Spinal Stenosis: What is it and how does physio help?

Spinal stenosis is a common medical condition where the spaces within your spine narrow. This may be due to normal wear and tear, a bulged disc, or changes in the spine triggered by the onset of osteoarthritis. 

This can compress the spinal nerves and pinch them. Some people with spinal stenosis may not experience any symptoms, but the pressure on your spinal nerves can result in tingling, numbness, muscle weakness and moderate to severe pain. 

Spinal stenosis occurs most frequently in the neck and lower back and the symptoms can become progressively worse over time. Most sufferers are over 50 years of age.

Spinal stenosis is diagnosed by a GP, specialist, physiotherapist or chiropractor. They will typically do a physical exam, take a history of your symptoms and order imaging tests such as an X-Ray, CT scan or MRI. 

 

Causes

The main cause of lumbar stenosis is wear and tear, leading to conditions such as osteoarthritis. Other potential causes include:

– Spinal injury

– Overgrowth of bone

– Tumour

– Bone diseases

– Narrowing of the spine

– Rheumatoid arthritis

– Stiff, thickened ligaments

– A bulging disc

 

Risk factors

The main risk factor for spinal stenosis is age, occurring most often in people over 50. 

Other risk factors include being female, having a genetically narrow spinal canal, and having previous spinal surgery or a spinal injury. 

 

Symptoms 

While there is a range of spinal stenosis symptoms that can develop slowly over time, they can all have a debilitating effect on your quality of life. Neck or back pain can impact your relationships, compromise your work performance, interfere with your gym routine and lifestyle.

When the nerve is compressed, a range of symptoms of varying severity can appear. 

The main symptom of spinal stenosis is pain and discomfort. Other symptoms of spinal stenosis include:

• Burning sensation and pain radiating into the lower body (sciatica)
• Cramping in legs
• Pins-and-needles sensation in the fingers or toes
• Numbness or tingling in the extremities
• Stiffness or soreness
• Muscle weakness
• Diminished reflexes
• Focal pain near the compression site
• Pain radiating along a nerve
• Burning pain

The exact location where the spinal stenosis symptoms surface is often determined by the area of the spine affected.

Stenosis in the upper or cervical spine in the neck can cause symptoms to appear throughout the upper body and extend into the arms and hands. Alternatively, stenosis in the lower back in the lumbar region of the spine can trigger pain in the hips, legs and feet.

 

Treatments

The treatments for spinal stenosis focus on symptom management. When choosing a treatment strategy, your doctor will consider your age, the suspected underlying cause of your condition and the exact type and severity of the symptoms you experience.

Treatment may include:

• Medicine to manage pain and inflammation
• Exercises for strength building
• Medical devices such as a back brace
• Steroid injections
• Decompression or PILD procedure
• Physiotherapy for balance, range of motion and strength
• Hot and cold packs for pain relief 

In most cases, treatment begins with a series of conservative therapies. This often comprises a combination of anti-inflammatory drugs and low-impact exercises followed by hot and cold compression therapy and rest.

Many people suffering from spinal stenosis try to reduce their pain by reducing their activity. However, that might lead to muscle weakness, further heightening their pain response. Simple exercises may help you to increase your strength and endurance and maintain your spine’s flexibility while stabilising it.

 

Steroid Injections

With spinal stenosis, the nerve roots may experience localised irritation and swelling where they are being compressed. Injecting a steroid into the area surrounding the compressed part of the spine won’t fix the underlying cause of the stenosis. However, in some patients, it can provide relief by decreasing the degree of inflammation and alleviating some of the pain associated with the condition.

However, it is important to weigh up the pros and cons with your healthcare practitioner because steroid injections don’t provide relief for everyone. Multiple steroid injections may weaken neighbouring connective tissue and bones, limiting the number of steroid injections you can receive each year.

Before you opt for a spinal injection (or any invasive medical procedure), you should consider the side effects and possible risks. Read our full article on spinal injections for more information.

 

PILD Procedure

Decompression or PILD procedure is another treatment option. This procedure removes a thin slice of the thickened ligament at the rear of the spinal column, increasing the space around the spinal canal and relieving the nerve compression.

As it is performed without a general anaesthetic, it is often considered a viable alternative for some patients with high surgical risks due to unrelated medical conditions.

While surgical interventions can be useful, not everybody fits the ideal profile of patients who benefit from surgery. Some patients would rather seek a second opinion before undergoing invasive treatments.

Talk to your doctor about the treatment plan that’s best for your specific condition. If your symptoms are mild, your doctor may elect to monitor your condition with regular follow-up appointments.

 

Physiotherapy

Physiotherapy may be able to provide relief to people living with spinal stenosis by providing manual therapy to loosen stiff joints and muscles and improve mobility, and by devising stretching and mobility exercises to support opening the space of the lower back to reduce pressure on the spine.

They may advise on posture and lifestyle, supporting people to reduce their back pain wherever possible. They can also use pain management and inflammation-reducing techniques such as hot and cold packs, hydrotherapy and dry needling. 

Physiotherapists are highly trained healthcare professionals and can provide specialised advice regarding exercise, symptom management, and medical devices. 

 

How the Brisbane Spine Clinic Can Help

At the Brisbane Spine Clinic, we offer a second opinion to spinal surgery. We are highly experienced in treating spinal conditions such as spinal stenosis and are confident in assessing, discussing and creating tailored physiotherapy programs for those living with chronic pain. 

Book a consultation with one of our spinal consultants.