What is spinal stenosis?
The spinal cord, nerves and arteries are housed by the spine, which acts as a hard casing to support and protect these vulnerable structures. The spine has a hollow column that allows the spinal cord to run from the brain to the rest of the body. At each spinal segment, nerves exit the spine and supply the tissues of the body. There is also an intricate network of small veins and arteries that provide blood to the spinal cord and vertebrae, providing them with the nutrients needed to operate.
Spinal stenosis is characterized by a narrowing of the spaces that house the spinal cord, nerves and blood supply. A variety of factors can cause spinal stenosis, however overwhelmingly it is caused by degenerative changes to the spine as we age. Many people over the age of 60 will have a degree of spinal stenosis, however not all will have pain. Clinically, spinal stenosis is often used to describe the painful symptoms of this condition rather than just the narrowing itself.
What are the symptoms?
Pain with walking or standing that radiates into the hips, thighs and even as far as the feet is the hallmark of spinal stenosis. Usually, this pain will be reduced with rest and forward movements of the spine. Spinal stenosis is a progressive condition and symptoms will gradually increase over time. The pain is often described as a deep ache and can be associated with fatigue, heaviness, weakness and numbness. It can affect just one leg, but often will be felt in both legs. There will often be associated back pain, however leg pain is usually the most severe complaint.
How can physiotherapy help?
There are many conditions that need to be excluded before a diagnosis can be made. Your physiotherapist is able to conduct a thorough examination and accurately diagnose this condition. In some cases, imaging may be requested. As mentioned earlier, many people have stenotic spinal changes without symptoms. Surgery to decompress the restricted nerves and stabilize the spine can be used in very severe cases.
For mild to moderate cases of spinal stenosis, physiotherapy can be extremely beneficial. Your physiotherapist can help you manage your pain through hands-on techniques and by providing a targeted exercise program based on biomechanical assessment. They are also able to help you to understand and manage your day in a way that helps to reduce flare-ups and maintain muscle strength.
Occasionally surgery is the right choice for you, then your physiotherapist is able to guide you through this treatment pathway, helping you to prepare and recover from surgery to get the best overall outcome possible.
Low back pain is one of the most common conditions treated by physiotherapists and if you are unlucky enough to have been a sufferer, you know that severe back pain can take over your life. With improved understanding, health professionals have come to identify some common myths about back pain that are inaccurate, misleading or even counterproductive...
Myth #1 – Discs can ‘slip’ out of place
Sitting between the vertebrae of the spine are soft discs that provide flexibility and shock absorption to the spine. In the past, many health professionals have told patients that these discs had ‘slipped’ as a way of explaining their pain to them. This is not entirely accurate, as these discs are actually very secure and rarely, if ever 'slip' out of place. Discs may bulge slightly or in some cases tear, however more often than not these injuries will heal without any permanent damage and exist in many people without causing any pain at all. Incorrectly thinking that a part of your spine has permanently ‘slipped’ out of place can cause you to move differently, which can create more pain and dysfunction in itself.
Myth #2 – If you have low back pain, you should stay in bed
When back pain strikes, our natural instinct is to rest, avoid movement and wait for the pain to pass. However, studies have shown that being active and performing targeted and gentle exercises can help improve low back pain. In fact, our impulse to stop moving and protect our spines can actually cause abnormal movement patterns and stress, leading to ongoing pain after the original injury has healed. If you are unsure of what kind of exercises you should be doing, your physiotherapist can help guide you with a targeted exercise program.
Myth #3 – Severe pain means severe damage
Pain that is severe, strikes suddenly and without warning can be a very scary experience. If this happens to you, you could be forgiven for assuming you must have sustained a very serious injury. The fact is, however, that the spine, being surrounded by nerves, is a particularly sensitive area of the body and pain in this area can be very strong without significant damage. A small ligament sprain or a muscle spasm can actually cause a large amount of pain, but it is common for intense symptoms to settle down quickly, even disappearing within a few days. In many cases, symptoms that last for longer than 2-3 weeks are caused by changes to your movement patterns in response to this pain and not the original injury itself.
If you are suffering from back pain, the best person to see is your physiotherapist. They can help you to recover without any complications or side effects and help you safely return to your usual activities while also ruling out any serious damage that might need further investigation.