This was a question from my father. He needed some exercises for lumbar stenosis because he was recently diagnosed with it. My dad was and is still very active. He had retired and was working as an electrician to keep himself busy. In his late 60s he began having pain down his legs whenever he was standing or walking. The pain would go away when he was sitting. The pain eventually became so severe that he stopped working and had difficulty walking more than a block. He had all the classic signs of lumbar spinal stenosis.
What is lumbar spinal stenosis?
The spine is made up of 33 vertebrae. The vertebrae are the bones of the spine. They are stacked on one another to make a column. The spinal cord travels through the column with nerves exiting at each vertebral level. The nerves exit at an area called the vertebral foramen. They exit on the left and right of the spine to innervate both sides of the body.
The first 7 vertebrae make up the cervical or neck region. The middle 12 vertebrae are the thoracic or mid back region. The next 5 vertebrae are the lumbar or low back. The next five segments make up the sacrum which is the triangular bone at the base of the spine. The sacral segments are fused meaning that the vertebra have grown together. The last 4 vertebrae are also fused. This is the coccyx or tailbone. Spinal stenosis is most common in the cervical and lumbar spine. For this post, I will only be talking about lumbar spinal stenosis.
There are two types of lumbar stenosis:
- Central canal stenosis – This is a narrowing of the spinal canal which puts pressure on the bundle of nerves that run through it. This will cause symptoms down both legs.
- Foraminal or lateral stenosis – This is a narrowing of the vertebral foramen where the nerve roots exit the spine. This will cause symptoms on only one side of the body.
What are the symptoms of lumbar spinal stenosis?
There are several symptoms associated with lumbar spinal stenosis. These include:
- Burning pain into the buttocks and down into the legs
- Numbness and tingling in the legs
- Weakness in the legs or feet
- Cramping in the legs
- Symptoms increase with standing or walking
- Symptoms decrease with sitting, lying down, or bending forward
- Shopping cart sign – This is when a person leans forward on the shopping cart to relieve symptoms
- Pain in the low back may or may not be present
- Red flags
- You need to get immediate medical attention if you have any of the following.
- Difficulty controlling your bowel or bladder,
- Numbness in your groin/pelvic area
- Weakness in both legs that makes it difficult to walk
- These are red flags for cauda equina syndrome. This is a very rare condition that occurs when the bundle of nerves at the end of the spinal cord are compressed. These nerves are called the cauda equina. If not treated this can lead to permanent loss of bowel and bladder functions as well as other problems.
- You need to get immediate medical attention if you have any of the following.
What causes lumbar spinal stenosis?
There are many causes of spinal stenosis. These include:
- Osteoarthritis – This is the most likely cause of lumbar spinal stenosis. Osteoarthritis is probably from wear and tear on the spine. However arthritis can also form in areas of previous trauma. My father was involved in a serious car accident about 30 years prior and had a serious back injury as a result. This may have been the cause of the arthritis that led to his stenosis.
- Spondylolisthesis – This is a slippage of one vertebra on top of the other which can lead to a narrowing of the spinal canal.
- Herniated discs – The discs are round, cushioning pads between each vertebrae. As we age, the discs will flatten out and the outer edges might crack or bulge. This could cause pressure on nerves near the disc.
- Tumors – It is rare but tumors can form in the spinal canal.
- Spinal injuries – Severe trauma such as a car accident can cause spinal fractures or swelling of tissue that could compress the spinal cord or nerves.
- Congenital spinal stenosis – This can occur when a person is born with a small spinal cord. Spinal stenosis can also occur with scoliosis.
What are the risk factors for spinal stenosis?
There are several common risk factors for lumbar spinal stenosis. These include:
- Age 50 or older
- More common in men
- Scoliosis or other spinal conditions
What should I do if I think that I have lumbar spinal stenosis?
- See your physician – This is a very important first step. You will probably see your primary care physician first. Your PCP can order imaging such as x-ray, CT-scan, or MRI. These, along with a physical exam, can help diagnose your condition. Having regular imaging done can also track the progression of the stenosis. Your doctor might also prescribe NSAIDS (nonsteroidal, anti-inflammatory medicines) to help with pain and swelling. You might be referred to a spine surgeon, neurologist, or a pain management physician.
- Physical therapy – Find a good physical therapist. Physical therapy can help decrease the pain and improve strength, posture, and flexibility. Spinal stenosis cannot be cured but physical therapy can aid in helping you perform activities in walking and standing for longer and with less symptoms. Your PT will teach you how to manage your symptoms so that they interfere with your life as little as possible
- Conservative treatment is the treatment of choice for lumbar spinal stenosis. However in some cases, surgery is required. This would include if you have any red flag symptoms or your quality of life is greatly diminished. My dad ended up having surgery. He had severe central canal stenosis and had pain in both legs that prevented him from walking any real distance. He was becoming depressed and conservative measures did not help. He had a lumbar fusion and returned to electrical work 6 months later at age 70.
What can I do?
- Exercise
- Aerobic – Performing low impact aerobic exercise is very beneficial for the spine. It increases the flow of nutrients and blood. Pick a type of exercise that does not exacerbate your pain. Examples of low impact aerobic exercise include walking, swimming, and biking. If you don’t currently have an exercise program, then slowly work into one. You might begin by riding a stationary bike for 5 to 10 minutes a day and slowly work up to 30-60 minutes over several weeks or months.
- Stretching – Stretching the muscles of the back and hips will increase your range of motion, improve posture, and decrease tension around the low back.
- Strengthening – Strengthening the muscles around the low back and hips will help stabilize the spine. Below are videos of strengthening and stretching exercises for the low back and hips. Using resistance bands is a nice economical way to increase difficulty and strength.
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- Avoid any activities that increase your symptoms. For spinal stenosis, these typically includes any activities that require prolonged walking or standing. It also includes any exercise that takes the low back into extension. Low back extension is when the spine bends backward like in a back bend or cobra pose. This position of the spine can put increased pressure on the nerves.
- Heat and ice – Heat can be very helpful when the back is feeling stiff. This might be first thing in the morning or after sitting for awhile. Heat also brings blood flow to the area and makes movement more comfortable. It could be helpful to sit with a heat pack for 15 minutes prior to exercise to help improve back mobility. Ice is very helpful to decrease inflammation after activity such as exercise, yard work, or heavy lifting. Ice the area after activity with an ice pack for 15 to 20 minutes to help decrease pain.
In review
- Lumbar spinal stenosis is narrowing of the spine that can put pressure on the nerves. It can affect one or both sides of the body.
- It’s symptoms include pain, weakness, and numbness down one or both legs.
- The symptoms occur with walking or standing and decrease significantly or completely with sitting.
- It occurs primarily in people older than 50 and is more common in men.
- Conservative treatment is the treatment of choice for lumbar spinal stenosis. This includes physical therapy and possible medication from your physician.
- There are things that you can do including exercising, heat, and ice.
- Avoid activities that increase your symptoms.
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Lumbar_Spinal_Stenosis
https://www.statpearls.com/articlelibrary/viewarticle/24463/
https://www.choosept.com/guide/physical-therapy-guide-spinal-stenosis