Living with Lumbar Spinal Stenosis

Many people with lumbar spinal stenosis find that they can successfully manage their condition through an easy self care program. This article presents a range or approaches an individual can take to manage low back pain and sciatica symptoms associated with lumbar spinal stenosis, including exercise and staying active, biomechanical awareness, pain management and nutrition.

Our bodies go through changes as we age. In the spine, the vertebrae may develop arthritis, the intervertebral discs may bulge, and the ligamentum flavum may buckle…..all of these changes, alone or in combination, may lead to spinal stenosis. The condition is essentially a “stenosis” (from the Greek word meaning “choking”) of the spine. There are two main types of spinal stenosis in the lower back:

• Foraminal stenosis. This refers to when the foramen, through which the nerve roots exit the spinal canal, becomes tight (ie. stenotic).
• Central stenosis. This occurs when the central part of the spinal canal becomes tight (stenotic).

Not all people with x-ray, MRI, or CT findings of spinal stenosis will have symptoms. In fact, as with osteoarthritis of the knee or hip and with other sources of back pain, imaging findings do not necessarily correlate with degree of symptoms. That is, symptoms may be much worse or less severe than one would suspect from looking at the degree of stenosis on imaging studies.

Spinal stenosis symptoms

When spinal stenosis causes symptoms, the symptoms usually include leg pain (sciatica), numbness, tingling and/or burning. In severe cases, there may also be leg weakness. The symptoms generally develop over a prolonged period of time, are intermittent, and are worse with activities in which the patient is bending the trunk backwards, and better with leaning forwards (as with sitting). In fact, often patients will say that in the grocery store, they don’t have any symptoms.

When asked for more details, the patient realizes that in the grocery store, he or she is leaning on the shopping cart, and thus flexing the trunk forward. By flexing forward, the spinal canal is “opened up” and the pressure is taken off the nerves and nerve roots. For the same reason, walking uphill is often easier and less painful for people with spinal stenosis (note that the trunk is flexed when walking uphill) than when walking downhill (where the trunk is extended, thus compressing the spinal canal and causing symptoms).

See the
Spinal Stenosis Interactive Video

Patients with symptoms of leg pain, numbness, tingling, burning and/or weakness need to get evaluated by a doctor to get a diagnosis for the cause of their symptoms. There are problems other than spinal stenosis that may cause these symptoms. For example, vascular claudication, in which the arteries are blocked, can cause similar symptoms. Generally, in vascular claudication, symptoms are not relieved by sitting and bending forward, and symptoms will cease immediately upon termination of exercise, as opposed to spinal stenosis in which it may take several minutes for symptoms to improve. Also, if the symptoms ever become progressive, or if bowel or bladder function changes, immediate medical attention should be sought.

• Grant Cooper, MD

July 25, 2007

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