Lumbar spinal stenosis is associated with spine degeneration and can be debilitating. It happens most often in the neck and lower back, making it difficult to carry out daily tasks. While there is no cure, there are treatments to help ease the uncomfortable symptoms.
When doctors are asked, “what is lumbar stenosis?” they tend to explain the structure of the spine since it gives a clearer picture of what is happening. The lumbar spine is comprised of five vertebral areas in the lower back. Nerves along the spinal cord travel through small openings on the sides of vertebrae, which are called foramina. These are the nerves that transmit sensations from the buttocks and lower extremities to the spinal cord and on to the brain. These nerves also transmit signals that produce movement of our legs, toes, and joints.
When someone is suffering from lumbar spinal stenosis, it means that either the spinal canal or one of the vertebral foramina has become narrow. When this narrowing is severe, it can lead to compression on the spine that results in painful symptoms. Lower back pain is just one of the signs of spinal stenosis.
The biggest risk factor for lumbar spinal stenosis is aging. Simply put, our spine experiences degeneration as we get older.
What Are the Causes of Lumbar Spinal Stenosis?
While aging is a major factor, lumbar spinal stenosis isn’t just an age-related problem. There are other reasons for the condition, such as arthritis and tumors. Below we briefly outline the various lumbar spinal stenosis causes.
- Degenerative arthritis – due to aging, athletic injuries, or obesity
- Degenerative disc disease – which can lead to loss of cartilage between the bones of joints and the formation of bone spurs.
- Spondylosis – a form of degenerative disc disease that puts pressure on nerve tissue, causing lumbar spinal stenosis symptoms.
- Tumors – local tumors or tumors that started in another part of the body and spread to the spine.
- Infection – although rare, a spinal infection can impact the nerves in the spine.
- Metabolic bone disorders – conditions that cause bone growth, such as Paget’s disease.
Most of the causes listed above are less common than degenerative arthritis. With degenerative arthritis, load-bearing joints are impacted because they tend to experience a lot of pressure and movement.
Symptoms of Lumbar Stenosis
While each situation is unique, there are some lumbar spinal stenosis symptoms that are classified as typical. The severity of symptoms often depends on the degree of degeneration or pressure.
Here are the most common lumbar spinal stenosis symptoms:
- Low back pain – some people have annoying lower back pain
- Burning pain in the buttocks or legs – this type of pain is usually sciatica, which is pain due to pressure on the spinal nerves. It often starts in the buttocks but then radiates down the leg.
- Weakness – when pressure reaches a certain point, some people will experience “foot drop,” which is a feeling that their foot is slapping the ground as they walk.
- Numbness or tingling – pressure on the nerve can cause numbness, tingling, or even a burning sensation in the buttocks or the legs
- Loss of sensation – this can occur in the legs and feet
Many people who have been diagnosed with lumbar spinal stenosis discover that they feel less pain when they lean forward or are sitting. Research suggests that leaning forward can increase the space for the nerves in the spine. Some sufferers have reported that while standing and walking is difficult, they can lean on a shopping cart and walk without too much agony.
Unfortunately, in cases where the cause is degenerative, the symptoms tend to get worse as times passes. This is due to the fact that degenerative arthritis is a progressive disease.
How is Lumbar Stenosis Diagnosed?
A lumbar stenosis diagnosis involves a complete medical history and physical evaluation. The patient is usually asked specific questions about symptoms, such as how long they have been present and what makes them feel worse. The doctor will also test the patient’s range of motion and feel for areas of tenderness in the spine. Legs may also be examined to assess reflexes, motion, strength, and sensation.
Since hips and knees can sometimes lead to problems that affect the back, the doctor may examine them as well.
Imaging tests may be ordered following the physical exam. Those tests could include the following:
- Spine X-ray – this can show loss of intervertebral disc height, bone spurs, and spinal instability.
- MRI – magnetic resonance imagining scans are considered a very effective tool in diagnosing lumbar spinal stenosis. An MRI can provide a view of nerves in the lower back and can detect if any nerves are being compressed.
- CT – computed tomography scans provide a cross-section image of the spine. A myelogram involves dye being injected into the spine first to help the nerves show up better. This enables the doctor to see whether or not nerves are being compressed.
- EMG – Electromyograms are nerve conduction studies. They test for damage or irritation of the nerves. This type of test can often help pinpoint exactly which nerves are causing the problem.
Treatment Methods for Lumbar Spinal Stenosis
There are many different options when it comes to lumbar spinal stenosis treatment. Your doctor will determine the best treatment based on your symptoms and test results. If you’ve been diagnosed with lumbar stenosis, hopefully, a nonsurgical treatment will help relieve your pain and discomfort.
However, surgery is a possibility in some cases. Non-surgical treatment involves restoring function and relieving pain but doesn’t improve narrowing of the spinal canal.
Physical therapy is often recommended for those who suffer from lumbar spinal stenosis. Stretching exercises, abdominal strengthening, and massage are known to help manage symptoms. Many people who end up having to go through surgical procedures for lumbar stenosis do participate in physical therapy following their operation.
Here is a list of various lumbar spinal stenosis treatment options, including surgical procedures:
- Lumbar traction – although there is no scientific evidence to support its effectiveness, there are some people who seem to find traction helpful.
- Anti-inflammatory medications – the pain involved in spinal stenosis can create swelling around the nerve. Anti-inflammatory drugs can provide some pain relief.
- Steroid injections – there are situations where steroid injections around the nerve of the epidural space can help decrease swelling and pain. Some people report that this approach also reduces the sensation of numbness in the legs. Those who decide to go this route are advised to get no more than three injections a year.
