By Kaitlin Dunn, PT Student McMaster
Photography (c) Steve Horvath for ISM Rehab
What is Lumbar Spinal Stenosis (LSS) ?
LSS is defined as a narrowing of the central spinal canal or intervertebral foramen in the lumbar (low back) segments of the spine (1). Narrowing can be caused by impeding soft tissue structures, such as disc protrusion or joint swelling, by abnormal bony growth, or by faulty posture (1). It can be congenital or acquired, most commonly occurring in older adults from natural aging of the spine or from surgery or infection (2). Narrowing of these spaces leads to compression of the nerves and blood supply present, eventually causing pain and discomfort (2).
LSS symptoms are usually exacerbated by walking and thus those with this condition tend to avoid walking and have a reduced walking capacity (1). Standing and extension of the lumbar spine can also produce symptoms, while sitting and bending forward provide relief (3). Movement into these different positions changes the alignment of the spine, either adding or reducing pressure on the compressed portions of the spine. Surgery to relieve symptoms of LSS is the most common reason for spinal surgery in those older than 65 years of age (4). Elderly populations with LSS can be greatly impacted in their daily functional abilities, quality of life, and degree of independence (4) .
LSS is defined as a narrowing of the central spinal canal or intervertebral foramen in the lumbar (low back) segments of the spine (1). Narrowing can be caused by impeding soft tissue structures, such as disc protrusion or joint swelling, by abnormal bony growth, or by faulty posture (1). It can be congenital or acquired, most commonly occurring in older adults from natural aging of the spine or from surgery or infection (2). Narrowing of these spaces leads to compression of the nerves and blood supply present, eventually causing pain and discomfort (2).
LSS symptoms are usually exacerbated by walking and thus those with this condition tend to avoid walking and have a reduced walking capacity (1). Standing and extension of the lumbar spine can also produce symptoms, while sitting and bending forward provide relief (3). Movement into these different positions changes the alignment of the spine, either adding or reducing pressure on the compressed portions of the spine. Surgery to relieve symptoms of LSS is the most common reason for spinal surgery in those older than 65 years of age (4). Elderly populations with LSS can be greatly impacted in their daily functional abilities, quality of life, and degree of independence (4) .
What are some symptoms of Lumbar Spinal Stenosis?
Symptoms may be present in one or both legs (3) Pain - In the low back, buttocks, thighs, and legs. Neurological symptoms - A cramping or burning feeling. These sensations can range from a dull ache in the low back to sharp, shooting pains in the legs. Weakness - Weakness in the muscles of the lower extremities. Numbness or tingling - Numbness or tingling into the legs. Balance deficits - Trouble keeping your balance. Difficulty walking and abnormal gait - Symptoms flare during prolonged walking. |
What kinds of treatments are available for my Lumbar Spinal Stenosis?
Exercise (aerobic, strength, flexibility) (3,5)
Specific exercises in lumbar flexion (such as cycling) (3,5) Body weight supported treadmill walking (3,5) Muscle coordination training and balance training (3) Braces and corsets (3,5) |
Ice, heat, ultrasound, massage, and electrical stimulation for symptomatic relief of pain (3,5)
Spinal manipulation (3) Postural Instruction (3) Education on the benefits of staying active (5) |
Phases of Treatment
Phase 1
Education about your condition, introduce symptom control and management techniques, and exercise prescription targeted to provide relief and build strength. It’s important to remain as active as possible because inactivity can lead to muscle wasting. Any activities that cause excessive pain should be modified.
Phase 2
Progression of strengthening and stretching exercises. Open dialogue between you and your physiotherapist will ensure a treatment program that is tailored to your specific needs.
Phase 3
Re-evaluation of your condition. In this stage your physiotherapist will discuss your progress with therapy and if your goals are being met. At this point, if your LSS is still symptomatic, other options beyond physiotherapy could be discussed such as surgical intervention.
Phase 1
Education about your condition, introduce symptom control and management techniques, and exercise prescription targeted to provide relief and build strength. It’s important to remain as active as possible because inactivity can lead to muscle wasting. Any activities that cause excessive pain should be modified.
Phase 2
Progression of strengthening and stretching exercises. Open dialogue between you and your physiotherapist will ensure a treatment program that is tailored to your specific needs.
Phase 3
Re-evaluation of your condition. In this stage your physiotherapist will discuss your progress with therapy and if your goals are being met. At this point, if your LSS is still symptomatic, other options beyond physiotherapy could be discussed such as surgical intervention.
Summary
At ISM Rehab we have an excellent multidisciplinary healthcare team which includes physiotherapists and assistants, registered massage therapists, physician assistants, orthopaedic surgeons, and physiatrists who can provide you with client-centered, holistic care. Our award winning physiotherapy services can help provide symptom relief, education, and management strategies for dealing with your lumbar spinal stenosis.
At ISM Rehab we have an excellent multidisciplinary healthcare team which includes physiotherapists and assistants, registered massage therapists, physician assistants, orthopaedic surgeons, and physiatrists who can provide you with client-centered, holistic care. Our award winning physiotherapy services can help provide symptom relief, education, and management strategies for dealing with your lumbar spinal stenosis.
References
(1) Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques. 7th ed. Philadelphia: F.A. Davis Company; 2018.
(2) Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis (Review). Cochrane Database of Systematic Reviews. 2016, Issue 1. Art. No.: CD010264. DOI: 10.1002/14651858.CD010264.pub2.
(3) Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016; 352:h6234.
(4) Ammendolia C, Stuber KJ, Rok E, et al. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication (Review). Cochrane Database of Systematic Reviews. 2013, Issue 8. Art. No.: CD010712. DOI: 10.1002/14651858.CD010712.
(5) Macedo LG, Hum A, Kuleba L, et al. Physical therapy interventions for degenerative lumbar spinal stenosis: a systematic review. Physical Therapy. 2013;93:1646–1660.
(1) Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques. 7th ed. Philadelphia: F.A. Davis Company; 2018.
(2) Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis (Review). Cochrane Database of Systematic Reviews. 2016, Issue 1. Art. No.: CD010264. DOI: 10.1002/14651858.CD010264.pub2.
(3) Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016; 352:h6234.
(4) Ammendolia C, Stuber KJ, Rok E, et al. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication (Review). Cochrane Database of Systematic Reviews. 2013, Issue 8. Art. No.: CD010712. DOI: 10.1002/14651858.CD010712.
(5) Macedo LG, Hum A, Kuleba L, et al. Physical therapy interventions for degenerative lumbar spinal stenosis: a systematic review. Physical Therapy. 2013;93:1646–1660.