Spinal stenosis is a term used to describe narrowing of the spinal canal. It can result from age related changes like osteoarthritis, thickened ligaments, herniated discs, or bone spurs (osteophytes). Typically affecting adults over 50, especially those over 60, spinal stenosis often impacts the lumbar (lower back) and cervical (neck) regions. Lumbar spinal stenosis may also cause leg pain and weakness that often worsens with walking and improves with sitting. 

Anatomy 

The lower back, or lumbar region, consists of five vertebrae (L1-L5) that form part of the spine. Each vertebra has a central opening called the spinal canal, which houses the spinal cord and nerve roots. As described above, there are a multitude of factors that can cause narrowing of the spinal canal leading to lumbar spinal stenosis. This narrowing can compress the nerve roots, causing symptoms like pain, numbness, and weakness in the lower extremities. Surrounding structures, including the intervertebral discs, facet joints, ligaments, and muscles, play a significant role in maintaining spinal stability but can also contribute to stenosis when they undergo age related changes.

Common Causes 

Spinal stenosis can be caused by several factors:

  • Age Related Changes: Osteoarthritis and degenerative disc disease can wear down spinal discs and facet joints, contributing to stenosis.
  • Herniated Discs: Bulging or herniated discs can protrude into the spinal canal, reducing space for the spinal cord and nerves.
  • Thickening of Ligaments: Ligaments in the spine can thicken over time, narrowing the spinal canal.
  • Bone Spurs (osteophytes): Overgrowth of bone, known as bone spurs or osteophytes, can develop from degenerative changes, encroaching on the spinal canal.
  • Congenital Factors: Genetic predispositions can lead to congenital stenosis, characterized by a narrow spinal canal or malformed vertebrae.
  • Infections or Tumors: These can also cause spinal narrowing.

 

Diagnosis 

As the term stenosis only refers to the canal narrowing (which can be asymptomatic in some people), the diagnosis for lumbar spinal stenosis is only made when symptoms are present. For this reason, a key part of our assessment and diagnosis process is listening to how your pain came about, when it started, what started it and how it has progressed over time. 

 

We will then assess your range of motion and functional capacity to try to identify provocative movements that we can modify during rehabilitation. This may include activities such as walking, squatting and hinging. We may also use some tests to identify if there is any nerve involvement or irritation which may be contributing to your symptoms. 

 

Imaging is not always necessary for lumbar spinal stenosis but it can be useful as part of the diagnostic process to rule out other factors that may be contributing to your pain. Imaging can also be used to show the extent of the changes occurring around the spinal canal. 

 

Management 

 

Management for Lumbar spinal stenosis varies significantly based on several factors such as the extent of the canal narrowing, if there is any other pathology present, the symptoms you are experiencing and your tolerance to movement and exercise. 

 

For this reason, at Motus Health and Performance, when managing spinal stenosis we’re big believers in focusing on your individual activity limitations and movement preferences. We work with you to promote confidence through movement, rather than fear from the label of ‘stenosis’ and longer term avoidance of exercise. This ensures a continued trust in your back and it’s capabilities and helps us make sure we get you back to doing what you love.

 

Soft tissue release and manual therapy techniques can be helpful to help with short term symptom modification and pain relief. Gentle exercises in comfortable positions and ranges can also be effective for improving symptoms. These start with flexion based movements such as knee hugs and pelvic tilting, which are often relieving for lumbar spinal stenosis symptoms, but will differ pending on your own limitations as discussed above.  

 

Further management in rehab will be highly dependent on your daily activity goals and exercise capacity which we will take into consideration when we create a tailored rehabilitation program and management plan for you!