Spinal Series - Part 3- Spinal Stenosis

Spinal Series - Part 3

Spinal Stenosis

What is Spinal Stenosis?

Spinal Stenosis is the term given to narrowing of the spinal canal and its lateral foramen. As a result of the reduced space within these canals, the exiting nerve root can be pinched or trapped leading to a referred pain along the respective neural pathway.

Spinal stenosis can occur at any spinal level and be caused by a variety of factors. This article will focus on lumbar spinal stenosis.

What causes Lumbar Spinal Stenosis?

There are several factors that can cause Spinal Stenosis including:

·     Degenerative Disc Disease

·     Osteophyte formation

·     Tumours

·     Infection

·     Metabolic bone disorders (Osteoporosis, Paget’s disease, etc)

In Spinal Series part 2, Degenerative Disc Disease was looked at in more detail and it was outlined how the reduction in disc height, usually attributed to age, can lead to encroachment of exiting nerve roots.

A secondary result of the vertebrae moving closer together with loss of disc height is the formation of ‘extra’ bone in the canals of the spine, both within the spinal canal and the vertebral foramen. These ‘osteophytes’ can also encroach on the nerve roots and cause referred pain.

Spinal tumours, Spinal infections and a variety of metabolic bone disorders can also occur within the spine and potentially lead to the narrowing of the canal and/or foramen. There are far too many ailments that fall within this category to discuss in more detail here, but there mechanism of reducing space within the canal is similar. Foreign masses restrict the ability for the nerves to glide within the canal and foramen, causing pain locally and referred along the relevant path.

What are the symptoms of Lumbar Spinal Stenosis?

The main symptoms of Lumbar Spinal Stenosis are:

·       Low back pain

·       Referred pain into the legs

·       Numbness & Pins & needles along the affected nerve root pathway

·       Loss of sensation along the associated dermatome.

Aggravating Factors

Due to the orientation of the spinal canal, being posterior to the vertebral body, spinal movements through this section can induce the above symptoms. Sufferers of spinal stenosis will most likely experience their symptoms when standing for long periods, walking for long periods & leaning backwards into extension.  Subsequently, symptoms are improved with lumbar flexion, sitting and leaning forward.

In the majority of cases, the cause of the spinal stenosis can not be removed without surgery and therefore the symptoms are likely to worsen with time and become increasingly more debilitating. Management of the symptoms non-invasively is preferred and only when this fails will surgery be considered.  

Surgical intervention may include decompression of the spinal nerve with or without spinal fusion. In most cases this will help to alleviate the leg pain but not necessarily the lower back pain.

Conservative management of Spinal Stenosis and Pilates

Taking into account the aggravating factors of spinal stenosis listed above, it should be of no surprise that a well structured personalised Pilates programme can be of great benefit to sufferers of Spianl stenosis. As the majority of cases respond negatively to extension movements the focus of the programme should be on flexion and secondly rotation. The client is likely to have had the symptoms for a long time and structural compensations will be apparent throughout the spine, including an increased thoracic kyphosis, the result of wanting to ‘flex’ away from pain.

As with all Pilates programmes, aim to build or restore a healthier spinal alignment and educate the client on how best to maintain it with appropriate exercise and you may just help them to reduce their symptoms, possibly even alleviating them.