Spinal Stenosis: Causes and Treatment

Spinal stenosis refers to narrowing of the space surrounding the nerves or spinal cord in the back.  Many people with signs of spinal stenosis on an MRI experience no symptoms.  Others experience pain or a deep aching sensation in the buttocks, thighs, or lower legs.  Symptoms are worse when standing or walking.  Other symptoms may include numbness or tingling in the legs and weakness of the foot or legs.  Many people have no pain when sitting or lying down.  Symptoms may be eased or completely relieved when walking leaning over a shopping cart.

Causes of Spinal Stenosis

spinal stenosis

Most people with spinal stenosis are over the age of 50.  Spinal stenosis is usually caused by normal age-related changes in the spine.  Arthritis of the joints in the spine is the most common cause.  This can be associated with degenerative changes to the intervertebral disc.  These age-related changes are normal and no different than graying of the hair or wrinkles of the skin.  In some people these changes result in pain and in others symptoms are never experienced.  It is also important to understand that the extent of stenosis on an MRI does not always match up to the severity of symptoms experienced.

Treatments for Spinal Stenosis

Contrary to popular belief, spinal stenosis does not always worsen.  There are treatments which can reduce pain and improve function.  Common treatments include activity modification, aerobic exercise, stretching exercise, strengthening exercise, massage, manual physical therapy, acupuncture, and injections.  Surgery is reserved when conservative treatments are unsuccessful.  The remainder of this article will discuss the role of physical therapy, injections, and surgery.

Physical Therapy

In most cases, regular exercise should be the first step in managing symptoms from spinal stenosis.  Physical therapists develop individualized exercise programs for people with stenosis.  This often includes stretching exercises for the lower back, hips, and legs.  The benefits of stretching can be accelerated by also including manual therapy treatments delivered by the physical therapist.  Manual physical therapy to the hips and low back has been shown to reduce pain and disability associated with stenosis.

Strengthening exercises for the core muscles and legs is beneficial to improve walking ability.  It is also important for the exercise program to include aerobic training.  This is usually in the form of cycling or treadmill walking.  People with spinal stenosis are encouraged to continue to walk.  Some pain with a walking program is expected and acceptable.  Your physical therapist will help you determine how much pain is appropriate.

Injections

Epidural steroid injections are used to treat back and leg pain associated with spinal stenosis.  This involves injecting anti-inflammatory medication into the epidural space surrounding the spinal nerve.  Decreasing inflammation around the nerve may alleviate symptoms into the legs.  Some people experience immediate relief of symptoms with epidural injections.  This can result in improved walking ability in the short-term.  However, research suggests the long-term effectiveness of injections is limited.

Surgery

spinal stenosis

Surgery for spinal stenosis involves removing bone around the compressed nerve or spinal cord.  This is referred to as spinal decompression surgery or a laminectomy.  Some surgeons also fuse vertebrae to prevent movement within the spine.   Complications from surgery occur in 10% to 24% of cases.   These include fracture, failed fusion, cardiac events, stroke, respiratory distress, and in very rare cases death.   Surgery can be very effective for some people.  However, research suggests there is no long-term difference between those who are treated conservatively and those who undergo surgery.

Conclusion

Symptoms associated with spinal stenosis are common in those over 50 years old.  In the majority of cases, symptoms and function can be improved with exercise, lifestyle changes, and other non-surgical treatments.  Conservative treatments should be exhausted before considering surgery for spinal stenosis.  Research shows people who complete a course of physical therapy are less likely to undergo surgery for spinal stenosis.  Talk to your physical therapist about what you can do to get back to doing what you love.


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