Lumbar Spinal Stenosis: Exercise Do’s and Don’ts

Where is the Lumbar Spine?

The lumbar spine is the five vertebral bodies that are located in the lower back area.

What is Lumbar Spinal Stenosis?

Stenosis is simply the narrowing of an opening. Most people know of this in regards to the plaque build-up inside the arteries. In this case, the gradual narrowing of the arteries can lead to high blood pressure and maybe even lead to a heart attack.

There are two types of spinal stenosis:

1. Foraminal Stenosis

2. Central Canal Stenosis

Foraminal Stenosis is the narrowing of the foramen, which I like to describe as the side windows of the spine. At every vertebral level of the spine, there are two spinal nerves that exit, one to each side. These spinal nerves exit the spinal column through these windows.

When someone is suffering from foraminal stenosis, the excess bone begins to grow around the edges of the window frame essentially closing down the width of the window. Eventually, this will come into contact with the spinal nerve causing compression and irritation of the nerve.

Central Canal Stenosis is the narrowing of the central spinal cord canal. The spinal cord is the main bundle (cord) of nerves that runs vertically along the spine. It is surrounded by the vertebral column made of bone. This bone protects the spinal cord from injury.

Central canal narrowing is most commonly caused by osteoarthritis of the spine, bone spurs, and herniated discs. Compression of the spinal cord will typically affect multiple nerves rather than just one nerve (Foraminal Stenosis) because the spinal cord is comprised of a bundle of nerves. When the compression begins to cause injury to the spinal cord resulting in the production of symptoms, it is known as myelopathy.

What are the Symptoms of Lumbar Spinal Stenosis?

Symptoms of lumbar spinal stenosis nerve compression and irritation include:

• Numbness, tingling, or burning sensation going down the buttocks, legs, and feet

• Weakness in the legs

• Weakness in the feet that causes a foot slap when walking (medically referred to as foot drop)

• Back pain

• Increased pain with standing and walking activities

• Loss of sensation in the feet

What’s the Difference Between Lumbar Spinal Stenosis and Sciatica?

If you’ve read my other article on Sciatica, you may have noticed that the symptoms between the two are very similar. That is because lumbar spinal stenosis can be a CAUSE of Sciatica symptoms.

Sciatica is truly the description of a collection of symptoms involving the Sciatic Nerve, even though lots of people mistakenly use the name to describe a condition. Sciatica can be caused by multiple things, one of those causes is Foraminal Stenosis as mentioned above resulting in symptoms that can involve the Sciatic Nerve.

You can treat both lumbar spinal stenosis and Sciatica with similar exercises including the spinal stenosis exercises at the bottom of this article.

Cauda Equina Syndrome

You’re probably still wondering when you would need immediate surgery as most of the things that I’ve talked so far about seem relatively treatable.

Well, as mentioned before, in some rare cases the compression to the spinal cord can lead to a severe risk of non-reparable damage. In the lumbar spine, this is known as Cauda Equina Syndrome. The Cauda Equina is a bundle of nerve roots located near the bottom of the spinal cord within the lumbar spine section.

When compression occurs to this area specifically, there is an increased risk of SEVERE injury if IMMEDIATE MEDICAL ATTENTION is not sought out.

Cauda Equina Syndrome “Red Flag” Symptoms include:

• Bowel and bladder dysfunction
  • • Difficulty urinating, urinary/stool incontinence, etc.)
• Saddle anesthesia
  • • numbness and tingling around the anus, genitals, or buttocks
• Sexual dysfunction
• Difficulty walking
• Sudden progressive weakness

IF YOU ARE EXPERIENCING ANY OF THESE RED FLAG SYMPTOMS, CONTACT YOUR DOCTOR OR MEDICAL PROVIDER IMMEDIATELY!

Testing and Diagnosis

X-rays of the lumbar spine can show joint space narrowing, joint alignment, and the severity of osteoarthritis. X-rays can only show bone, so any soft tissue involvement (muscles, tendons, nerves) must be viewed through other imaging services.

Magnetic Resonance Imaging (MRI) is the most common imaging conducted in order to assess nerve compression severity and location. It uses high-powered magnetics to “see” an image of the soft tissues in the body.

