Lumbar Stenosis
What is Lumbar Stenosis?
Lumbar spine stenosis (LSS) describes narrowing of various places in the spine. It can be one or any combination of sites including the central spinal canal, the outer aspect of the spine, or the space/tunnel in the spine where the nerve exits the spinal cord. The stenosis can then be subclassified by the anatomic site where there is the most significant amount of narrowing. Encroachment on the nerve by the surrounding bone and soft tissue can induce subsequent “neurogenic claudication” or radiculopathy causing leg pain, numbness, paresthesia, weakness and difficulty walking.
Spinal stenosis may be classified as either primary- caused by congenital/ developmental abnormalities, or secondary/acquired- arising from degenerative changes, trauma, infection or surgery. The process of degenerative stenosis results from chronic accumulation of mechanical stresses causing disc degeneration, joint inflammation and/or changes in the in the ligament surrounding this area.
Symptoms are thought to arise from a compromise of blood flow due to compression or in more severe cases, from direct pressure. The available space in the central spinal canal and outer aspects of the canal are reduces in extension positions of the spine (standing) and increases with flexion (forward bending). Because of the compression created in standing and walking positions, one is likely to feel more symptoms during those activities.
The reported incidence of spinal stenosis in patients with back pain is 3-14%, but not all patients meeting the clinical definition of stenosis will report symptoms. Patients with lumbar spine stenosis may fall somewhat unpredictably on a spectrum between asymptomatic and severely disabled. No relevant association has been shown between the MRI finding of “stenosis” and the severity of the patient's pain. The course of symptomatic individuals continues on a variable course with 50-70% of spinal stenosis patients remaining stable, while the remainder are divided fairly equally into groups that inconsistently improve or worsen.
Symptoms of primary stenosis (genetically acquired stenosis) may present early in life, while degenerative stenosis (acquired with age) is uncommon before age 50, rarely appearing before the sixth or seventh decade. Stenosis is the most common reason for lumbar spine surgery in those over 65.
What Will Lumbar Stenosis Look and Feel Like?
Symptomatic spinal stenosis often presents as chronic lower back pain with transient symptoms into the buttock and legs. Patients may report symptoms on one or both sides including pain, tingling, numbness, fatigue, heaviness and/or weakness. Leg pain complaints are generally perceived as more bothersome than local, low back symptoms. Symptoms are on both sides in about 70% of patients.
Although many other causes of lower back pain are exacerbated by prolonged sitting, lumbar stenosis patients report progressively increasing symptoms from standing or walking and, instead, relief while sitting. Patients may report diminished symptoms when walking with a shopping cart or lawn mower, which induces slight forward lean of the spine. Walking down hill tends to increase the patient’s spinal extension and is generally more uncomfortable than walking up hill. As the condition progresses, patients often adopt a slightly forward flexed posture and feel their posture is always leaning forward. Patients are generally more comfortable sleeping on their side in a fetal position, as opposed to lying flat. Progression of stenosis may also result in a wide-based walking gait, exercise intolerance and/or major lifestyle restrictions. Patients with more significant progression of stenosis may report urinary incontinence.
At Boulder Sports Chiropractic, our doctors will treat stenosis with Class IV Laser Therapy, Active Release Technique, chiropractic adjustments, muscle stimulation, and physical therapy.
If you feel you have been suffering with generalized low back pain or low back pain caused by stenosis, click below to make an appointment today to see how our doctors can help you get pain relief.