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.
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.
Exercise and staying active
With joints in the spine as with joints everywhere else in the body, there is a truism – “use it or lose it”. Staying active is one of the most important things to do to manage the symptoms of lumbar spinal stenosis. The key is to find activities that that are doable and are enjoyable and will also not exacerbate or bring on the symptoms. Here are 5 important reasons to stay active:
Exercise will increase the blood flow to the back, bringing needed oxygen and nutrients and washing away toxic metabolites.
Exercise will strengthen the muscles around the spine, helping to take the pressure off of the bones and other static structures in the back.
Exercise will help maintain flexibility, which will help prevent tight muscles that pull and torque the spine, which can worsen spinal stenosis symptoms.
Exercise will help maintain a healthy weight. Excess weight can lead to worsening back and leg pain.
Staying active helps with emotional and mental health as well. A healthy mind in a healthy body. Mens sana in corpore sano. When one is feeling sluggish and down, it is that much harder for the body to physically feel better. Getting up and moving gets the blood and endorphins flowing and improves one's overall outlook, which in turn helps reduce pain and improve physical symptoms.
As described before, people with lumbar spinal stenosis often find that activities in which they are bent over are more comfortable. Examples of exercises that may work include:
Some people find bicycle riding an enjoyable and rewarding activity. Stationary biking may be preferable.
Others find swimming to be a positive activity, or water therapy (which is exercise in a pool).
Joining a gym and working with a therapist or trainer to learn some good stretching and core strengthening exercises.
Remember that the best exercise is one that will become part of one's daily routine. Planning to bicycle everyday for one hour won't do any good if it isn't fun and doesn't become part of the routine. Pick something that is personally rewarding, fun and enjoyable. Ideally, find an activity that can be done regardless of weather conditions so that exercise can be made part of everyday life.
Remember to always check with the doctor before starting any new exercise regimen. The doctor may also recommend a physical therapist to learn exercises that can then be incorporated into a daily exercise routine.
Don't exercise through pain and other symptoms. If the symptoms are brought on by the activity, or worsen during or after the activity, stop and discuss it with the doctor.
Posture and biomechanical awareness
The back works with every activity throughout the day—picking
something up, sitting in a chair, changing positions or opening
a door, all require the multiple structures in the back to function.
The back is designed for this kind of work, but it is important
to do these kinds of activities in a healthy way to protect the
back from strain or injury.
When picking something up, even a light object, take care not to bend from the waist. Instead, bend from the hips and knees. Keep the back straight. Hold the object to be lifted close to the body.
Practice good posture! Good standing posture includes standing with weight on the balls of the feet, keeping the feet shoulder-width apart, not locking the knees, keeping the head directly over the neck and not slouched forward. When sitting, avoid leaning forward, make sure there is proper lumbar support for the inward curve of the low back, and keep both feet flat on the ground.
Pain management
Common pain management tools at home include icing the lower back after exercise (a frozen bag of peas works well for this purpose). Apply the cold pack for about 10 minutes at a time. If there is a lack of sensation in the lower back area, do not use ice or heat to avoid damaging your skin.
Heat over tight muscles in the lower back can be very helpful.
A topical pain reliever (such as capsaicin or other brand name) can be helpful. Remember that even though it is topical, it is still a medicine. Use only as directed on the package.
A massage from a spouse (site this article as your excuse for asking for it) can help relieve tight, sore muscles.
Over-the-counter pain medications include acetaminophen (such as Tylenol) and NSAIDs (non-steroidal anti-inflammatory drugs, such as Advil) are also effective. All medications carry the risk of side effects. In general, if you have liver problems or kidney problems, talk to your doctor before taking these medications. Additionally, if you have high blood pressure or heart problems talk to your doctor before taking NSAIDs. With the above caveats, many people do find short-term relief from over the counter medications, but long-term use without the supervision of a doctor should be discouraged.
If symptoms are severe, progressive or interfering with daily life, it is a good idea to have a discussion with the doctor to review different treatment options. There are lots of ways to control the spinal stenosis symptoms, including prescription medications, physical therapy and exercises, injections (including possibly epidural steroid injections), and, occasionally surgery.
Nutrition
Believe it or not, you really are what you eat. Stay hydrated, eat plenty of fruits and vegetables, don't smoke, minimize red meat, caffeine and alcohol. A healthy diet will help you stay at a healthy weight, reduce the body's propensity towards inflammation, and keep your spinal discs as well as all your tissues hydrated, all of which will help reduce pain and other spinal stenosis symptoms.
See related Health Hub:
Spinal stenosis
