Spinal stenosis is a bit of a “catch-all term” in the medical field. It is said that anywhere from 1.7 - 13.1% of the population is characterized as having spinal stenosis. The use of a CT scan or MRI is the most common way to diagnose this problem. The most affected regions are the:
Spinal stenosis is defined as, ‘narrowing of the spinal canal', or narrowing of the spaces within your spine. . In other words, the area where the spinal cord and nerves exist becomes narrow, or smaller in size. This can lead to a pinched nerve, neck pain, lower back pain, cervical radiculopathy, lumbar radiculopathy, sciatica, or a pinched sciatic nerve.
Stenosis is more likely to occur as we age and will worsen over time. The best defense for stenosis is prevention. Staying active, eating healthy, and maintaining a healthy weight will all decrease the chances of a spinal stenosis diagnosis.
Spinal Stenosis symptoms
Severe stenosis leads to a pinched nerve. When a nerve becomes pinched it causes sensations of tingling, numbness, burning, or weakness. If you’re experiencing weakness please seek immediate medical attention. This can be a sign something severe is occurring and could lead to permanent damage if not addressed.
Cervical stenosis (neck) symptoms:
- Tingling, numbness, or burning into the shoulder, arm, or hand.
- Weakness into shoulder, arm, or hand (requires immediate medical attention)
- Neck pain
Lumbar stenosis (lower back) symptoms;
- Tingling, numbness, or burning into the buttock, upper or lower leg, or the foot.
- Weakness into the buttock/hip, upper or lower leg, or the foot (requires immediate medical attention)
- Lower back pain
Research has shown people with spinal stenosis are also 3 times more likely to experience neck pain or back pain.
Causes for Spinal Stenosis
There are a number of problems that can lead to spinal stenosis. The most common cause are:
Herniated disc - when a disc herniates it can invade the spinal canal, thus causing spinal stenosis.
Degenerative disc disease - This is characterized as shrinking (or wear and tear) of the discs between the spinal vertebrae. This causes a smaller amount of space for the nerves to exit the spine.
Bone spurs - If a bone spur (osteophyte) is within the spinal canal it will cause stenosis.
Tumors - A tumor must be present within the spinal canal to cause stenosis.
Spinal injuries - An injury that causes the spine to curve or one vertebra to displace/slip on top of another can lead to stenosis.
However, just because someone has been diagnosed with spinal stenosis does not mean it always causes pain. Our physical therapy in Durham, NC has helped many people overcome neck pain, back pain, or nerve pain in the arm or leg even though spinal stenosis was present. With proper treatment nearly all pain associated with stenosis can be managed conservatively.
Treatment for Spinal Stenosis
Treatment really depends on the root cause of the spinal stenosis. For example, if a herniated disc is causing stenosis then treatment is different than that for degenerative disc disease. However, as the research has proven, not everyone diagnosed with degenerative disc disease, a herniated disc, or spinal stenosis will experience pain. This also means that your pain could be caused by something other than one of these diagnoses.
This is why we need to rule out other possible pain triggers prior to assuming the spinal stenosis is the root cause of the pain. This way we can make the best treatment strategy for long-term health. Here are some of our most common treatment approaches for spinal stenosis:
Decrease movements that cause stenosis: If degenerative disc disease is actually causing the pain then spinal extension should increase the symptoms. If a herniated disc is actually causing the pain then spinal flexion should increase symptoms.
Rule out referred pain: If you’re experiencing symptoms in the arm(s) or leg(s) then you’ll want to rule out the possibility of the rotator cuff referring pain into the arm. We do this by gently pressing over the rotator cuff with our fingers. If the client reports symptoms into the arm this is a positive sign that requires treatment. Piriformis syndrome can also cause pain in the leg.
A nerve can be pinched outside of the spine: Piriformis syndrome or a pinched nerve in the shoulder are two possible pain triggers that mimic spinal stenosis but aren’t.
Rule out nerve tension testing: There are 3 main branches of nerves in the arm (median, ulnar, and radial) and 3 in the leg (femoral and 2 sciatic branches: tibial and peroneal). Placing each of these nerves on tension can mimic spinal stenosis symptoms. These are easily tested with the client lying down.
Treatment for spinal stenosis ultimately comes down to treating the root cause of the symptoms. A healthcare provider should rule out any other causes that can mimic spinal stenosis symptoms prior to assuming stenosis is in fact the cause of pain.
When an accurate diagnosis of spinal stenosis is made, a physical therapist should assess the entire body for any weakness or stiffness in the shoulders, neck, spine, and hips. A stiff or weak shoulder or hip joint can lead to compensation from the spine, thus increasing symptoms.
In our experience, many people who are diagnosed with spinal stenosis are dealing with pain due to something other than the diagnosis. If you have spinal stenosis be sure to test for other factors that cause symptoms similar to stenosis.
No, it does not. This study found that 24.2% of people present with no symptoms. There are many problems that can mimic symptoms that are consistent with spinal stenosis. Therefore, be very cautious about assuming the root cause of your pain is due to spinal stenosis, even if you have been diagnosed with it.
Find a physical therapist (or another provider) who rules out all possible causes for your symptoms. In our experience, many people will be told their problem is something that it's not.
A detailed movement assessment performed on the entire body will start to identify problems that mimic spinal stenosis symptoms.
Severe spinal stenosis will cause nerve symptoms. These are tingling, numbness, burning, or pins and needles. Depending on the root cause of spinal stenosis the symptoms should improve with certain movements and get worse with other movements (spinal flexion and extension).
For example, if degenerative disc disease is causing spinal stenosis then spinal extension should increase symptoms and spinal flexion should improve symptoms.
Conversely, a herniated disc should increase symptoms with spinal flexion and decrease symptoms with spinal extension.
There are many other problems that cause symptoms similar to spinal stenosis. Therefore, find a provider who rules out all other possible causes prior to assuming spinal stenosis is the cause.
Physical therapy is unlikely to fix spinal stenosis but that doesn't mean it won't fix the symptoms associated with spinal stenosis.
You can live a healthy, active, and pain-free life with a diagnosis of spinal stenosis if proper treatment and rehab are provided.
Furthermore, surgery can be avoided for nearly all people with spinal stenosis. Find a provider who doesn't just treat the diagnosis and rules out all other possible causes for your pain.
Physical therapy should also perform a detailed full-body assessment and address any contributing movement dysfunctions.
Cortisone shots can help with the symptoms caused by spinal stenosis, but they will not improve the diagnosis itself. In fact, cortisone shots have been shown to cause cartilage damage, bone loss, and muscle loss. Occasionally, cortisone shots are necessary, but they should never be relied upon, or be the only form of treatment provided.
Regular exercise, maintaining a healthy weight, and proper nutrition are going to be your best long-term strategies for improving spinal stenosis. If you're able to exercise and pain doesn't limit you then absolutely exercise. Something as simple as walking can help immensely. Resistance training should become part of your exercise routine as it serves to improve muscle strength which will reduce the stresses placed on the spine.
It really depends on what's causing the spinal stenosis. However, movements that are painful should be avoided until the pain is improved. You'll always want to reintroduce movements that were once painful as treatment diminishes symptoms. Our bodies and nervous system require movement in all directions. In fact, most people who suffer from pain are in pain because they lack movement in one or multiple directions.
Wondering if our physical therapy clinic is the right approach for your problem?
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