One of the common conditions that we see at Coordinated Health is spinal stenosis. People often ask what is spinal stenosis. And I’ll use a model to kind of describe what that is. Now, this is the site where spinal stenosis actually occurs. And spinal stenosis can occur for several reasons, as we look at the spinal canal. There’s a ligament that sits here in the back of the canal called the ligamentum flavum.
As we age, that the ligament can thicken. And as it thickens, it can compress the nerve roots inside the spinal canal. Secondarily, again, looking from the side at these cartilage discs, it’s not uncommon as we age for these discs to start to degenerate. As they degenerate or start to thin, they can then bulge back into the canal.
And as they bulge in the canal, you can imagine that the canal narrows over time and starts to compress the nerves. And finally, the third component that can contribute to spinal stenosis are the facet joints or these little joints in the back.
Now, these joints are just like any other joint in the body. And they, too, can or are susceptible to arthritis. When arthritis occurs in these joints, the bone spurs can grow into the canal. And as the bone spurs grow in, they can pinch nerves or also narrow that spinal canal.
So those are the three main components of spinal stenosis that would cause narrowing of the spinal canal both centrally and where the nerves exit on the side. – The classic spinal stenosis patient has narrowing of the nerve hole. When that person stands upright and walks through the mall or the supermarket, they’re actually leaning their lower back backwards a bit, making those nerve holes a little bit smaller.
And that irritates those nerves. And eventually as that person walks a bit, they get pain usually down the backs of the legs, can be down through the hamstring and even down into the calf. When someone with classic spinal stenosis sits, that pain goes away almost instantly because they’re opening up those nerve holes and relieving the pressure on those nerves. The other classic sign that patients will often tell us before we even get a chance to ask is what we call the shopping cart sign.
And that’s the individual that go to the supermarket and grab the shopping cart no matter how many items they have, and they do great if they’re walking with a shopping cart. They can walk all day long. As soon as they get rid of that shopping cart and walk straight up, they have a problem. Most people believe it’s because they’re somewhat resting their spine as they lean forward on the shopping cart.
Actually what’s happening is those individuals unbeknownst to them are bending their spine forward a bit and gaping the space around the nerves in the back, so they’re automatically relieving the pressure and the irritation on the nerves and relieving their leg symptoms. When a patient comes in with complaints, we’re not quite sure exactly what’s happening.
We use our physical exam to both try to elicit what may be the pain source and rule out any dangerous problems. We test things like neurologic function. We want to test the muscular strength and the sensation and the reflexes in the legs. Those neurologic functions relate to how the nerve roots are working as they exit the spine.
We then test things like spinal motion in forward flexion, in extension, in side bending, to see whether or not there’s any restrictions within the joints, the muscle, or disc structures of the spine, as we try to elicit what they pain source may be. Just above this normal disc we can see an abnormal lumbar disc that is bulging out into the spinal canal. And as it’s bulging, we can see that it’s actually narrowing the spinal canal compared to the distance that we see down here with the normal disc and spinal canal.
This narrowing within the spinal canal right here is called spinal stenosis. And it’s a potential site of impingement on a nerve. These are the nerves then that extend down through the spinal canal. They exit and will go down to the leg. And so the nerve actually becomes compressed here. And as it’s compressed, someone can experience pain down the length of that nerve as it extends from the back all the way down to the leg and in some cases into the foot. And this would be the site of the original compression.
– Treatment options for spinal stenosis, again, just like any other condition, span the entire spectrum of lumbar treatment, starting from the most conservative and ending with the most aggressive. Most conservative is medical management, medication treatments, anti-inflammatories, ice, muscle relaxer for the muscular pain that goes along with this, and things like physical therapy, chiropractic care to manipulate, stretch and strengthen the spine, to support the structures a bit better.
Decompression therapy can be an option for spinal stenosis by decompressing the spine or what was known as traction. You can get some blood flow back into the discs, help the discs reshape and heal a bit better. And certainly, our interventional treatment option, such as epidural injections or joint procedures, are very common necessity in the spinal stenosis patient because it’s often those structures that need to be treated and calmed down to alleviate the patient’s symptoms.
Surgery is warranted if conservative and interventional care fails. The surgeries for spinal stenosis range everywhere from minimally invasive procedure using very small incisions, very small decompressive surgeries to open the spaces up to more involved fusion surgeries to remove more bone or more disc space and stabilize the spine if need be. – There are two goals in treating your back pain. The first is to treat your acute pain.
And the second is to address the functional limitations that are causing you pain. You can’t treat just your symptoms if you don’t know what’s causing them. Chiropractic care is an important tool in reducing the acute pain while physical therapy addresses your functional limitations or impairment. But both therapy and chiropractic care are education based.
They focus on your ability to move in all planes as well as to maintain correct posture. Maintaining that correct postural alignment includes keeping your feet straight, your hips tucked in, your shoulders back, and your chin tucked. Individual comprehensive progressive physical therapy programs focus on four areas. The first is to improve functional core strength.
This provides you a firm base so your limbs can generate force and motion. The second is functional stretching. This is to regain or improve the range of motion and flexibility of the muscles in your back in all directions. The third is functional endurance. This is to improve your muscular endurance and your ability to maintain correct postural alignment.
And finally, the last area is functional balance and proprioception. Proprioception means improving your ability to maintain balance in all planes. At Coordinated Health we work as a team in your education and treatment. But you’re the key member of that team. Maintaining a pain-free back means working hard to understand and apply the principles that we teach you. Stretching and strengthening your back on a daily basis will help prevent recurrences of back pain, allow you to move better, and improve the quality of your life.