CT Myelography is typically a backup option if an MRI cannot be performed (if someone has a pacemaker, etc.). It uses a continuous, live x-ray image (fluoroscopy) with a contrast dye injection within the spinal cord lining in order to provide an image of the spinal cord. This type of imaging results in higher exposure to radiation to the patient, so it is not used as often as an MRI (which does not use radiation).

Spinal Stenosis Treatment Options

Lumbar spinal stenosis exercises can be quite effective for those suffering from mild to moderate stenotic symptoms.

♦Physical Therapy

Physical therapy exercises and stretches can often provide key relief of symptoms that are produced both directly and indirectly from spinal stenosis. Spinal stenosis exercises should target core strength, lower extremity flexibility, and spine mobility.

In some cases, it may be beneficial to see a physical therapist in person in order to trial lumbar traction, which is a device used while lying down that helps to reduce lumbar compression on the nerves. Removing the compression from the nerves can allow the reduction of nerve pain into the buttocks and down the legs. The ComforTrac Lumbar At-Home Traction Device is the exact one I use with patients in my clinic and it can be of great benefit if used daily to help with nerve healing. Plus it’s much more convenient when performed at home!

9.4

Lumbar Traction Kit

• COMFORTRAC LUMBAR TRACTION KIT
• PROVIDES SIMPLE LUMBAR SPINE DECOMPRESSION
• DISCOMFORT RELIEF FOR A HOST OF BACK & NERVE PROBLEMS
• AT-HOME COMFORT
• EASY TO ADJUST

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Those suffering from spinal stenosis tend to find that lumbar extension (leaning back position) aggravates their pain, numbness, tingling symptoms in the back and legs. This is due to the increased compression on the nerve/s that is caused by extension positions.

Have you ever noticed an elderly man or woman standing in a significantly bent-over position while using a shopping cart, cane, or walker? In the physical therapy world, this bent-over (flexed) position is referred to as a stenotic posture. Over time, that individual becomes accustomed to having increased pain when standing upright (extended position) and decreased pain when being bent forward, so they develop this habit of always staying in this bent position.

The problem arises when they’ve spent so much time in the forward bent position that their body loses the ability to reverse that posture and go into extension. This can also lead to other low back injuries over time as well.

Whenever we finally see them in physical therapy, we have to try and improve their ability to regain at least a neutral position if they can tolerate it without increased pain.

♦Aquatic Therapy

Aquatic therapy or simply exercising in a pool helps to unweight the body. If you’re standing in water up to your waist, your body weight is reduced by 50%. At chest height, your body weight is reduced by a whopping 67%! Exercising in a pool surprisingly is a lot of work, so start easy by spending only 10-15 minutes exercising, then gradually increase the time as your body allows.

♦Corticosteroid Injections

Corticosteroid injections provide an anti-inflammatory effect near the irritated spinal nerve/s. Since the injection will have to be placed near the spine, it is performed under fluoroscopy (to ensure proper placement).

Oftentimes, a patient will receive this injection as a first-line defense and then be referred to physical therapy for spinal stenosis exercises. The injection can help improve the patient’s tolerance to physical therapy activities.

♦Surgical Intervention

Surgical intervention may be required if any of the previous Red Flag symptoms are observed or if the patient’s pain has not improved with an injection/physical therapy. Surgical procedures include:

1. Microdiscectomy

   • Typically younger patients, partial removal of the damaged disc in the spine

2. Laminectomy

   • Typically older patients, removal of a piece of bone of the vertebral body that relieves compression on the spinal nerves

3. Laminectomy with spine fusion

   • Rarely indicated, helps to stabilize the spine if instability is an issue

Spinal Stenosis Exercises to Avoid

Spinal stenosis exercises should follow some basic guidelines in order to NOT increase nerve compression. As always, if you feel that an exercise is increasing the symptoms (pain, numbness, tingling, burning) in the back, buttocks, legs, then it is best to modify the exercise or stop the exercise altogether.

Other activities to avoid when someone has spinal stenosis include:

1. High impact activities

   • Running, jumping, jogging

2. Long walks or sustained standing

3. Back extension exercises and stretches

   • i.e. yoga poses such as cobra and bridging, deadlift, back extension machine

4. Sedentary lifestyle

   • too much bed rest or sitting will only make the body stiffer and tighter and can lead to muscle atrophy (weakness)