Spinal Stenosis: Explanation for Pain in the Back and Down the Leg
Does walking increase the pain in your back and down your leg?
Does your leg pain feel better when you lean forward or sit down?
If you answered YES to the questions above you could have spinal stenosis.
What is Spinal Stenosis?
Spinal stenosis occurs as a result of the normal wear and tear and degeneration that occurs in the spine with age. The key word here is NORMAL. This process is part of the natural process of aging. Spinal stenosis specifically refers to the narrowing of the canals formed by the spinal vertebra making the tunnels that the nerves travel through much narrower. These types of degenerative changes typically develop gradually over a prolonged period of time and if our body is functioning optimally, we can easily adapt to the changes and we remain symptom free. In some circumstances, when there is an overload of tissue strain, a significant change in lifestyle or if there has been injury to the back, the tissues may not adapt quick enough and the result is that you feel pain and stiffness. Sometimes this change and degenerative process can put pressure on the nerves that exit your spine and this can create pain, numbness or tightness that travels down your leg. Rest assured that our bodies are remarkable and you will adapt! Some tough cases will require individualized treatment from a qualified and experienced physiotherapist or chiropractor to get you back on track.
What Causes Spinal Stenosis in the Lower Back?
Lower back spinal stenosis is ultimately caused by wear and tear and can be influenced by your genetics as well as any previous injuries or recurrent strain that you have placed on your low back. This means that the process of wear and tear is unavoidable but your genetics and the strain that you put on your back can either speed up or slow down this process.
To simplify this even further, if you put a lot of pressure on your spine doing heavy work like bending, twisting and lifting like in a manual labour intensive job you will speed up the degenerative process. The terms spinal stenosis, wear and tear joint degeneration or osteoarthritis in the spine can all be used to refer to this condition and are often used interchangeably.
Below is a list of the degenerative changes that can be related to Spinal Stenosis:
Disc Bulge or Disc Herniation
Disc Bulges and Disc Herniations are degenerative changes that could be related to Spinal Stenosis. There is a disc in between each spinal bone and its fluid centre helps to absorb shock through the spine. If too much pressure is put through the spine, the discs can bulge and even herniate. Over time the chronic inflammation of the discs can lead to narrowing and sclerosis, boney growths around the disc. This can lead to pressure or rubbing against the nerve roots exiting the spine and pain down the leg.
Facet Joint Degeneration
The facet joints are the joints that connect two spinal vertebrae together. Every spinal vertebra is connected to the one above and below at the facet joints on the left and right side of the vertebrae. Over time, with increased compression, the facet joints start to wear down. The cartilage in the facet joints start to wear down and sometimes there are bone spurs that grow at the edges of these joints. This can cause pain in your low back and also can increase the pressure around the nerve roots causing pain in your legs.
Thickening of Ligamentum Flavum
The ligamentum flavum is a ligament that travels down the spinal canal from the neck to the low back. It helps to reinforce the tunnel where the spinal cord travel down and this thick ligament protects the spinal canal by limiting movement of the spinal bones. With age, the ligament gets thicker and can increase the pressure on the spinal canal and nerve roots. The ligament can get so thick that it narrows the passage way of the spinal cord and nerve roots. This can lead to increase pressure on the nerve roots as well and cause pain in one or both legs.
Spondylolisthesis of the Spinal Bones
Spondylolithesis happens when one spinal vertebrae slips forward on the spinal vertebrae below it. This can happen when you have a fall or a big injury but quite often it can occur as a result of the degeneration process we talked about before. The degeneration will cause enough wear and tear near the back of the vertebrae, like a rope rubbing over rocks, that eventually there will be too much pressure and the vertebrae will start to slip forward. When the vertebrae slips forward enough the tunnel for the spinal cord gets smaller and the tunnel for the nerve roots gets sheered and compressed. The nerve roots can have increased pressure on them and this can cause pain in the back and leg.
Chiropractic and Physiotherapy Treatment for Spinal Stenosis?
All of these degenerative changes can seem daunting. However, there is definitely hope! Visit a trusted chiropractor or physiotherapist who will help you develop an individualized treatment plan to get you on the road to recovery. Ultimately, your nerves and joints will get adapted to the wear and tear and become tough enough to endure these changes but having a strong core and good mobility through your hips and spine will decrease the pressure on your joints and reduce the tension through your nerves.
The best physiotherapists and chiropractors will incorporate some of the following treatment methods listed below:
- Education about positions and activities to avoid
- Core strengthening program
- Manual therapies to increase hip and spine mobility
- Soft tissue release such as Active Release Therapy
Treatment with your physiotherapist and chiropractor may be complimented with massage therapy for pain control, to relieve muscle tension, to improve joint mobility and provide relaxation through muscles that may be guarded or in spasm.
What are the Best Exercises to do for Spinal Stenosis?
When you are diagnosed or suspect you have spinal stenosis it is important that you take steps to strengthen your core muscles.
Below are three progressions, listed easiest to hardest. We always recommend working with an experienced physiotherapist or chiropractor who will choose the most suitable exercises for you.
Transverse Abdominis in crook
Lying on your back with your feet flat and your knees bent. Your spine should be resting in a relaxed position with its natural curves and good rib cage and pelvis placement. Engage a very gentle tension around your abdominals like a corset was just done up but do not hold your breath or brace. Hold your trunk and pelvis steady as you slide one leg at a time out and in along the floor.
Repeat 10x per leg 2-3x day
Lying on your back with your hand placed in the air directly over your shoulders and your knees placed directly over your hips with shins parallel to the floor (table top position). Maintain your trunk in a neutral positon and bring the opposite arm and leg away from the centre of your body, slowly and controlled. Do not let your pelvis rock or your rib cage raise off the ground. Switch and perform the same movement on the other side. If you notice excessive arching in your low back as you perform this maneuver, then try only moving one limb and if the arching continues, you will need to step back until you are strong enough. Remember do not brace or hold your breath.
Repeat 10x per side 2-3x day.
How can you Treat Spinal Stenosis at Home?
At home, you can take steps for improving your symptoms with a balance of rest and activities that do not exacerbate your symptoms.
You will want to start a gradual core strengthening program (see above). You will also want to ensure that your lifestyle activities are modified to reduce strain and load on your spine. This may involve changing your work space and sitting postures or modifying the way you lift and move.
Once your symptoms have settled and you are progressing well with core strength you will gradually re-introduce your pre-injury activities back into your routine and return to your normal lifestyle.
Everyone’s experience with Spinal Stenosis can be different and these are just some general suggestions. It is always recommended that you have a professional assess you and help guide you through an individualized treatment plan for best results.
How Long does it Take to Recover from Spinal Stenosis?
Resolution of symptoms can take 6 weeks to several months to resolve depending on the severity of symptoms and the patient’s lifestyle.
The sooner you seek treatment from a professional Chiropractor, Physiotherapist or assessment from a Sport Medicine Physician skilled in treatment of spinal stenosis, the more favorable the recovery timeline.
Contact us to book your appointment today!
Dr. Ken Nakamura, Chiropractor
Dr. Ken Nakamura is a chiropractor practicing at Rebalance Sports Medicine in downtown Toronto.