What activities should be avoided with spinal stenosis?
What is the best treatment for spinal stenosis?
What is the latest treatment for spinal stenosis?
Spinal stenosis treatment physical therapy
Many people with mild spinal stenosis find that nonsurgical treatments such as pain medication and physical therapy relieve symptoms and help them remain active.
Manual therapy for spinal stenosis
Physical therapy for spinal stenosis involves a combination of manual therapy, postural education, and exercises. The goal of spinal stenosis PT is to reduce discomfort and help the patient return to normal daily activities. Manual therapy and postural education can both help to alleviate pain, while exercises improve mobility.
Common exercises for spinal stenosis include:
- Stretching, to reduce stress on joints.
- Education, to help you improve and maintain your posture.
- Exercise, to strengthen muscles.
- Manual therapy, including massage, to improve or keep range of motion.
- Heat therapy, to improve blood circulation to the muscles and other soft tissues.
- Ice therapy, to help relieve pain.
- Cycling and limited walking, to promote good physical conditioning.
- Aquatic exercises, to allow your body to exercise without pressure on the spine.
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What activities should be avoided with spinal stenosis?
· Avoid stretching in a standing position and extension stretches.
Thanks to the simple force of gravity, doing stretches while standing up puts unnecessary stress on your spine. If you have lumbar spinal stenosis, your spinal cord already has extra pressure on it from the narrowing canal; stretching in a standing position adds to it.
Also, avoid doing extension stretches (those where you bend backwards). These exercises are often done to increase flexibility but for those with spinal stenosis, the backwards position collapses the spinal canal even more, which could potentially exacerbate your symptoms.
Instead, try stretching while laying down.
When you stretch sitting down, you won’t be putting any additional stress on your spine. Knee stretches, in particular, are safe for those with spinal stenosis. To do knee stretches, lie on your back and gently pull one bent knee up to your chest. Hold it for a few seconds, then slowly return the bent leg to the floor. Repeat with your other leg. Then bring both knees up to your chest together, hold for a few seconds, and release both legs. These types of flexion exercises opens up the canal and may even help to relieve the symptoms of stenosis somewhat.
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· Avoid doing free weights.
Putting a weight bar across your shoulders and doing squatsor doing any other type of weight lifting compresses your spine. That means the discs in between your vertebrae flatten somewhat, which can also lead to further compression on the nearby nerves. And while our bodies are generally built to handle compression to a certain degree, this type of exercise isn’t beneficial for someone with spinal stenosis.
Instead, try using a weight machine.
A weight machine is designed to support your body while you’re working out a specific muscle group. So while you’re lifting weights to strengthen your arms or legs, the machine is helping to stabilize your back (as long as you’re using it properly). That helps reduce potential issues for stenosis patients who are weight-lifting. Sitting while weight lifting is also not as traumatic for your back generally, because the forces placed upon your spine are reduced.
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· Avoid running and similar high-impact exercises.
Pounding your feet on a hard surface for a length of time increases the compressive load on your spine. So if you have spinal stenosis, this type of repetitive impact will very likely irritate your spinal stenosis. And for those who are wondering whether walking helps spinal stenosis, the answer is…not really. While it’s always beneficial to keep moving, long walks on a hard surface can put the same kind of stress on your back that running can, and may cause your pain to flare up.
Instead, try swimming, cycling, or an elliptical machine.
Activities like these give your metabolism a boost (which helps you burn more calories) but are much easier on your spine than running or walking. Swimming is particularly ideal for spinal stenosis patients because it works a broad range of muscles and allows you to stretch and exercise simultaneously all in the gentle, non-weight-bearing environment of water.2 You can also try water walking, both forward and backward, in chest-high water. You’ll get a great workout without any damaging impact to your spine.
What about cervical stenosis?
What exercises should you avoid?
If your stenosis is located in the neck, avoid doing arm-strengthening exercises that involve lifting weights up over your head. This put a huge strain on the discs in your neck and could make your condition worse. You should also avoid any exercise that moves your head in a circular pattern (like a neck roll) or that involve excessive flexion of the neck. All place undue pressure on an area of your spine that is already compromised.
Instead, try exercises that stretch and strengthen the muscles in your upper back, including moderate strength training (without the movements mentioned in the previous paragraph). As with lumbar spinal stenosis, swimming and cycling are excellent low-impact exercises that are safe to do even with narrowing of the cervical spine.
What is the best treatment for spinal stenosis?
Treatment for spinal stenosis depends on the location of the stenosis and the severity of your signs and symptoms.
Talk to your doctor about the treatment that’s best for your situation. If your symptoms are mild or you aren’t experiencing any, your doctor may monitor your condition with regular follow-up appointments. He or she may offer some self-care tips that you can do at home. If these don’t help, he or she may recommend medications or physical therapy. Surgery may be an option if other treatments haven’t helped.
