What Causes Spinal Stenosis and What You Can Do About It

Back prob­lems are com­plex phe­nom­e­na.

How can we extract some order (and under­stand­ing) from this com­plex­i­ty?  One strat­e­gy is to look for the seem­ing­ly objec­tive facts that show up on an MRI or CT scan.  Doc­tors who fol­low this plan will focus on diag­nos­ing the things you can see on these sta­t­ic imag­ing tests: dis­crete, local areas of anatom­i­cal alter­ation or degen­er­a­tion.

Steno­sis is one of those diag­nos­tic cat­e­gories that sums up an impor­tant fea­ture of many patients’ back prob­lems.

The word steno­sis comes in handy in many areas of med­i­cine. It refers to a nar­row­ing of any tubu­lar struc­ture. For instance, the arter­ies are one of the com­mon anatom­i­cal parts that can become stenot­ic.

The spinal canal — the open space in your col­umn of spinal bones through which the spinal cord runs — can also be nar­rowed. If your prob­lem is in the low back, you have lum­bar spinal steno­sis.  (You can also have steno­sis in the neck  - cer­vi­cal spinal steno­sis.)

Causes of Spinal Stenosis

There’s typ­i­cal­ly a degen­er­a­tive com­po­nent to lum­bar spinal steno­sis. Over the years, your discs bulge out and com­pro­mise the space in the spinal canal occu­pied by the spinal cord. Because these degen­er­a­tive changes are so com­mon, a cer­tain degree of steno­sis is near­ly inevitable as you age. But if you’re lucky, it may nev­er be sub­stan­tial enough to cause you any symp­toms.

In an unlucky minor­i­ty of peo­ple, the shape of the spinal canal is small­er than aver­age to begin with; that makes it more like­ly that you’ll even­tu­al­ly devel­op symp­to­matic steno­sis.

Here are three pic­tures that depict the com­mon sce­nar­ios:

Optimal Space in Spinal Canal

Opti­mal Space in Spinal Canal

 

Smaller Than Average Spinal Canal Predisposes to Symptomatic Stenosis

Small­er Than Aver­age Spinal Canal Pre­dis­pos­es to Symp­to­matic Steno­sis

 

Bulging Disc Squeezes Space for Spinal Cord

Bulging Disc Squeezes Space for Spinal Cord

 

Symptoms of Lumbar Spinal Canal Stenosis

The symp­toms of steno­sis can vary. Here are some of the pos­si­bil­i­ties:

• Low back pain
• Pain in the but­tocks or legs
• Lim­it­ed abil­i­ty to walk – your legs seem heavy and fatigue quick­ly

Your symp­toms can also vary wide­ly from day to day depend­ing on your activ­i­ty and oth­er wild card fac­tors.

Diagnostic Overlap

Because bulging, degen­er­a­tive discs are often part of the cause of steno­sis, the con­di­tion can co-exist with the prob­lem of a her­ni­at­ed disc caus­ing pinch­ing of a spe­cif­ic nerve root or roots.

In both sit­u­a­tions, there’s abnor­mal pres­sure being put on your nerves. The dif­fer­ence is, that in the case of spe­cif­ic pres­sure on a nerve root, one of the nerves emerg­ing from the spine is get­ting pinched, where­as, in the case of steno­sis, the nerves are get­ting pinched before they leave the spinal cord.

That means that the symp­toms of steno­sis are less spe­cif­ic and more dif­fuse than the symp­toms of a pinched nerve root.

Anoth­er fac­tor that adds a lay­er of sub­tle­ty to the diag­nos­tic process is the “all of the above” phe­nom­e­non:  Many peo­ple have symp­toms which com­bine the fea­tures of a pinched nerve root with steno­sis.

Three Keys to Self-Care of Stenosis

There are three things you have to do for your­self if you are expe­ri­enc­ing symp­toms of lum­bar spinal steno­sis.

  1. Lum­bar spinal steno­sis is a degen­er­a­tive con­di­tion of the low back. That means that you should be vig­i­lant in apply­ing all of the gen­er­al prin­ci­ples of improv­ing the bio­me­chan­ics of the low back, such as:
    • Using prop­er abdom­i­nal sup­port in dai­ly activ­i­ties and exer­cise.
    • Avoid­ing pro­longed sit­ting, or, when you are sit­ting, use a chair that requires you to engage dynam­ic sup­port.
    • Devel­op­ing a reg­u­lar low back exer­cise pro­gram. You can begin with Dr. Lavine’s Top 5 Exer­cis­es for the Low Back.
  2. There’s a spe­cif­ic rest posi­tion that alle­vi­ates the pain of steno­sis for many peo­ple. It involves rest­ing the low back in a posi­tion of flex­ion. The sim­plest way to do this is to lie on your back, and hug both knees into your chest, curl­ing the low back. Hold the posi­tion for 1–5 min­utes.
  3. Even if your legs feel heavy and begin to give out on you after you’ve walked only a few blocks, you can con­tin­ue to build mus­cle endurance and improve your walk­ing dis­tance. That means – keep walk­ing. If your legs start to go south on you, take a brief rest and then press on. If you con­tin­ue to exer­cise your leg mus­cles, they’ll gain strength and endurance.

