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Understanding Spinal Stenosis: What You Need to Know Spinal stenosis is a widespread condition that impacts a significant number of Americans, especially as they age. It's likely that either you or someone you know has encountered this diagnosis.
What is Spinal Stenosis? In medical terms, stenosis refers to the abnormal narrowing or constriction of any body passage or structure. However, when it affects the spine, it's known as spinal stenosis.
Breakdown: Zones, Sites, and Levels
Zones of the Spine: The spinal column consists of 33 vertebrae, divided into five zones: cervical, thoracic, lumbar, sacral, and coccygeal.
2. Site
Vertebrae have two major types “holes” or openings that play a role
in spinal stenosis.
Central Canal-this is the main opening located in the middle of each vertebrae through which the spinal cord runs through.
Foramen-this second type of opening lie on both the right and left sides of each vertebrae through which the nerves (which branch off the spinal cord) exit the cord and travel down into our arms and legs. The area where a nerve travels through the foramen is called the nerve root.
Stenosis of the central canal results in decreased diameter of the central opening and subsequently loss of room for the spinal cord.
This decreased diameter causes compression on the spinal cord itself. The same happens to the nerve root in stenosis of the foramen.
3. Level
Each vertebrae is denoted by the first letter of the zone it is in followed by the number of that vertebrae. The location will be described by the numbers of the two vertebrae that the stenosis is occurring. The most common zones that spinal stenosis occurs in is the cervical and lumbar spines.
Note: the coccygeal vertebrae are fused and not identified by individual levels.
So, if you have been told you have right L3/4 foraminal lumbar spinal stenosis, it means that there is a narrowing of the right side foramen (site) in the lumbar spine (zone), occurring between the L3 and L4 vertebrae (level).
CAUSES
Some people are born with a narrower canal then normal, however in the majority of cases of spinal stenosis the cause are associated with wear and tear. Over time, this impacts different openings within vertebrae and exerts pressure on nerves. Common factors include:
arthritis
bone spurs
spinal ligaments that have thickened (and are taking up more space)
herniated discs
tumor
other spinal injuries
In most cases, several of these go hand in hand and occur together. When we do things that increase forces over the spine and the spinal discs, the body responds accordingly. It creates inflammation over the joints resulting in arthritis.
As arthritis progresses, it lies down more bone to try to protect itself resulting in bone spurs. The increased pressures cause the spinal discs to bulge and herniate. Finally, ligaments abnormally thicken as a way to deal with the increased forces.
None of these responses occur neatly and in an organized fashion, actually the body is in protection mode and will “build up” the tissue at the sites where there is the greatest forces. This can cause a haphazard breakdown of tissues in some areas with an abnormal build-up of tissues in others.
This lack of symmetry and excess tissue build up-whether bone, ligament, disc or all-can and does encroach on the openings in the vertebrae. This in turn, puts pressure on the nerves and surrounding structures which contributes to the symptoms of spinal stenosis.
SPOTTING THE SYMPTOMS
Since stenosis is related to impingement of the nerves and surrounding structures, the symptoms of stenosis follow this trend:
Pain or stiffness in neck (cervical) or low back (lumbar)
Numbness/tingling into the arms (cervical) or legs (lumbar)
Weakness of hands/grip strength or in legs
Difficulty walking
Balance problems
Incontinence issues
The symptoms will depend on the location and severity of the stenosis. Multiple spinal levels can be affected, thereby presenting a range of symptoms.
DIAGNOSTICS
The most common tests that are given to diagnose spinal stenosis include:
X-ray-identifies bony changes and spurring
MRI-shows issues with ligaments, herniated discs and the presence of tumors, as well as where nerve roots may be experiencing impingement
CT scan-this is done if you are unable to have an MRI for medical reasons. This shows the presence of herniated discs, tumors, bone spurs, and outlines the spinal cord and nerve roots
There is actually no “gold standard” test for spinal stenosis and many diagnoses are done by the types of symptoms a person is having.
SEVERITY
Spinal stenosis is typically defined as mild, moderate, or severe. This is diagnosed by taking measurements of the size of the openings (either central canal or foramen) on an MRI or CT scan.
