Spinal Stenosis
by Jennifer Martin, D.P.T.
Spinal Stenosis can cause leg pain (sciatica) and back pain, and result in difficulty standing up straight and walking. Flexing forward and sitting are usually your most comfortable positions if you have spinal stenosis.
Your spinal cord travels through the middle of your spinal column, carrying messages to and from the brain. It's a bit like an electrical circuit. There are also spaces where nerves branch off the spinal cord and travel through small holes at the sides of the vertebrae. Nerves require space to allow their electrical messages to travel without interference.
"Stenosis" comes from a Greek word meaning "narrow". If you have spinal stenosis, you have a narrowing of the spinal canal, which houses the spinal cord, or of the foramen (hole) where the nerves exit spine.
This lack of space for the nerves can place pressure on your spinal cord or on the nerves that travel to your legs or arms and interfere with the electrical messages carried by the nerves. This creates the potential for back pain, leg pain, numbness, and weakness.
In some cases, the blood vessels in and around your spine are also involved, creating claudication, which also contributes to leg pain with walking.
Naturally, due to these symptoms, stenosis can interfere with your daily activities.
Spinal stenosis is much more common in the low back (lumbar spine) than in the neck (cervical spine). In the lower back, stenosis is most likely to occur in the last two lumbar vertebrae, causing low back pain and leg symptoms.
What Causes Spinal Stenosis?
Spinal stenosis can occur naturally as a congenital condition - meaning that you were born with narrowing. Stenosis is more commonly the result of degeneration of the vertebra, discs, joints of the spine. Stenosis can also be the result of a spinal tumor.
Spinal stenosis is a diagnosis, and a diagnosis only explains the pathology that you have. It does not explain the root cause: how you got it in the first place. With the exception of congenital stenosis, you still don't know how the problem developed.
Any degenerative condition of the spine is a natural result of abnormal loads placed on the spine over a long period of time, causing a breakdown of the structures. Things that might contribute to an abnormal load on the lower back are:
- Unbalanced postural and alignment
- Poor body mechanics such as incorrect bending and lifting tactics
- Being overweight
- Core and overall weakness
- History of past back pain or trauma
Here's an Example of a Real World Cause of Spinal Stenosis...
Let's say you had a very active younger life, you backpacked with a heavy pack, played a lot of sports, and carried your children around on your hip. Throughout the years you had a few "back spasms", but these went away without much incident.
Over the last few years you've noticed that your back is very stiff and when you stand up from sitting you have difficulty and pain trying to straighten up. When you're sitting or leaning forward you have little to no pain, but as soon as you are up it's quite painful.
Sometimes you get pain and tingling down your legs. These are indicative of a narrowing or stenosis in your spine, which can develop after years of activity.
Here's another example:
Maybe you grew up on a farm and did a lot of lifting and manual labor around the farm. After you left home, you sat at a desk for work but did a lot of yard and housework on weekends but did nothing during the week to stay in good shape.
Gradually, you notice you're not able to tolerate lifting as well as you once could. One day while trimming branches on a tree overhead you get burning into both legs, as well as cramping. You noticed your balance is not as good at it used to be. Your spine has taken excessive stresses over the years, leading to stenotic changes that indicate narrowing.
Most stenosis is the result of activities done over a lifetime, often because of poor full body mechanics, and without the core muscular stabilization you need to protect your back. Through repetitive "micro injuries", your body begins to develop weakness in discs or ligaments, and bone spurs or arthritis develops, which then decreases the space for your nerves to travel, leading to stenosis.
Common Remedies and Solutions
There are several natural solutions for stenosis, including balancing your posture and alignment, learning better body mechanics and strengthening the core muscles that stabilize and support your spine. Acupuncture and nutritional changes can also be helpful for the treatment of stenosis.
Traditional medical interventions include anti-inflammatory medication (NSAIDs), epidural injections and surgery. Surgery for spinal stenosis focuses on decompressing the structures that are causing the symptoms of back pain and leg pain.
