Spinal or Central Stenosis
This occurs when the space available in the spinal canal is reduced, essentially narrowing the canal.
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Synonym for spinal stenosis.
- Central stenosis
What is spinal stenosis?
This occurs when the space available in the spinal canal is reduced, essentially narrowing the canal.
What is the spinal canal?
It is the space that runs through the entire spine from top to bottom and contains the spinal cord, nerve roots of the back, veins, and arteries.
What are the causes of spinal stenosis?
The narrowing of the spinal canal is caused by progressive wear and tear of the spine with age. Therefore, it is generally people over the age of 60 who may develop spinal stenosis.
What are the symptoms of spinal stenosis?
It is important to know that spinal stenosis can be completely asymptomatic.
When spinal stenosis is symptomatic, the main symptoms are:
- Gradual pain that can manifest in the lower back, buttocks, or even in the legs.
- The pain is increased by:
- Walking (worse if walking for longer periods)
- Standing for long periods.
- Bending the back backwards
- Pain is reduced by:
- Bending forward
- Sitting
- Lying down
- Going up stairs is generally easier than going down stairs.
- Some people with spinal stenosis have no pain in the back and 100% of their symptoms are in the legs.
If you also experience numbness or tingling that radiates down your legs, the spinal stenosis may be irritating one or more nerves. This is called radiculopathy (see that section).
What are the serious symptoms of spinal stenosis to watch out for?
The presence of certain signs and symptoms should prompt you to seek prompt medical attention at the emergency room or from a doctor.
These include:
- Severe weakness or paralysis of one or both legs
- Significant or even complete loss of sensation in one or both legs
- Recent loss of balance when walking
- Significant and new incoordination
- New difficulties with bladder or bowel control
- Loss of sensation in the genital area or when wiping after a bowel movement
Serious symptoms are only present in less than 1% of cases of lower back pain. Most of the time, although the pain can be very unpleasant, the condition improves.
How is spinal stenosis diagnosed?
Diagnosis is made based on a review of your symptoms and a clinical examination.
In some rarer cases, radiological exams (X-rays, MRI, EMG) are necessary to determine the severity of the spinal stenosis or to see if it is compressing the spinal cord or a nerve in the back.
It is important to know that what is seen on X-rays or other types of imaging is not always relevant.
When should you consult a physiotherapist for spinal stenosis?
You should consult a physiotherapist if you have one or more of the symptoms described above or if your doctor has ruled out any other causes that may be responsible for your symptoms.
You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.
What are the physiotherapy treatments for spinal stenosis?
Your physiotherapist will perform an assessment to determine your limitations by evaluating the following elements:
- Your joint mobility
- The gliding of your nerves
- The quality of your movements
- Your strength and stability
- Depending on the results of the assessment, the physiotherapist will: Mobilize your spine and nerves to reduce pain and improve your movement.
- Give you specific exercises to re-educate the control of your back movements
- Give you exercises to regain mobility, reduce pain and regain your muscle strength.
- Teach you how to properly manage your daily activities and hobbies to optimize healing
- Give you advice for your posture and movements.
It is important to note that spinal stenosis itself cannot be cured, as it is a wear-and-tear process that is irreversible. However, the symptoms associated with lumbar spinal stenosis can be completely eliminated with treatment, even if the spinal stenosis is still present in the spine.
What to do at home for spinal stenosis?
Temporarily stop doing the movements that cause too much pain, and then gradually start doing them again. Don't remain completely still for long periods, as you will become stiffer and experience more pain afterward.
Here are some other tips that may help:
- At the grocery store, use the cart to lean on and be slightly bent forward.
- Do repeated back flexions (bending forward).
- Take short, frequent seated breaks when you go for long walks or have to stand for long periods.
- Limit the amount of time spent standing (sit down every 20 minutes while the pain decreases).
- If you are standing still, place one foot in front of the other and make small weight transfers forward and backward.
- When cooking, place one foot inside the cabinet in front of you.
- When the pain is present, spend a few minutes lying on your side with a pillow between your knees. This should relieve you.
If you don't see any improvement after 10 days, you should consult a physiotherapist.
If you are a runner, please refer to the blog post on running (link to come) for practical tips for running.
Did you know?
- 90% of lower back pain episodes heal in 6 to 12 weeks
- 50% of lower back pain episodes heal in 1-2 weeks
To learn more...
You can listen to the podcast "Parle-moi de santé" produced by one of our physiotherapists, Alexis Gougeon. Episode #7 discusses the topic of lower back pain.
Episode #7 lower back pain
Find the episode on YouTube :
Click below to listen to episodes on podcast platforms:
https://open.spotify.com/episode/3Ymcb0gWLyns48Kb6vJ5J8?si=092c6516549b47d7
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Sources
- Alexander CE, Varacallo M. Lumbosacral Radiculopathy. InStatPearls [Internet] 2019 Mar 23. StatPearls Publishing.
- Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, Hwang SW, Mendel RC, Reitman CA. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). The Spine Journal. 2013 Jul 1;13(7):734-43.
- Wu L, Cruz R. Lumbar spinal stenosis. StatPearls [Internet]. 2020 Sep 3.
- Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. Bmj. 2016 Jan 4;352.
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