By Nancy Alexander, PT, CSCS
Some things just go better together. A hearty red wine goes well with a steak dinner. Serving fish or chicken? Perhaps a Chardonnay or Pinot Grigio is your style. Just like a fine wine pairs beautifully with a certain meal, some musculoskeletal conditions pair well with certain exercise techniques. Today we will discuss a spinal condition known as stenosis and learn how flexion, or bending forward, often pairs perfectly with treating your symptoms.
The spine protects the spinal cord and helps the body stand and bend. Nerves from the spinal cord exit near the back of the spine through bony openings where spinal vertebrae meet. Spinal stenosis is caused by narrowing of the spinal openings in one or both of these areas:
- The space at the center of the spine.
- The areas where nerves branch out from the spine and feed other areas of the body.
Narrowing of these bony openings puts pressure on nerves and the spinal cord, causing pain in your back and your limbs where those nerves are headed. There is simply less room for the spinal cord and these nerves to occupy. Spinal stenosis is more common in people 50 years old or older. (Arthritis Foundation)
Causes
As noted above, osteoarthritis is the most common cause of spinal stenosis. But people with other types of arthritis and related conditions that affect the spine may also develop this. Younger people with a spine injury or a narrow spinal canal, or people with scoliosis (an abnormal curve of the spine) are also at risk. A back or neck injury, a spinal tumor or having too much fluoride or calcium in the body can also make someone more likely to develop spinal stenosis, according to the Arthritis Foundation.
Symptoms
According to the Mayo Clinic, spinal stenosis happens most often in your neck or low back. Spinal stenosis often causes no symptoms. When symptoms do happen, they typically start slowly and get worse over time. The location of your symptoms depends on which part of the spine is affected. Stenosis at your neck typically affects your arms because the nerves that originate there travel to those limbs. Nerves at your low back, or lumbar spine, serve your legs so that will be where symptoms can occur. Symptoms of stenosis at your lower back often begin with pain in your low back, and/or legs, especially when you are standing and walking.
You may have symptoms only in your arms or legs with or without neck or back pain. Your symptoms may include pain, tingling, numbness, and muscle weakness. When symptoms get worse over time as noted above, the most common cause is wear-and-tear damage to the spine related to arthritis.
Some people may have a very serious type of spinal stenosis called cauda equine syndrome. With this condition, people may also have a loss of control of the bowel or bladder as well as problems having sex. (Arthritis Foundation)
Diagnosis
To help determine this diagnosis, your doctor will perform a physical exam, ask questions about your medical history and might order imaging such as X-rays, magnetic resonance imaging (MRI), or computerized topography (CT). In some cases, your doctor may inject liquid dye into your spinal column to see it better. This is called a myelogram test.
It is important to note that stenosis may not be the only condition responsible for your symptoms. Arthritis, degenerative disc disease, and spondylolisthesis are some conditions that may accompany stenosis. It is important that your health care provider or physical therapist perform a thorough assessment to help discern the cause of your symptoms.
Treatment
When spinal stenosis is the primary cause of your symptoms, your treatment may include:
- Pain medications such as ibuprofen, naproxen, and acetaminophen for temporary use.
- Antidepressants which help ease chronic (long-lasting) pain.
- Anti-seizure drugs to reduce pain caused by damaged nerves.
- Opioids for temporary use (they carry the risk of serious side effects and addiction).
- Physical therapy.
- Steroid injections.
- Surgery – usually considered when symptoms result in nerve damage and are causing problems with walking, or bowel and bladder function.
(Arthritis Foundation)
A physical therapist typically treats your stenosis using a customized program that includes strategic stretching, core strengthening, modalities such as heat or ice, distraction techniques such as traction (if appropriate), and positional activities to help you reduce your symptoms.
Positional activities and maneuvers can be very successful in reducing your symptoms. In the clinic we call this a “directional preference.” Whether stenosis occurs at your neck or low back, one maneuver is likely to be very beneficial in helping you control your pain and other symptoms. And that is flexion. Flexion, or bending forward, consistently helps reduce symptoms that are due to stenosis.
When symptoms are originating at your neck, bending your head forward as if to bring your chin to your chest, if often effective. If your low back is causing your symptoms, bending forward at the waist or hips can be equally effective. If sitting reliably helps reduce your pain, chances are good that bending forward will also help. And it will likely help more because there is simply more bend at the spine allowing the openings where your nerves travel to open up as wide as they can. Once that pressure on the nerves is lessened or removed, you feel better.
Flexion pairs beautifully with stenosis. Be sure to check out my Low Back Stretch video (https://youtu.be/XjbLBykVCF4) on my YouTube channel for more information and details on how you can use this maneuver. If you have osteoporosis of the spine, bending forward at the hips – in the form of a hip hinge – if preferred to help you minimize compressive forces at your spine.
Prognosis
If you have spinal stenosis you may be able to be active with the condition, although you may need to make some changes in your activities or work. Treatments as noted above may be beneficial for years.
People who have serious spinal stenosis may need surgery. Surgery can create more space inside the spine that can ease your symptoms caused by pressure on the spinal cord or nerves. Spine surgery will often partly or fully relieve symptoms in your legs or arms. However, it is hard to predict if you will improve and how much relief surgery will provide. Your physician and other health care providers can help guide you through this decision.
Please realize that surgery can’t cure your arthritis, so pain in your spine due to arthritis (and other conditions if present) may continue.
Contact your physician if you have symptoms consistent with spinal stenosis so that you can find relief quickly. Imaging and/or a referral to physical therapy may be your initial steps. Immediately contact your physician if more serious symptoms are present that may include:
- Difficulty or poor balance when walking
- Worsening numbness and weakness of your arms or legs
- Problems controlling urine or bowel movements
These represent a more serious condition that requires immediate attention.
For milder symptoms, a physical therapist can help you create your personalized treatment plan to alleviate symptoms and improve your mobility and function. Symptoms primarily due to stenosis respond very well to flexion-based activities such as sitting and bending forward. If these make your symptoms worse, please stop and let your health care provider know. But if they help, consider them the perfect pairing with your stenosis symptoms and perform them often to help you feel better now.
Sources:
Arthritis Foundation: https://www.arthritis.org/diseases/spinal-stenosis
Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/spinal-stenosis/symptoms-causes/syc-20352961
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