I had trouble deciding how to write about spinal conditions. I wasn't sure if I should group all the conditions and make one general post on the neck and one general post on the low back or go more in depth about specific conditions that occur in both. There are so many similarities in the neck and low back that I decided to go with the latter so that you guys can have a better understanding of each condition.
Overview
There are two types of stenosis: spinal (central) stenosis and foraminal (lateral) stenosis. Both kinds of stenosis commonly occur in the neck and low back. Stenosis is defined as a narrowing of the open spaces in the spine. In central spinal stenosis, narrowing of the spinal canal causes pressure on the spinal cord. In lateral foraminal stenosis, narrowing of the foramen (holes in which nerves traverse through) causes pressure on the nerves that travel to the arms and legs. While spinal stenosis may not cause any signs or symptoms in some people, others may experience pain, numbness, tingling, muscle weakness, or even loss of bladder and bowel function.
Causes
Stenosis is typically caused by aging and general wear-and-tear of the spine related to arthritis. It is common in those over 50 years of age. Osteoarthritis and build up of bone spurs in and around the spine reduces the amount of space available within the spine, leading to compression of either the spinal cord or nerve roots. Space-occupying contents or growths, such as herniated or bulging discs, thickened ligaments, tumours, swelling, or displaced spinal segments, can also cause a narrowing of these open spaces. If a nerve is inflamed or irritated, its passing through these narrowed foramen causes it to become compressed, resulting in various signs and symptoms.
Signs and symptoms
In the neck (cervical spine):
- Slow onset of symptoms that develop over time
- Pain, numbness, tingling, or weakness in the neck, upper back, arm, and hand (and possibly in the legs as well)
- Weakness with grip
- Clumsiness and problems with fine motor skills
In the low back (lumbar spine):
- Slow onset of symptoms that develop over time
- Pain, numbness, tingling, or weakness in the low back, buttock, leg, and foot
- Increased discomfort with standing and walking
- Symptoms that ease with bending or sitting
If severe enough, stenosis may cause problems with the bladder and bowel (incontinence), sexual dysfunction, issues with walking, balance, and coordination, and even muscle paralysis. Go to emerge right away if any of these signs and symptoms are exhibited.
Physiotherapy Treatment
- Rest: Rest and de-loading techniques are employed to reduce inflammation in the spine and nerves.
- Activity modification: Typically, people who have stenosis find symptom relief with sitting or bending forward. This flexed position "opens up" the spinal column and enlarges the spaces between the vertebrae. Stenotic patients may find themselves walking with a forward stoop or looking downwards. Caution must be taken not to get used to these maladaptive postures. It is also important to minimize activities that worsen the spinal stenosis symptoms (i.e. instead of walking upright, lean on a shopping cart or walker; instead of sitting in a straight-back chair, sit in a recliner chair; avoid excessive overhead activities; and take frequent breaks to prevent flareups). Another activity modification may include biking instead of walking.
- Modalities: Heat, ice, ultrasound, laser, and electrical stim are used to control inflammation and minimize pain.
- Acupuncture and dry needling: I find that acupuncture is quite beneficial, especially when using points that run along the same meridian/channel as the affected nerve. Dry needling can be used to release tight muscles that surround the spine. Decreasing muscle spasms or muscle tension will put less pressure on the vertebrae and exiting nerves.
- Manual therapy: Soft tissue therapy, nerve and joint mobilizations, and stretching techniques are used to address flexibility and mobility issues.
- Exercise: Exercising brings blood flow to the area to help with healing. It also increases the strength and flexibility of the muscles around the spine to take pressure off the boney structures of the vertebrae. Exercising helps to maintain a healthy weight -- excess weight puts more stress on the joints. Range of motion, flexibility, strengthening, and stability exercises are usually recommended. Aerobic exercises such as swimming and biking are beneficial as well.
- Bracing and taping: Taping and bracing techniques are useful in temporarily offloading the painful structures of the neck and back.
Other treatments
- Medications to control pain and inflammation
- Injections
- Surgery