Lumbar spine stenosis describes narrowing of the central spinal canal. Stenosis in the lumbar spine can cause leg pain, numbness, weakness and difficulty walking.
Spinal stenosis is typically caused by degeneration. The process of degenerative stenosis results from chronic accumulation of mechanical stresses causing intervertebral disc degeneration, facet hypertrophy and ligamentum flavum wrinkling (2,49) Central spinal stenosis most typically affects the three lowest lumbar levels, and foraminal stenosis most commonly involves the L5 nerve root, as the L5-S1 foramen has the least free space. (2,3).
Symptoms of stenosis:
Symptomatic spinal stenosis often presents as chronic lower back pain with symptoms involving the buttock and lower extremity.
- Patients may report pain on both sides of their buttock and legs, paresthesia, numbness, fatigue, heaviness and/or weakness in their legs.
- Complaints in the leg are generally perceived as more bothersome than back symptoms.
- Symptoms are on both sides in almost 7 out of 10 patients (13,45).
- Lumbar spine stenosis patients report progressively increasing symptoms from standing or walking and relief while sitting.
- Patients may report diminished symptoms when walking with a shopping cart or lawn mower, which induces forward bending.
- Walking down hill tends to increase the patient’s lumbar lordosis and is generally more uncomfortable than walking up hill.
- As the condition progresses, patients often adopt a slightly forward flexed posture with knee, hip and trunk bending (14).
- Patients are generally more comfortable sleeping on their side in a fetal position, as opposed to lying flat (15).
- Progression of stenosis may result in a wide-based gait, exercise intolerance and major lifestyle restrictions. Patients with more significant cauda equina compression may report urinary incontinence. (16,46)
Stenosis is the most common reason for lumbar spine surgery in those over 65. (13)
Conservative treatment of stenosis at Creekside Chiropractic and Rehabilitation:
Comprehensive conservative care has been shown to help some patients with LSS. (54)
Goals for treatment:
Goals for the conservative management of lumbar spine stenosis include restoring mobility and function, decompressing neural structures and releasing neural adhesions. (27)
Best Conservative Treatment Options:
- Manual therapy
- Manipulation including flexion-distraction
- Soft tissue therapy
- Nerve flossing/glide
- Exercise rehabilitation & stretching
Research shows Chiropractic + Exercise is the superior treatment:
Chiropractic spinal mobilization with exercise training has demonstrated superior outcomes for stenosis patients when compared to medical care, steroid injections or group exercise. (63) Rehab programs should include manual therapy, stretching and endurance strengthening exercises to prevent de-conditioning (28-30).
Manual therapy, mobilization, and manipulation:
Distraction manipulation, i.e., Cox flexion distraction, may be a useful tool (33).
Nerve mobilization and nerve flossing:
Nerve mobilization techniques may help to release perineural adhesions. Sciatic mobilization may be initiated by performing a straight leg raise to tolerance and then rhythmically moving the ankle while gradually increasing sciatic stretch. (34)
Exercises for stenosis:
Exercise prescriptions should complement the treatment goals of increasing mobility. Exercise programs should include (35):
- Hamstring stretches
- Knee to chest pulls
- Sciatic nerve flossing exercises
Acupuncture treatment for stenosis:
A comparative study of patients with lumbar spine stenosis found that acupuncture was significantly more effective than medication. (52)
Home exercises and treatments:
- Recumbent cycling is usually tolerated and may help maintain aerobic function and overall fitness.
- Patients should limit provocative activities, including heavy lifting or those that induce extension, i.e, prolonged standing or overhead activity.
- Patients who are forced to stand may find relief by slightly elevating one foot on a stool, cabinet, bar rail, etc.
- The use of a rigid brace should be discouraged, as this will likely induce extension and provoke symptoms. (36)
- Inversion tables may provide palliative relief; however caution should be taken to ensure that the user is able to get themselves back up.
Common Medical treatment of Stenosis:
- Typical medical management may include the use of NSAIDs, oral corticosteroids, gabapentin, diclofenac, and tricyclic antidepressants. (37,38)
- The use of epidural steroid injections is controversial with many studies showing no or only little short-term benefit (39-41), while other research suggests some benefits (62).
- Patients who continue to experience debilitating symptoms and loss of function in spite of conservative efforts may be candidates for minimally invasive lumbar decompression surgery (MILD), laminectomy and/ or spinal fusion surgery (42-44,53)
- However, in the absence of neurologic deficit, surgery has shown no significant benefit over more conservative options (55).
At Creekside Chiropractic & Performance Center, we are highly trained to treat lumbar stenosis. We are the only inter-disciplinary clinic in Sheboygan county that provides chiropractic, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.
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