Medications
Your doctor may prescribe:
- Pain relievers. Pain medications such as ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, others) and acetaminophen (Tylenol, others) may be used temporarily to ease the discomfort of spinal stenosis. They are typically recommended for a short time only, as there’s little evidence of benefit from long-term use.
- Antidepressants. Nightly doses of tricyclic antidepressants, such as amitriptyline, can help ease chronic pain.
- Anti-seizure drugs. Some anti-seizure drugs, such as gabapentin (Neurontin) and pregabalin (Lyrica), are used to reduce pain caused by damaged nerves.
- Opioids. Drugs that contain codeine-related drugs such as oxycodone (Oxycontin, Roxicodone) and hydrocodone (Norco, Vicodin) may be useful for short-term pain relief. Opioids may also be considered cautiously for long-term treatment. But they carry the risk of serious side effects, including becoming habit forming.
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Physical therapy
It’s common for people who have spinal stenosis to become less active, in an effort to reduce pain. But that can lead to muscle weakness, which can result in more pain. A physical therapist can teach you exercises that may help:
- Build up your strength and endurance
- Maintain the flexibility and stability of your spine
- Improve your balance
Steroid injections
Your nerve roots may become irritated and swollen at the spots where they are being pinched. While injecting a steroid medication (corticosteroid) into the space around impingement won’t fix the stenosis, it can help reduce the inflammation and relieve some of the pain.
Steroid injections don’t work for everyone. And repeated steroid injections can weaken nearby bones and connective tissue, so you can only get these injections a few times a year.
Decompression procedure
With this procedure, needle-like instruments are used to remove a portion of a thickened ligament in the back of the spinal column to increase spinal canal space and remove nerve root impingement. Only patients with lumbar spinal stenosis and a thickened ligament are eligible for this type of decompression.
The procedure is called percutaneous image-guided lumbar decompression (PILD). It has also been called minimally invasive lumbar decompression (MILD), but to avoid confusion with minimally invasive surgical procedures, doctors have adopted the term PILD.
Because PILD is performed without general anesthesia, it may be an option for some people with high surgical risks from other medical problems.
Surgery
Surgery may be considered if other treatments haven’t helped or if you’re disabled by your symptoms. The goals of surgery include relieving the pressure on your spinal cord or nerve roots by creating more space within the spinal canal. Surgery to decompress the area of stenosis is the most definitive way to try to resolve symptoms of spinal stenosis.
Research shows that spine surgeries result in fewer complications when done by highly experienced surgeons. Don’t hesitate to ask about your surgeon’s experience with spinal stenosis surgery. If you have any doubts, get a second opinion.
Examples of surgical procedures to treat spinal stenosis include:
- Laminectomy. This procedure removes the back part (lamina) of the affected vertebra. A laminectomy is sometimes called decompression surgery because it eases the pressure on the nerves by creating more space around them.
In some cases, that vertebra may need to be linked to adjoining vertebrae with metal hardware and a bone graft (spinal fusion) to maintain the spine’s strength.
- Laminotomy. This procedure removes only a portion of the lamina, typically carving a hole just big enough to relieve the pressure in a particular spot.
- Laminoplasty. This procedure is performed only on the vertebrae in the neck (cervical spine). It opens up the space within the spinal canal by creating a hinge on the lamina. Metal hardware bridges the gap in the opened section of the spine.
- Minimally invasive surgery. This approach to surgery removes bone or lamina in a way that reduces the damage to nearby healthy tissue. This results in less need to do fusions.
While fusions are a useful way to stabilize the spine and reduce pain, by avoiding them you can reduce potential risks, such as post-surgical pain and inflammation and disease in nearby sections of the spine. In addition to reducing the need for spinal fusion, a minimally invasive approach to surgery has been shown to result in a shorter recovery time.
In most cases, these space-creating operations help reduce spinal stenosis symptoms. But some people’s symptoms stay the same or get worse after surgery. Other surgical risks include infection, a tear in the membrane that covers the spinal cord, a blood clot in a leg vein and neurological deterioration.
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Potential future treatments
Clinical trials are underway to test the use of stem cells to treat degenerative spinal disease, an approach sometimes called regenerative medicine. Genomic medicine trials are also being done, which could result in new gene therapies for spinal stenosis.
Alternative medicine
Integrative medicine and alternative therapies may be used with conventional treatments to help you cope with spinal stenosis pain. Examples include:
- Massage therapy
- Chiropractic treatment
- Acupuncture
What is the latest treatment for spinal stenosis?
However, conservative treatments, such as NSAIDS, physical therapy and epidural steroid injections, only work for a fraction of people. Also, when they do work, the effect is often not sustained and requires repeated treatments.
Open spine surgery, on the other hand, works to relieve pressure on spinal nerves, but surgery and anesthesia may carry increased risk in older patients.
Now, there’s a new outpatient option called mild®, which stands for minimally invasive lumbar decompression. It is only an option for patients who have significant LSS due to thickening of the ligamentum flavum, or ligaments of the spine.
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