Interestingly, there is very little correlation between the severity of stenosis found on diagnostic tests and the symptoms experienced.
I have worked with patients that have had mild symptoms with severe stenosis and those that had significant symptoms with very little stenosis seen on the MRI. I have even had patients that have had diagnostic testing done for an unrelated issue, spinal stenosis was found and they had no symptoms of it at all!
So, how can you reduce your chances of getting spinal stenosis?
The number one thing to do is to reduce the excessive forces over your spine. You do this in 3 ways:
1. MAINTAINING OPTIMAL POSTURE
Our posture plays a huge role in the forces that go through our spine, particularly how we sit, as we tend to spend more time in this position than any other. Poor sitting postures place significantly larger forces through our spine and soft tissues and this leads to increased wear and tear.
As we are spending more time on technology, maintaining good, supported postures are essential. Make sure that you are sitting properly at your desk or while using a laptop with these critical body positions.
2. GETTING AND STAYING FLEXIBLE
Keeping your muscles loose and moving easily is another important way of reducing the stress over the spine. Stretching should not be painful or difficult, rather you should start slowly and gently, only pulling until you feel a mild comfortable stretch. As you gain flexibility, you can increase your pull.
One of my FAVORITE tools for people to use in a stretching program is the OPTP stretch strap. This makes things much easier by reducing strain and excessive pulling with your hands and arms. It also allows you to relax easier and reduce holding your breath (which is not advised).
If you like, sign up and grab these 5 simple stretches for FREE to increase your flexibility, improve your posture and decrease stress over your spine.
3. GAINING AND MAINTAINING STRONG CORE MUSCLES
Finally, having strong core muscles is critical for spinal support and protection. Core muscle strengthening is a very misunderstood topic and one that is daunting for many people.
Core strengthening does not mean you have to kill yourself in the gym, flip tires, or engage in a hard core Cross Fit program. You can actually start very slowly and you do not even have to sweat! Just getting these particular muscles activated can go a long way in protecting your spine and reducing pain.
I talk more specifically about misconceptions of core strengthening in this post and what the core actually is here. Core strengthening does not have to be intimidating!
You can even try some beginner core exercises safely on your own - check out these.
These three approaches will all go a long way in reducing the increased load over your spine and the soft tissues that contribute to spinal stenosis. I have links to options for addressing these 3 approaches below.
While it's a lifelong condition, many manage it well with lifestyle adjustments. Maintaining posture, gentle exercises, and core strengthening help alleviate symptoms and improve quality of life.
Start being mindful of your posture, begin a gentle, progressive stretching routine, and build up the strength of your core muscles. You can start making small steps towards all three of these areas no matter where you are in your situation.
Finally, if you want more STEP-BY-STEP instruction as to EXACTLY what to do for low back and sciatica pain, check out my short Soothe Your Spine video program which walks you through what I teach my own patients in the clinic.
The program allows you to do everything in the privacy of your own home, work at your own pace, and do not need any equipment. You can purchase the program HERE.
If you have any questions or concerns regarding spinal stenosis, see your physician or your physical therapist for a complete evaluation.
You do not have to be constrained by spinal stenosis-just start small and go slowly. If done properly and consistently, even the smallest of changes can make the biggest difference!
Stay Well and Feel Good,
Always consult your physician before beginning any exercise program. This general information is not intended to diagnose any medical condition or to replace your healthcare professional. Consult with your healthcare professional to design an appropriate exercise prescription. If you experience any pain or difficulty with these exercises, stop and consult your healthcare provider.
Hi! I am Dr. Kim MacDonald. I am a physical therapist who specializes in empowering my patients to optimize how they move their bodies and improve their ability to do the things they love regardless of age, experience, or capabilities.
My experience in the health care field allows me to teach the tools you need to ensure that you are working safely to improve your pain and maximize your physical potential.
If you would like to know more about how you can help yourself be healthier and live a more active lifestyle, join me here. Sign up to stay updated on new info, tips, and resources.
If you are having back pain or sciatica and cannot get relief, check out my quick Soothe Your Spine video course on what you should be doing to reduce your pain
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