Physical Therapy Can Help Spinal Stenosis

Spinal stenosis is defined as an abnormal narrowing of the space in the spinal canal.  There are two main categories of spinal stenosis:

1) Primary spinal stenosis, which is known as congenital, is present since birth and typically becomes apparent in the fourth decade of life.

2) Secondary spinal, which is known as acquired, typically arises from degeneration of the spine caused from trauma, systemic disease or tumors, disc protrusion, arthritis, a stress fracture called a spondylolisthesis, and surgical issues such as scarring or hardware (Akuthota et al., 2003; Thomas, 2003).

Symptoms of spinal stenosis can be unilateral (on one side) or bilateral (both sides) include:

    • Leg cramping
    • Leg pain
    • Leg heaviness and weakness
    • Pain with spinal movement
    • Numbness/paresthesia

It is very important to discern the origin of back and leg pain in order to effectively treat the problem.  Inappropriate treatment can make the symptoms worse.  Other diagnoses that mimic spinal stenosis include but are not limited to vascular claudication, cancer, peripheral neuropathy, ankylosing spondylitis, skeletal hypertrophy, herniated disc, and hip arthrosis.

Symptoms that should be considered red flags for immediate medical attention
(Dutton, 2008; Thomas 2003) include:

    • Constant and severe night pain
    • Unexplained weight loss
    • Loss of appetite
    • Unusual fatigue
    • Fever or night sweats
    • Onset of difficulty with balance and coordination
    • Difficulty walking
    • Alteration of bowel or bladder function
    • History of carcinoma
    • Use of steroids
    • Severe pain in recumbent position
    • Progressive neurological deficits

Spinal stenosis can be treated conservatively with physical therapy, nonsteroidal anti-inflammatory medications, epidural injections, and lifestyle modifications.  When conservative treatment is not effective after at least three to six months of treatment, surgical intervention may be an option.  The goal for surgical intervention is to reduce pressure on the spinal nerves.  Surgical approaches include simple decompression or decompression with a lumbar fusion (Fu et al., 2010).

References

Akuthota., Lento, P., & Sowa, G. (2003).  Pathogenesis of lumbar stenosis pain: Why does anasymptomatic stenotic patient flare? Physical Medicine and Rehabilitation Clinics of North America,   14(1), 17-28.

Dutton., M. (2008).  Orthopedic examination, evaluation, and intervention (2nd ed.)(p. 1568). New York: McGraw-Hill.

Thomas, S.A. (2003). Spinal stenosis: History and physical examination. Physical Medicine and Rehabilitation Clinics of North America,14, 29-39.

Fu, K.M., Smith, J.S., Polly, D.W. Jr., Perra, J.H., Sansur, C.A., Broadstone, P.A., et al. (2010). Morbidity and mortality in the surgical treatment of 10,329 adults with degenerative lumbar stenosis. Journal of Neurosurgery: Spine, 12(5), 443-446.

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