Spinal Stenosis

Can Physiotherapy help Spinal Stenosis?

About 80% of people will have back or neck pain during their lifetimes. One cause of back or neck pain can be spinal stenosis.

What is Spinal Stenosis?

Spinal stenosis is a narrowing of the openings in your vertebrae and spinal column that your spinal nerves and spinal cord travel through.

The narrowing within your vertebrae and spinal column results in too much pressure on the spinal cord (central stenosis) or your spinal nerves (lateral stenosis). Spinal stenosis may occur in the neck or in the low back.

What causes Spinal Stenosis?

The most common reason for spinal stenosis developing is related to age-related bony degeneration in your spine:

Degenerative changes in the cartilage between your joints cause Osteoarthritis to develop. In response to these degenerative changes within the joint space, your body can create additional bony growth (bone spurs) to attempt to provide additional support to your joints. This additional bone spurs can place pressure on your spinal nerves where they exit your spinal canal.

As we age, our spinal discs lose fluid and reduce the space between each vertebra (a common reason for losing height as we get older). This narrowed space leaves less room for your spinal nerves to exit from your spinal cord.

Spinal injuries from falls or accidents when we are younger, diseases of the bone or spinal tumors can also create a thickening of specific spinal ligaments, which in turn can also lead to spinal stenosis.

Signs and Symptoms of Spinal Stenosis

Pain, numbness, tingling, or weakness in either of your arms and shoulders, legs, or trunk

Occasional problems with bowel or bladder function

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.

Diagnosis of Spinal Stenosis

Your physiotherapist will conduct a thorough subjective and objective examination of your spine, including talking to you about your past medical history.

Other questions we may ask are the area and quality of your pain, weakness, and other symptoms such as numbness or pins and needles. We may also ask about any bladder or bowel weakness or dysfunction or reduced capacity to use your limbs.

Your City Physiotherapy your physiotherapist may look at your muscle strength and sensation to determine how severe the pressure on your spinal nerve or spinal cord is. We will observe your posture and the range of movement of your spinal joints and limbs. We perform a hands-on assessment of your individual spinal joints to determine how immobile they have become.

We may refer you for X-ray or MRI imaging of your spine to assist us in making our diagnosis.

Recent research tells us that physiotherapy management and conservative care will result in better outcomes in every case except the most severe cases of spinal stenosis (severe muscle weakness or extremely high levels of pain) over surgery.

Physiotherapy Can Help Spinal Stenosis Symptoms – Don’t put up with pain

Your Physiotherapy treatment will consist of a range of treatments, including teaching you specific movements to take pressure off your nerve root, thereby reducing pain.

You will learn specific range of movement and stretching exercises to improve mobility in your spinal joints and flexibility of your muscles. Better range of movement in your spinal joints and muscles can provide very good pain relief.

Your Physiotherapist will teach you dynamic core strengthening exercises in addition to strengthening exercises for your upper limbs, lower limbs, and neck.

Increasing your cardiovascular exercise tolerance (Aerobic Exercise) will also help to calm down your nervous system response to pain and increase your ability to cope with activities that you may have stopped previously.

So far, the treatment sounds like you have to do a great deal of exercise, but the good news is that research indicates that if you can increase your tolerance for more specific exercise you will be able to manage your pain and other symptoms more efficiently.  This is a very important aspect to your overall recovery, as self- management tools and attitude towards empowering yourself with tools to assist the management of your spinal stenosis and other chronic pain conditions is a strong predictor of how your nervous system will cope with a diagnosis like spinal stenosis.

Your physiotherapist will most likely use a variety of other treatments such as dry needling, mindful-based stress reduction techniques, postural re-education and other manual therapy techniques.

Acute Medical Management of Spinal Stenosis

From a conservative medical treatment perspective, you may require medication to assist your pain and inflammation in your acute stage recovery. This will be discussed with your GP.  It is important to note that traditional pain medication such as opioids are not usually prescribed as they have been shown to have minimal first line effects of reducing pain that arises from your spinal stenosis placing pressure on your nervous system (neuropathic pain). In fact, these kinds of medications have been shown to wind up the nervous system over the longer term and can lead to a vicious cycle of pain and or dependence developing. Hence prescription of codeine-based medications is usually not given or not for very long, if at all.  Medications you may be prescribed may include medications such as anti-inflammatory medication, medication to assist in calming the nervous system (low-dose tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors) and/or medication to calm the spasms in your muscles (low-dose anticonvulsants).

The Good News 

 Spinal stenosis can be managed with conservative treatment, even though the cause for spinal stenosis does not go away. It is very important to be vigilant about your self-management and to develop a good partnership between yourself, your physiotherapist and your medical practitioners so that together we can tackle your spinal stenosis. You must have the right tools at your disposal and we can be there to assist you with treatment to maintain the health of your spinal cord and spinal nerves to ensure you live the best quality life you can.

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