Physical Therapy for Spinal Stenosis
Physical Therapy for Spinal Stenosis
Could Your Pain Be Spinal Stenosis?
Most people will experience back pain at some point in their lives. In most cases, back pain is self-limiting and resolves on its own. Spinal stenosis is one cause of back pain that can lead to persistent or recurring symptoms. In this case, it is a good idea to seek the help of an expert. Research shows conservative care such as physical therapy is an excellent choice to address back pain and spinal stenosis is one of the many causes of back pain addressed at our clinic. In this article we will delve deeper into spinal stenosis, how it is diagnosed and how physical therapy can address your symptoms in both the short and longer term.
WHAT IS SPINAL STENOSIS AND HOW DOES IT FEEL?
Spinal stenosis refers to a narrowing of the spaces created by the vertebrae in the spinal column causing pressure on the delicate nerves. It typically occurs in the neck (cervical spine) and lower back (lumbar spine). When narrowing occurs in the central spinal canal that houses the spinal cord it is called central stenosis. This can put pressure on the spinal cord itself. When narrowing occurs on the lateral portion of the vertebrae it is called lateral stenosis and may put pressure on the spinal nerves that exit from the spinal canal and travel out to the skin, bones, joints, muscles and organs. This pressure causes the classic symptoms of spinal stenosis including pain in the neck and/or back pain, numbness, tingling or weakness in the arms, shoulders, legs or trunk possibly accompanied by intermittent bowel and bladder problems.
In many cases stenosis develops as a natural result of aging. Loss of intervertebral disc height, arthritis and the development of bone spurs can all cause spinal stenosis. In some cases stenosis may be the result of thickening of the spinal ligament or medical conditions like Paget disease or a spinal tumor.
Because of the narrowing, many people with spinal stenosis find they are most comfortable when their spine is flexed such as when sitting. Alternatively, they find it difficult to walk or stand for long periods of time. At the grocery store, for example, many people with spinal stenosis will find themselves leaning over their shopping cart as this relieves some of the nerve compression created by the stenosis and allows them to shop longer. This is called the “shopping cart sign”.
HOW IS SPINAL STENOSIS DIAGNOSED?
Many times patients come to physical therapy already diagnosed with spinal stenosis. In some cases, however, a physical therapist may be the first one to suspect this condition. One symptom in particular may lead PT’s to suspect spinal stenosis. If an individual complains of pain, tingling or cramping, weakness or heaviness in the hips, legs or buttocks with activity, spinal stenosis should be on the differential. Two different conditions may be the culprit here.
One condition called vascular claudication is a symptom of peripheral artery disease. Peripheral artery disease causes narrowing of the vessels that carry blood and oxygen to working muscles. Decreased blood flow caused by this narrowing can lead to the symptoms listed above. Alternatively, neurogenic claudication is the result of compression of the spinal nerves caused by spinal stenosis. Because these conditions can be difficult to differentiate by symptom report, a test called the Bicycle Test of Van Gelderen was developed to provide some further insight into the underlying cause. During this test an individual rides a bicycle in an upright position and a forward leaning position. If the individual experiences symptoms of claudication in both positions then a vascular origin is suspected. If symptoms are experienced while upright and relieved while leaning forward then spinal stenosis is suspected as the forward leaning position helps relieve compression and irritation of the spinal nerves.
Imaging of the spine is the most definitive way to diagnose spinal stenosis. X-rays, MRIs and CT scans can all be used to evaluate the spine. By looking at the bony and soft tissue structures of the spine doctors and therapists can evaluate the alignment of the spine and look for areas where the spinal canal or the foramina (holes created by the vertebrae through which spinal nerves exit the spinal canal) are narrowed. In some cases, narrowing of the spinal canal or foramina found on imaging may correlate directly with symptoms like pain with prolonged standing. Other times, the findings are incidental and despite the narrowing, do not present any problems for the patient. This is important to remember when looking at imaging studies. Not every so-called abnormality found on imaging results in symptoms so it is important to take into account a full patient history and exam to determine if other factors not shown on imaging should be addressed instead or additionally.
IS PHYSICAL THERAPY USEFUL IN TREATING SPINAL STENOSIS?
The short answer is yes! While physical therapy cannot reverse arthritis or increase the height of your intervertebral discs, research shows that conservative treatment like physical therapy can be useful in managing the symptoms of spinal stenosis. The goal of physical therapy for stenosis is to increase your tolerance for functional activities like walking, climbing stairs, standing and so forth. While each patient will receive an individualized physical rehabilitation program depending on their needs and goals, there are some common interventions used in the treatment of stenosis.
Your therapist may apply some gentle hands-on manual therapy to the muscles, joints and soft tissue to optimize alignment and mobility while also providing pain relief. They will create a program of flexibility and strengthening exercises to help provide good alignment and support to the spine. You will be educated on strategies for modifying your posture or activities to reduce discomfort and possibly on how to integrate an assistive device into your routine to improve your ability to stand and walk.
If you have been diagnosed with spinal stenosis and symptoms are limiting your ability to perform daily activities it is time to take action. Call and schedule an initial evaluation with Evolve Physical Therapy today and let our team of expert physical therapists help you achieve symptom reduction and improve your daily function.
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About EvolveNY-
Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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