Marin Movement Center Physical Therapy Blog

Marion Kregeloh, PT, CFP provides health information for physical therapy, osteoporosis, chronic pain, physical therapy, orthopedic therapy, Feldenkrais, in the Marin Movement Center blog.

Degenerative Changes in the Back: Lumbar stenosis

Posted by Marion Kregeloh
Marion Kregeloh
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on Monday, 02 April 2012 in [ Back ]

Lumbar stenosis is a narrowing of the lumbar spinal canal. It mostly occurs in adults older than 50 and is the most common cause for spinal surgery in people older than 65 of age. Stenosis can be congenital but the most common cause is degeneration with age. Conditions such as osteoarthritis, loss of height of the intervertebral discs or thickened ligaments are aging related sources. Other conditions that can lead to stenosis are tumors, injuries to the spine or Paget's disease, to mention some.

Depending on which nerves are compressed, lumbar stenosis can cause pain or cramps in the legs, especially when standing and walking. The pain typically eases with sitting and bending forward.

Complications of lumbar stenosis can lead to incontinence, muscle weakness and cauda equina syndrome. The latter causes compression of the lower nerve roots which may lead to paralysis and requires immediate medical attention.

Many patients with lumbar stenosis that we see in my physical therapy practice can improve their symptoms through a targeted exercise approach. The focus needs to be on core/abdominal strengthening and teaching the patient unloading positions and good body mechanics. It is important to avoid twisting movements and any jerky movements of the spine. Lumbar traction of the lumbar spine can also be helpful and some of our patients like a home traction unit. It supports the unloading effect and can give pain relief. Modalities such as ultrasound, heat and/or ice packs and TENS (transcutaneous electrical stimulation) are pain management tools that impact each patient differently and can be used as needed. At times we recommend a back support belt if worn only for short periods during the day to further allow the spine to be unloaded while actively strengthen abdominal muscles as part of a daily exercise routine. Some of our patients find good pain relief while strengthening their core with aquatic therapy, especially with water walking in 3.5 - 4' deep water. The traction effect of the water is reducing pressure in the spine while the water also provides resistance and supports abdominal strengthening. We offer aquatic therapy right here at the Mt Tam Racquet club. All our patients have a floor (or bed) exercise routine that is custom-taylored to their condition and fitness level.

Steroid injections are common procedures that are performed by doctors as part of pain and inflammation management. One study (Johnsson et al.) followed 32 patients with moderate stenosis symptoms for 4 years without surgery. Results showed 16% with worsening of their pain and 30% with declined walking ability.

If symptoms persist despite a targeted conservative approach, surgery needs to be considered in patients with certain findings. Decompression laminectomies are common surgeries for stenosis while fusions may also be indicated. Several other surgery technologies are already available, as well as tested and developed. I encourage my patients to do their own research and discuss all their questions with the prospective surgeon.

If you have any questions regarding exercise routines or want more information, please contact Marion Kregeloh, PT, CFP at 415.479.1765.

 

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