by Paula Allia
Spinal stenosis is a condition of the spine that causes a narrowing of either the central vertebral canal where
the spinal cord is housed or in the intervertebral foramen where the nerve roots exit from the spinal cord to supply
both sensory and motor information to the many muscles in our body that require information to function. There are 7 cervical, 12 thoracic, 5 lumbar vertebrae as well as a sacral base (also associated with nerves) and a coccyx. The most common areas of spinal stenosis are in the cervical and lumbar levels.
The word stenosis means narrowing. A person may actually be born with stenosis because their central spinal canal is smaller in diameter than average. In this situation the person may or may not be symptomatic. The more common spinal stenosis is a degenerative process that occurs from the aging process and/or the wear and tear in the various vertebral levels. Over time, overworked ligaments can become hypertrophied, bones can develop spurs (osteophytes) or a disc can bulge or herniate. These degenerative issues narrow either the central or intervertebral canals and thus spinal stenosis is now present. The symptoms of spinal stenosis vary. Some people with stenosis remain asymptomatic but typically over time, the degenerate spinal stenosis may present with pain, tingling or numbness in the associated nerve root levels.
These sensory signs may come and go but if pressure remains on the nerves then permanent sensory loss can occur. More advanced stenosis may actually compress deep into the motor portion of the nerves and cause actual motor weakness which is recognized by a decrease in strength of the muscles that are innervated by the compressed
When symptoms of spinal stenosis are present it is pertinent to figure out the cause of such symptoms and try to alleviate the compression on the nerve roots. There are many things one can do to help themselves and it may take time to figure out the exact positioning needed to remove the compression on the nerve structure. The key is that if you have symptoms of tingling or numbness, opening up the appropriate level of the spinal is needed to remove the peripheral symptoms. Depending upon the level or levels involved the positioning varies.
Also, there are known patterns of nerve root distribution into an arm or leg that is associated with each nerve root. In the cervical region of the sensory distributions for nerves is more specific but in the lumbar spine there are overlaps of nerve roots distributions that can create confusion and a trickiness to figuring out just how to relieve the symptoms. In addition to knowing what level of compression one is experiencing. It is also important to know that your symptoms are being caused by stenosis and not from a newly herniated disc.
There are various techniques and positions that can unload a nerve but exercises should be pretty specific to your needs. Knowing how much degenerative change is present helps the health professionals to teach one to minimize symptoms. Specificity of exercises for you will be different than someone else depending upon the level(s) involved.
Various exercises are prescribed for spinal stenosis. It is usually a combination of the right unloading exercises and then strengthening/stretching exercises that help a person function with less symptoms. Flexion exercises of the spine in a controlled way may unload the nerve root compression.
For example with degenerative spinal stenosis where the disc is thinned and loss of height is present, pulling your knees toward your chest may alleviate the pain and or tingling. Pulling up only enough to rid the symptoms is suggested and not further than necessary. This exercise may be contraindicated if there is an acute disc herniation
and thus being too aggressive with this exercise could cause advanced leakage of discal material thus caution is advised.
Backward bending exercises compress the posterior structures of the spine and can cause back pain or neurological symptoms with spinal stenosis. Thus excessive arching of the spine especially for prolonged positioning in not advised. It is, however good to maintain the ability to arch for general mobility or the spine as able. Proper positioning in activities of daily living are key components to the health of your spine. It is typical that people with stenosis feel better sitting, leaning forward, or unweighting themselves. An acute disc injury is usually aggravated by sitting.
Sitting with a slight lean forward opens up the foramen and this can alleviate the symptoms of stenosis. Strengthening the stomach muscles and finding the angles that relieve symptoms are necessary for one to stay active. Learn about how to help yourself and be patient. If you do not start to help yourself control these issues,
the spine can further degenerate. To Your Health!
For further information please call Paula Allia, PT, DHSc, at the downtown Fitness Together (239) 263-9348.