If you relate to the above, then it might be that your back has a condition known as ‘Spinal Stenosis’. Spinal stenosis is a condition where changes to the spinal canal cause neural and vascular structures to be compressed due to the decreased space in the spinal canal. These changes can cause pain and numbness in the buttock, leg, or thigh area especially during prolonged periods of standing or walking. You may feel like your legs will collapse or, perhaps, you find that you are falling often for no apparent cause. Usually, these symptoms are relieved by sitting or bending forward. Although it can happen to anyone, people of ages 60 years and older are more likely to be affected. Research (Backstrom et al, 2011) shows that between the ages 40 and 60, the prevalence of lumber stenosis has increased from 16% to 38.8%, and between the ages 60 and 70, the prevalence increased furthermore to 47.2%.
The condition of spinal stenosis often has the following components: wear and tear of the intervertebral discs (cushion between adjacent vertebrae), narrowing the spinal canal, age-related changes of the vertebrae, osteoarthritis and bulging or herniation of the intervertebral discs. The pressure in the spinal canal, on rare occasions, can be from a tumour or an infection.
The diagnosis of spinal stenosis is not merely using X-rays or MRI. The severity of structural pathology correlates poorly to the severity of the signs and symptoms. Therefore, imaging like X-rays and MRI should not be the sole diagnostic tool, and a diagnosis is made thorough physical assessment evaluation.
Physiotherapists are trained to make the necessary evaluation and complete a physical assessment. The physiotherapist will include spinal, muscular, and neurological assessment where they will check the integrity of the spinal system and keep a careful eye out for provoking symptoms. Usually, the symptoms of spinal stenosis can be evoked while bending backwards, muscle power testing generally shows a weaker core, and neurological testing is positive for symptoms of neurological claudication (cramping, pins and needles, altered reflexes of the feet) and other neurological symptoms such as numbness.
Management:
Spinal stenosis rarely leads to progressive neurological injury, therefore non-operative options such as Physiotherapy, are useful to improve functional status and reduce symptoms. Lumber corsets and corticosteroid injections would only be beneficial for temporary pain relief. Lumber corsets should be avoided for prolonged periods of time as it may cause atrophy of the spinal muscles, leading to increasing symptoms.
Physiotherapists provide education of the condition as well as lifestyle modifications that help in managing the spinal stenosis. Posture, core training, exercise advice, office chair ergonomics and pacing strategies are all important to be addressed. Manual therapy which means that the physiotherapist mobilises the vertebra of the spine will decrease the spinal stiffness and lessen the pressure on the spinal cord. Mobilisations and massage both are useful to provide pain relief. According to Backstrom et al (2011) physiotherapy must include mobilisation of the hip joint for the purpose of regaining range of motion from this stiff joint which is a key element to restoration of function. Exercise and aerobic training are beneficial to improve overall fitness and function, however, a spinal stenosis suffer needs careful advice as to which exercises and sport to partake in as some may cause further damage to the spinal cord.
In a meta-analysis of published research of the spinal stenosis condition (Lee et al, 2015), 60% to 90% of patients experience symptom relief after conservative management of spinal stenosis. Back pain may still be present if the nature of the stenosis was caused by degenerative arthritis. Surgery is usually advised if the patient as a severe neurological fallout. In this case, post-operative rehabilitation and management is important for the success of the operation and to return to previous function.
Spinal stenosis is a common disease process, but through physiotherapeutic management we can relief your symptoms and restore your functionality.
To book an appointment with a physiotherapist, contact Michelle on 031 765 8898 or book online https://www.debbiecameronphysio.co.za/online-booking
References:
Backstrom KM, Whitman JM, Flynn TW. Lumbar spinal stenosis-diagnosis and management of the aging spine. Manual therapy. 2011 Aug 1;16(4):308-17.
Lee, S.Y. et al. (2015) ‘Lumbar stenosis: A recent update by review of literature’, Asian Spine Journal, 9(5), p. 818. doi:10.4184/asj.2015.9.5.818.
Lumbar spinal stenosis (no date) Physiopedia. Available at: https://www.physio-pedia.com/Lumbar_Spinal_Stenosis?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal (Accessed: 09 April 2024).
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