By Dr Danica Newbold, B.HSci (Chiro), M.ClinChiro, Ad.Dip Myo. Certified Cox® Technic Chiropractor and Myotherapist.
Lumbar Spinal Stenosis is a complex, painful, and sometimes debilitating condition. A chronic disorder, it is a progressive spinal condition quite often associated with ageing and degeneration.
It is characterised by the narrowing of the spinal canal spaces, which house the spinal cord and spinal nerves, putting pressure on them, and causing pain, numbness, and weakness in the lower limbs. It may present as lower back and/or leg pain (either one-sided or both) that is increased with activity (such as walking). Patients often describe the relief of their symptoms upon rest or leaning forward. Numbness, tingling or decreased sensation from the lower back into the leg/s may also be noted – also commonly associated with balance issues and falls in the elderly.
Degenerative changes in the spine are seen in up to 95% of people by age 50 (1). Spinal stenosis most often occurs in adults over the age of 60 (1). It is estimated that by 2025, 6 out of 10 people over 65 will be diagnosed with spinal stenosis. Diagnosis is often long and laborious; patients have usually been to numerous doctors, specialists, and healthcare practitioners in an effort to find relief for their symptoms. Confirmation of spinal stenosis can often be made based on detailed clinical history, physical examination and specific imaging of the spine (MRI or CT).
Conservative management of spinal stenosis may involve several modalities, including:
- Active Physical Therapy – such as exercise, spinal stretches, and core strengthening/rehabilitation.
- Passive Physical Therapy – such as gentle Chiropractic care utilising Cox® Flexion-Distraction and Spinal Decompression Therapy and soft tissue therapies.
- Analgesia and Anti-inflammatories – Pain and inflammatory management are essential factors when managing spinal stenosis. Your primary physicians can provide you with the best advice regarding this.
- Steroid injections (also known as epidural steroid injections) – Cortisone injections around the nerves or in the “epidural space” in the spine may decrease swelling and pain. However, the long-term benefits of epidural steroid injections have not been proven (3).
- Surgery – Surgical interventions are usually reserved as a last resort for patients with spinal stenosis. Procedures may include surgical nerve root decompression (laminectomy) or spinal fusions. Surgery appears effective in carefully selected patients who present with back, buttock, and lower extremity pain and do not improve with conservative management (3). In 2016, a Cochran review of surgical and non-surgical interventions for Lumbar Spinal Stenosis (LSS) was conducted. It revealed that “no clear benefits were observed with surgery versus non-surgical treatment.” However, the author did conclude that the rate of side effects of undergoing surgery ranged from “10% to 24%” and that “no side effects were reported for any conservative treatment” (2). Approximately 600,000 surgical procedures are performed in the US for lumbar spinal stenosis (3).
Long-term commitment to conservative management is essential to achieving the desired outcomes of a more pain-free and productive lifestyle, all of which may be obtained under conservative management. A study has revealed that patients often benefit from individualised treatment and rehabilitation programs and that exercises improved their overall pain levels and physical limitations (4). If you have symptoms of, or have been diagnosed with Lumbar Spinal Stenosis, speak to one of our Cox® Certified Chiropractors in clinic about this complex condition and what management options would best benefit your condition.
REFERENCES:
- https://orthoinfo.aaos.org/en/diseases–conditions/lumbar-spinal-stenosis/
- Zaina F, Tomkins‐Lane C, Carragee E, Negrini S: Surgical Versus Non‐Surgical Treatment For Lumbar Spinal Stenosis. Cochrane Database Syst Rev 2016;(1):CD010264
- Katz JN,Zimmerman ZE,Mass H,Makhni MC. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA 2022; 327(17):1688‐1699.
- Bove A, Lynch A, Ammendolia C, Schneider M: Patients’ experience with non-surgical treatment for lumbar spinal stenosis: a qualitative study. Spine J. 2018 Apr;18(4):639-647. doi: 10.1016/j.spinee.2017.08.254. Epub 2017 Sep 21.
Top 3 Stretches for Spring
SEATED NECK STRETCH
From a seated position, tilt your head to the side, with the opposite arm (to head tilt) reach over your head and gently pull down on the head towards the shoulder. Hold for 30-60 seconds. Remember to do both sides!
LEG ROLL
Position yourself lying flat on the floor with an exercise ball placed under the legs. Ensure the hips and knees and bent to approx. 90 degrees. Gently and slowly rock to ball from side to side, halfway down to the floor on each side. Continue for 30-60 seconds.
RESISTANCE BAND SQUATS
From a squat position, grasp the ends of a resistance band in each hand and position it under the feet, ensuring they are shoulder-width apart. Engage the core and keep a neutral spine., standing to a fully upright position. Ensure when squatting, the knees do not extend too far over the toes. Repeat 5-10 times
