Spinal Stenosis- What Is It and How Is It Treated?
Here at the Algonquin Chiropractic Center, many of our patients come in with back pain. This pain can lead from a variety of causes, but one common source is spinal stenosis. So, let’s discuss this condition, what causes it, and how it’s treated.
What Causes Spinal Stenosis?
Let’s turn to Mayo Clinic for an overview:
“Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck…
The backbone (spine) runs from your neck to your lower back. The bones of your spine form a spinal canal, which protects your spinal cord (nerves).
Some people are born with a small spinal canal. But most spinal stenosis occurs when something happens to narrow the open space within the spine. Causes of spinal stenosis may include:
- Overgrowth of bone. Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal.
- Herniated disks. The soft cushions that act as shock absorbers between your vertebrae tend to dry out with age. Cracks in a disk’s exterior may allow some of the soft inner material to escape and press on the spinal cord or nerves.
- Thickened ligaments. The tough cords that help hold the bones of your spine together can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal.
- Abnormal growths can form inside the spinal cord, within the membranes that cover the spinal cord or in the space between the spinal cord and vertebrae. These are uncommon and identifiable on spine imaging with an MRI or CT.
- Spinal injuries. Car accidents and other trauma can cause dislocations or fractures of one or more vertebrae. Displaced bone from a spinal fracture may damage the contents of the spinal canal. Swelling of nearby tissue immediately after back surgery also can put pressure on the spinal cord or nerves.”
Most commonly in our clinic we will see older patients with moderate to advance osteoarthritis who have spinal stenosis in the neck and/or low back.
What Are the Symptoms of Spinal Stenosis?
Returning again to Mayo Clinic:
“Many people have evidence of spinal stenosis on an MRI or CT scan but may not have symptoms. When they do occur, they often start gradually and worsen over time. Symptoms vary depending on the location of the stenosis and which nerves are affected.
In the neck (cervical spine)
- Numbness or tingling in a hand, arm, foot or leg
- Weakness in a hand, arm, foot or leg
- Problems with walking and balance
- Neck pain
- In severe cases, bowel or bladder dysfunction (urinary urgency and incontinence)
In the lower back (lumbar spine)
- Numbness or tingling in a foot or leg
- Weakness in a foot or leg
- Pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit
- Back pain”
Typically, a patient over 50 will present a history of low back pain and more recently pain, cramping, or tingling in one or both legs. These patients can stand or walk for a period of time from a few seconds to 20-30 minutes before they develop increased leg pain, cramping, or numbness. Sitting down, bending forward, or leaning over a shopping cart will relieve the pain.
Next time you are in a supermarket look for the older people leaning over their shopping carts—they have spinal stenosis!
These patients feel worse when they are walking and being active. So, what do they do? They sit! They sit to avoid or relieve the pain.
Spinal stenosis is more than back and leg pain. People go from being active and living an active lifestyle to sitting most of the day. A sedentary lifestyle will cause you to gain weight, increase your risk of diabetes, heart disease, and peripheral artery disease, and cause you to become “deconditioned.”
We know bones grow when they are stressed by physical activity, so when you’re deconditioned your bones will become weaker, causing osteoporosis. When you’re deconditioned your balance isn’t as good either. Having weak bones and losing your balance is a recipe for a hip fracture, spinal fracture, or head injury.
So how do we treat this?
How is Spinal Stenosis Treated?
Looking at Mayo Clinic’s website, they list medication, physical therapy, steroid injections, and surgery as the only treatment for spinal stenosis.
Let’s look at those options:
Medication–In May of 2017 the FDA recommended physicians look for non-pharmacological (no drugs) treatments when dealing with pain, including chiropractic. In Section II of their “Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain,” they listed chiropractic as an option.
Soon after, the American College of Physicians recommended non-pharmacological treatments as a first line of treatment.
These recommendations are all designed to keep people away from opioid drugs and the devastating addiction that can go along with their use.
Physical Therapy–In 2006 a study in the European Spine Journal found that patients with leg pain did “significantly better” with our techniques compared to physical therapy. Patients also had “significantly lower pain scores” after one year. Physical therapy has its place, but if you have leg pain you may want to consider chiropractic first.
Steroid Injections–How effective are cortisone injections for relieving back and leg pain?
Another study in the December 2004 issue of the Cleveland Clinic Journal of Medicine found that 50-75% of patients with radicular pain (leg pain) had temporary relief after the injections, and only 25-57% received excellent long-term relief.
Meanwhile, the Archives of Physical Medicine and Rehabilitation in March 2004 reported that lumbar injections provide only 32% of patients sustained relief.
Surgery–As a general rule, most people want to avoid surgery if they can. On top of that, in 2008 the British Medical Journal reported that outcomes for surgically treated patients and conservatively-treated patients were similar after one and even two years. Why go through surgery if you won’t be any better than you would have been without it?
You can avoid all this!
According to the Spine Journal in 2012:
- 0% of spine surgery patients have at least one documented complication
- 0% had an extended stay in the hospital due to complications
- 5% had post-operative complications
- 5% had surgical complications
- 5% died
As it turns out, even the mighty Mayo Clinic may not have all the answers for spinal stenosis.
Does this make sense? You want to take as few meds as possible, right? You want to stay off opioids at all costs. Injections may be an option, but if we can avoid it, even better. We also want to avoid surgery at all costs.
With proprietary, individualized treatment plans for spinal stenosis and leg pain, we use a combination of the Cox Technic, massage therapy, spinal bracing, orthotics, vibration therapy, laser therapy, and rehab to improve patients’ quality of life.
Spinal stenosis surgeons don’t like us, but you will like the results!