Is Spinal Stenosis Keeping You From The Activities You Enjoy?
Listen to Jacob Smith on our podcast Memorial Health Radio in the new episode titled Spinal Stenosis.
Transcription
Melanie Cole (Host): Spinal stenosis is a condition in which the spinal column narrows and starts compressing the spinal cord. This process may be gradual, and if the narrowing is minimal, no symptoms may occur. However, too much narrowing can compress the nerves and cause pain and limited range of motion for the individual. My guest today is Dr. Jacob Smith. He’s an orthopedic surgeon with Memorial Health System. Welcome to the show, Dr. Smith. Spinal stenosis, is this something that has to happen? Is it age-related? Are we all coming down the pike for this?
Dr. Jacob Smith (Guest): Spinal stenosis is age-related. That happens as a result of natural age-related degenerative processes that happen in the spine. It the combination of the disc height collapsing as we age, and the secondary bony arthritis that develops secondary to that. Those combined factors narrow the spinal canal, which is the space that the spinal cord is traveling in — as well as the nerve roots — are traveling in the lower lumbar spine.
Melanie: So how does it affect the person? If they start to get spinal stenosis, would they notice it in their posture? Would they notice it in back pain, or even possibly in leg pain? What would they notice?
Dr. Smith: One of the earliest symptoms of spinal stenosis – and classic symptoms of spinal stenosis, is a pain in the buttock and down the back of your thigh. This sometimes may be accompanied by numbness and tingling. If we’re talking about stenosis in the cervical spine or your neck, it could be these symptoms down your arms.
The patient also may find that they are able to alleviate this pain down their buttock and legs if they sit down or lean forward, which will open up the spinal canal, perhaps a few millimeters, and not have as much direct compression on those nerves.
Melanie: If they do feel this numbness or tingling down their arm or in the case of the lumbar spine, maybe down the back of their thigh or their leg, how do you diagnose that this is what’s going on?
Dr. Smith: In order to diagnose spinal stenosis, usually your physician will order a plain X-ray, perform a physical examination, and then that will usually be followed by an MRI of that portion of the spine.
Melanie: Would an MRI show this narrowing in the spine? It will actually show what nerves are being pressed on? Is that true?
Dr. Smith: The MRI will show us what levels the narrowing is located at in the spine as well as how many levels are involved.
Melanie: And what’s the treatment for spinal stenosis, Dr. Smith? What can be done for it? If it’s an age-related thing, is there anything that can be done to relieve some of the pressure and pain?
Dr. Smith: Spinal stenosis is treated initially with conservative management as long as there is no progressive neurological compromise, such as paralysis, profound weakness, or a drop-foot. We initially try some anti-inflammatory medication combined with physical therapy, and in the physical therapy, we work on strengthening of the lumbar paraspinal muscles, as well as the core strengthening of the abdominal muscles. We also specifically do flexion-based exercises and really try to strengthen those core abdominal muscles in the case of spinal stenosis because extension based exercises would usually exacerbate the symptoms because it will narrow the already narrowed spinal canal further.
Melanie: That’s a good point, and I’m glad you brought that up, Dr. Smith. What about restricted activity? Are there – because we want people to maintain that good core strength, and you’re talking about extension exercises, what might some of those be? What restricted activities might you tell your patients about what they should or should not be doing if they have spinal stenosis?
Dr. Smith: Avoiding any activities or position where you would have your spine in extension is going to perhaps aggravate your spinal stenosis symptoms. Patients may find that this is brought on by overhead reaching where they would look up and extend their back into that extended position, so this would be some positions and activities that you would want to try to avoid.
Melanie: Do you advise bracing, or icing, or heat? Do any of these things help?
Dr. Smith: Bracing is not directly going to alleviate the spinal stenosis. Bracing is used for some support and comfort to help with some of the back pain. However, we usually do not recommend wearing a brace 24-hours of the day because we do not want the paraspinal muscles, as well as the core abdominal muscles to atrophy or weaken.
Melanie: And what about things like ice or heat? Might they help somebody with spinal stenosis?
Dr. Smith: Ice and heat alternating can help alleviate some of the back pain and perhaps the back spasms associated with stenosis. It’s really not going to alleviate the leg symptoms or arm symptoms.
Melanie: And what do you tell your patients, Dr. Smith, if they ask you about trying chiropractic treatment, or acupuncture, or yoga, or any of these other methods that could possibly help?
Dr. Smith: Alternative treatment options such as chiropractic management or acupuncture can have some benefit to the proper patient. Certainly, if the spinal stenosis is very moderate to severe, we probably would not recommend these treatment options. However, in the more minimal to the mild category, it is possible that acupuncture or chiropractic treatments or yoga type exercises could benefit the patient.
Melanie: What would you like to tell patients and people with older relatives that they love that might be suffering from spinal stenosis — as we all shrink as we age, and this becomes more of a possibility – what do you want them to know about this condition, possibly preventing it, or keeping a good, healthy back?
Dr. Smith: There’s really no way to prevent spinal stenosis from developing. It’s the natural age-related, degenerative processes that happen to the aging spine. In some individuals, it’s going to happen faster than others as we do think there may be some genetic predisposition to accelerated degenerative disc changes. Certainly, people who smoke and use other tobacco products are susceptible to accelerated degenerative disc processes, which could result in secondary spinal stenosis.
In order to keep your back as healthy as possible, we recommend a good, healthy back program in a physical therapy office to include strengthening of the lumbar paraspinal muscles, as well as the strengthening of the core abdominal muscles, so you have a good balance between your back muscles and the abdominal muscles.
Melanie: Thank you, so much, for being with us today, Dr. Smith. That’s great information for people to hear. You’re listening to Memorial Health Radio with Memorial Health System, and for more information, you can go to MHSystem.org, that’s MHSystem.org. This is Melanie Cole. Thanks, so much, for listening.
