Spinal Stenosis

With an aging US population, spinal disorders related to degeneration are increasing. This is especially true for a condition called spinal stenosis. Spinal stenosis often accompanies other conditions such as Degenerative Disc Disease (DDD) and Degenerative Joint Disease (DJD).

What is Stenosis?

Understanding spinal stenosis begins with a Greek lesson: stenosis means “a narrowing.” So spinal stenosis is a narrowing of the openings of your spine. In a more detailed explanation, degenerative central canal spinal stenosis is the process in which the central spinal canal (which houses the spinal cord and nerves) becomes smaller, thus encroaching upon the spinal cord and nerves. The spinal canal is a bony tunnel that is formed along the entire length of the spinal column. With age, trauma and repetitive use the canal can narrow with scar tissue, additional bone formation such as bone spurs or ligament thickening.

Foraminal stenosis is another type of stenosis that affects the openings where the nerve exits the spine through a hole called the foramina. If the joints of the vertebrae start to degenerate (arthritis) they can become inflamed and swell. With long term aggravation bone spurs can form making the foraminal openings smaller thus putting pressure on the nerves.

As the spaces get smaller the nerves get compressed which may result in more swelling. This further compresses or irritate the nerves, which may then result in any of the symptoms associated with stenosis, including pain, numbness, pins and needles, weakness and even bowel or bladder problems.

Nerves need 3 things to be healthy. They need space, movement and blood flow. Stenosis is a space problem. Nerves do not like pressure and with sustained pressure the blood flow is choked off and often pain and burning are the results. As pain increases, movement often decreases and a vicious cycle begins.

Spinal stenosis is quite common because changes in the spine—like this narrowing—are a natural part of growing older. Of course, that doesn’t mean that only older people will get spinal stenosis, or that everyone will get spinal stenosis as they age, but it is more common in older people.

Here’s an amazing thing about spinal stenosis: it may not even cause you pain. The channels in your spine may narrow, but they might not press on your spinal cord or nerve roots. No pressing means no pain.

Symptoms and Causes

Degenerative stenosis is a common spinal disorder and accounts for more than 90% of spinal stenosis cases. The spine starts degenerating early in life and is accompanied by extra bone (sclerosis), widening of the vertebrae (traction spurs) and thickening of the ligaments in and around the spinal column. This leads to a progressive encroachment of the spinal cord and/or spinal nerves. With positions that extend or straighten the spine (example – standing), the canals are even further closed, resulting in symptoms. Patients often feel better when they sit down, lean forward (creating space) or bring their knees to their chest, thus opening the spinal canal and getting blood flow around the nerves.

Since spinal stenosis can gradually develop as you age, the symptoms can also gradually develop—and gradually get worse. Also, symptoms can vary a great deal. You may have no symptoms at all, since narrowing of the spinal canal or other channels does not always compress the spinal cord or nerves. But when your spinal cord or nerve roots become compressed and squeezed, you’ll feel it.

Your symptoms also depend on where your spinal canal has narrowed. Generally, spinal stenosis affects your low back (lumbar spine) or your neck (cervical spine). It’s not as common to have stenosis in your mid-back (thoracic spine).

Symptoms of Lumbar Spinal Stenosis: Spinal stenosis in your low back (lumbar spine) can cause pain or cramping in your legs when you stand for long periods of time or when you walk. The discomfort usually eases if you bend forward or sit down, but comes back when you stand upright.

Think of it this way: as you walk through the grocery store, does leaning forward on the grocery cart reduce your pain? Pain that eases when you bend forward is typical of lumbar spinal stenosis.

Symptoms of Cervical Spinal Stenosis: Spinal stenosis in your neck (cervical spine) can cause pain in the neck and shoulders. It may radiate down your arm or hand. Cervical spinal stenosis can also cause headaches, numbness, or muscle weakness. It can also affect the nerves that control your balance, which can lead to clumsiness or a tendency to fall.

Treatment for Stenosis

Studies have shown that movement, exercise and positioning are effective treatment strategies in managing and even slowing down the progression of spinal stenosis. The Physical Therapists at RehabAuthority will design personalized exercise programs aiming to increase and maintain space in and around the spinal canal as well as exercises designed to “slide and glide” the nerves in the area to enhance circulation to the nerves. Additionally, patients will be advised to make appropriate lifestyle changes to pace activities that require prolonged loading.

In severe cases of stenosis, patients may not respond well to Physical Therapy. In such cases it is not uncommon for physicians to utilize epidural steroid injections. These injections are mostly performed under x-ray (fluoroscopy) and are aimed to reduce the swelling of the nerves. These injections may reduce the swelling (create space) and allow for more effective Physical Therapy rehabilitation.

If symptoms persist, patients may be referred on to a spine surgeon for consultation. If surgery is indicated, the surgeon often performs a procedure called a laminectomy, whereby he/she cuts out a little piece of the bone in the area of the encroachment, which will help relieve pressure on the nerve and ease the pain.

Rehabilitation following these procedures is also of utmost importance as many people have been severely limited in their physical activities before surgery due to pain. The Physical Therapists at RehabAuthority will design a custom tailored rehabilitation program specific to your individual wants and needs.

RehabAuthority offers the physical therapy solutions such as back pain, shoulder pain and knee pain in Boise and throughout Idaho.