- Acupuncture – in less severe cases of lumbar spinal stenosis, acupuncture can be helpful in treating pain.
- Chiropractic manipulation – manipulation of the spine by a qualified chiropractor is usually safe and can help in some cases of lumbar stenosis pain. If you have osteoporosis, manipulation can make symptoms worse.
- Ice – treatment with ice is usually effective following physical therapy for lumbar stenosis. The ice can numb the area to bring temporary relief from pain. If there is a lack of sensation in the back area, do not use ice.
- Heat – treatment with heat can help loosen up tight muscles. Heat stimulates blood flow and the healing process. Like ice, if there is no sensation in the area to begin with, do not use heat.
- Surgery – this is often prescribed for those who have a poor quality of life due to the pain they are experiencing. The two main surgeries for lumbar spinal stenosis are laminectomy and spinal fusion. A laminectomy removes bone, bone spurs, and ligament that are compressing the nerves. It is a procedure that can be invasive, involving a large incision or minimally invasive using smaller incisions. Spinal fusion is when a surgeon fuses together two or more vertebrae to help them heal into a single strong bone.
Exercises for Lumbar Stenosis
Lumbar spinal stenosis exercises are an important part of pain management and recovery for many patients. Research suggests that when it comes to conditions like lumbar stenosis a four-fold approach to physical therapy management is best. This means a combination of patient education, manual therapy, exercise, and aerobic training. All of this is based on the expert consensus that it will provide both symptom relief and improve overall fitness and function. While there are many different exercises for lumbar stenosis some of the most widely recommended include un-weighted treadmill walking, lumbar flexion, hip strengthening, as well as passive stretching.
The following is a rundown of lumbar stenosis exercises:
- Un-weighted treadmill – this exercise relieves or lifts pressure off the spine as a person walks on a treadmill. Many patients respond dramatically to un-weighting after just a couple of session using the equipment. Those who don’t have a positive response are encouraged to cycle, walk on an inclined treadmill, or do pool walking.
- Lumbar flexion – spinal mobility and lumbar flexion exercises have long been an important part of treatment for degenerative spinal conditions. Both manual therapy and self-stretching can improve flexibility and address overall stiffness. An example would be lying flat on your back with your knees bent and then slowly drawing one knee up towards your chest. As the leg is lowered back down, the abdomen is tightened in order to stabilize the back. This exercise can also be done with both legs at once.
- Lumbar rotation – the patient should be lying on his or her back with legs straight. Bend one leg and rotate it over the straight leg. One arm should be laid out on the floor while the other supports the bent leg.
- Thoracic extension – there are many variations of the thoracic extension exercise, but essentially it means moving the trunk of your body backward. An example would be raising your hands and arms above your head as you are lying down.
- Hip mobility – strong hips support the spine so hip abduction exercises are often recommended. One form of the exercise calls for you to lie down on your right or left side with your legs together (one on top of the other). You then raise the top leg straight up and down about ten times before switching sides and doing it over again.
- Hip strengthening – weakness in the hip extensors and abductors are typical with spinal conditions and resistive exercises have proven to be helpful. Resistive training makes your muscles work against a weight or force. Some examples of resistance training include free weights, resistance bands, weight machines and even your own body weight. Usually, physical therapists show you how to perform hip strengthening exercises using resistance techniques.
- Core strengthening – these exercises are designed to help people minimize symptoms while standing and walking. There are many different exercises that strengthen your core muscles, including abdominal muscles, back muscles, as well as muscles around the pelvis.
- Self-stretching – whether you suffer from lumbar spinal stenosis or not, self-stretching exercises are beneficial. They loosen muscles and improve flexibility. The rectus femoris stretch is a good option. You lie on your back with both knees bent. You then grab hold of your left knee and pull it toward your chest as far as you can while you let your right foot off the edge of the bed toward the floor. Iliopsoas self-stretch can also be effective. One version of this exercise calls for you to lie down on the floor with your knees bent and then press your back into the floor.
- Passive stretching – this type of stretching involves another person helping you to stretch a muscle, using your hands or using a piece of equipment. Here’s an example: lie on your back with one leg straight and the other leg bent at the knee with the foot flat on the floor. Lift your straight leg with your hand, a towel or a strap as far as you can, keeping your knee straight.
When it comes to exercises, it’s important to make sure you warm up. Five to ten minutes of warming up can help prevent injuries. When you start to sweat, it means that the temperature of your muscles is ideal for stretching. Stretches should be held for 20 to 30 seconds, but if you can’t tolerate that length of time, start with just a few seconds and build up to 20 seconds. Additionally, you should be performing exercises, such as stretches, three to five times each day to gain long-term strength and flexibility.
How to Prevent Lumbar Spinal Stenosis?
While you can’t prevent lumbar spinal stenosis, you can lower your risk. Getting regular exercise to strengthen muscles and maintain flexibility is paramount. Maintaining good posture and a healthy weight will also go a long way in protecting the spine. Posture is something a lot of people don’t think about, but learning to lift heavy objects safely, sleeping on a firm mattress, and sitting in a chair that supports your back are all important for good posture.
Prognosis of Lumbar Spinal Stenosis
It’s natural to want to know the prognosis for spinal conditions. After all, they can have a significant effect on day-to-day living. The outlook for lumbar spinal stenosis depends on the severity of the symptoms at the time treatment begins. It also depends on the underlying cause. Research does suggest that the prognosis for those who undergo conservative treatment is generally good.
If you are suffering from low back pain and any of the other symptoms we’ve outlined, the sooner you seek medical attention, the better. Without treatment, spinal problems can progress and become rather immobilizing.
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