Medical Treatment of Lumbar Spinal Canal Stenosis

One of the first rec­om­men­da­tions a typ­i­cal med­ical doc­tor might make if you have steno­sis is to see a phys­i­cal ther­a­pist. That’s not a bad idea. Every­one needs to improve the bio­me­chan­i­cal func­tion of the spine and main­tain mus­cle strength, and, if you lack aware­ness of prop­er body mechan­ics or have dif­fi­cul­ty moti­vat­ing your­self to exer­cise, a phys­i­cal ther­a­pist can help.

A sec­ond option used in the med­ical world is epidur­al steroid injec­tions. An epidur­al injec­tion blasts the area with pow­er­ful anti-inflam­ma­to­ry chem­i­cals. I’m not an expert on their use, but my under­stand­ing is that, in the case of steno­sis, where the prob­lem is more gen­er­al and dif­fuse, the results of epidur­al injec­tions are less con­sis­tent than when the same pro­ce­dure is used for a more dis­crete area of disc bulging affect­ing a sin­gle nerve root.  At best, the use of epidur­al injec­tions affords only tem­po­rary relief.  (Though for a lucky few the “tem­po­rary” relief can last six months to a year or more.)

A third option is surgery to open up the space around the spinal cord. As a doc­tor of chi­ro­prac­tic I’m habit­u­al­ly skep­ti­cal of sur­gi­cal approach­es, and I con­sid­er that my job is to help patients avoid the need for surgery alto­geth­er. How­ev­er, surgery for spinal steno­sis has a pret­ty good track record.  Only those with more seri­ous symp­toms are typ­i­cal can­di­dates for surgery, and your sur­geon has to do a good job of select­ing sur­gi­cal can­di­dates.

Though based on my pro­fes­sion­al loy­al­ties I hate to admit it,  opt­ing for surgery isn’t crazy if oth­er options have fall­en short of giv­ing you ade­quate relief.

Dr. Lavine’s Approach to Spinal Stenosis

Here’s what I do to help my steno­sis patients.

  1. Make sure you under­stand basic prin­ci­ples of pos­tur­al align­ment and can apply them when sit­ting, stand­ing, walk­ing, bend­ing, exer­cis­ing, and through­out your dai­ly life.
  2. Teach you a sequence of exer­cis­es for low back sup­port and flex­i­bil­i­ty.
  3. Gen­tly mobi­lize the low back to main­tain lim­ber­ness of the joints. Seg­men­tal­ly tar­get­ed, brief-impulse chi­ro­prac­tic manip­u­la­tion, though usu­al­ly not con­traindi­cat­ed, can be less effec­tive in a long-devel­op­ing con­di­tion like steno­sis.
  4. Pro­vide Neu­ro­Tac­tile ™ Ther­a­py, a light form of nerve reflex treat­ment, to give your nerves a max­i­mum chance to main­tain their integri­ty and bounce back if they’ve been pinched.
  5. Offer lum­bar decom­pres­sion with the DRX-9000. Lum­bar spinal steno­sis is the end-point of a long term trend of low back com­pres­sion, disc bulging and degen­er­a­tion. The tech­nique of spinal decom­pres­sion has evolved specif­i­cal­ly to reverse these bio­me­chan­i­cal changes. Though I cau­tion patients that achiev­ing results may take longer (than in a younger per­son with a recent­ly-mint­ed bulging disc) and may not be as com­plete, the DRX-9000 nonethe­less offers a sig­nif­i­cant chance of long-term relief for steno­sis suf­fer­ers.

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About Ronald Lavine, D.C.

Dr. Lavine has more than thirty years' experience helping patients alleviate pain and restore health using diverse, scientifically-based manual therapy and therapeutic exercise and alignment methods.

His website, askdrlavine.com, provides more information about his approach.

Please contact him at drlavine@yourbodyofknowledge.com or at 212-400-9663.

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2 Responses to What Causes Spinal Stenosis and What You Can Do About It

  1. Pingback: back pain stretches

  2. robert gearhart says:

    drx9000 trac­tion is need­ed. i live in elgin,il.60123
    what’s your clos­est loca­tion for treat­ment. i need help 815–790-5471

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