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

Smaller Than Average Spinal Canal Predisposes to Stenosis

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.

Five Keys to Self-Care of Stenosis

1. While you’re standing, and throughout your day, use the deeper-lying abdominal muscles to “draw in” the abdominal wall to give your spine ongoing support for daily activities.
2. Avoiding prolonged sitting, or, when you are sitting, use a chair that requires you to engage dynamic support.
3. Commit to a regular low back exercise program.
4. 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.
5. 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.

I’m always optimistic that non-surgical options will ultimately alleviate an individual’s problems, but, although 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 flexion-distraction. 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, flexion-distraction nonetheless offers a significant chance of long-term relief for stenosis sufferers.

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