinal stenosis include scoliosis, trauma, and tumors.
How does it affect you? How serious is it?
In rare cases, it is possible for lumbar spinal stenosis to lead to more serious complications. Immediate medical attention is warranted when the lumbar spinal stenosis compresses the spinal cord and / or the cauda equina. Signs and symptoms that indicate compression of these tissues typically include one or more of the following below:
- Intolerably severe lower back pain.
- Severe sharp, shooting, and burning pain in the legs.
- Progressive weakness in one or both legs.
- Numbness of the inner thighs and/or around the anal region.
- Urinary retention.
- Loss of bowel and/or bladder control.
These symptoms may indicate cauda equina syndrome (compression of the cauda equina nerves) or conus medullaris syndrome (compression of the terminal part of the spinal cord).
Overall, lumbar spinal stenosis can cause mild to serious symptoms, affecting your daily life. While non-surgical treatments are tried first, the patient may decide to have surgery if the symptoms are severe and cause significant dysfunction.
Recommended Treatment & Rehabilitation
A healthcare provider will begin by reviewing your medical history, ask about your symptoms and conduct a physical exam. During your physical exam, your healthcare provider may feel your spine, pressing on a different area to see if this is what causes the pain.
Your provider will also ask you to bend in different directions to see if different spine positions bring on pain or other symptoms. Your provider will tend to check your balance, watch how you move and walk, and check your arm and leg strength. Afterward, you will have imaging tests to examine your spine and determine the exact location, type, and extent of the problem. Imaging studies include:
- MRI – Magnetic resonance imaging uses radio waves and a powerful magnet to create cross-sectional images of the spine. MRI images provide detailed images of the nerves, discs, spinal cord, and presence of any tumors.
- X-rays – X-rays use a small amount of radiation and can show changes in bone structures, such as loss of disc height and development of bone spurs that are narrowing the space in the spine.
- CT scans – A computed tomography (CT) scan is a combination of X-rays that creates cross-sectional images of the spine. A CT myelogram adds a contrast dye to more clearly see the spinal cord and nerves.
A physiotherapist’s total purpose is to help you continue to participate in your daily activities and life roles. He/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 physiotherapist will design a specialized treatment program to meet your unique needs and goals. These programs include the following:
- Gentle movement – Your physiotherapist may teach your specific movements to help take pressure off the nerve root, which can help alleviate pain.
- 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 workloads off your spinal joints.
- 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.
- Aerobic exercises – You might learn aerobic exercise movements to increase your tolerance for activities that might have been affected by the lumbar spinal stenosis, such as walking.
Your physiotherapist may decide to use a combination of other treatments as well, including:
- Manual therapy – Your physiotherapist may conduct manual therapy such as massage to improve the mobility of stiff joints that may be contributing to your symptoms.
- Equipment usage – Your physiotherapist 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 a simple change in how you stand, walk, and sit.
To improve your lumbar spinal stenosis symptoms, focus on strengthening your core, hip, and back muscles with these exercises. Here are some exercise examples for you to try:
Cat cow pose
This specific yoga pose offers gentle stretching to warm you up. Firstly, get on your hands and knees on a mat. While breathing, arch your back and extend your neck while raising your gaze to the ceiling. Hold for 10 seconds, then bring your head down and your chin toward your chest while simultaneously bringing your abdomen up and rounding your back like a cat stretching. Lastly, hold for 10 seconds, then repeat these movements 10 more times a day.
Lower back release
Lie on your back with knees bent and feet flat on the floor. Contract your abdominal muscles to pull the navel toward the spine and flatten the lower back to the floor. Hold for 5-10 seconds, then release before repeating 20 times a day.
Stand with your feet together and bring your hands together over your head. Gently reach your hands backward while arching your back without causing pain. Hold for one minute, then slowly stand upright and bring your hands to your sides. It is recommended to repeat this exercise 10 times a day.
Lie on the floor with your knees bent and feet flat on the floor. Position your arms at your sides, with palms down. As you exhale, raise your hips off the floor and push them toward the ceiling to create a slope from your knees to your chest. While continuing to breathe, hold the pose for up to 30 seconds, then return to the starting position, repeating 10 times a day.
Alternative & Homeopathic Treatment
Choices of lumbar spinal stenosis treatments depend on what is causing your symptoms, the location of the problem, and the severity of your symptoms. If your symptoms are mild, your healthcare provider may recommend some homeopathic treatments first. Here are some home remedies you can try:
- Heat application – Heat typically is the better choice for pain due to spinal injuries in general. Heat increases blood flow, which relaxes muscles and relieves aching joints.
- Ice application – If heat is not relieving your symptoms, try an ice pack or frozen gel pack. Usually, ice is applied 20 minutes on and 20 minutes off. Ice reduces swelling, tenderness, and inflammation.
- Pain relievers – Pain medications such as ibuprofen, naproxen, and acetaminophen may be used temporarily to ease the discomfort of lumbar spinal stenosis.