Lumbar Stenosis

If you have been diagnosed with lumbar stenosis, it can be a confusing and frustrating time of your life. For one, what does it mean, and now you have a diagnosis. What do you do? Rest assured, there are answers, and you aren’t alone. Let’s start by defining lumbar stenosis. The word lumbar is the name for the last five vertebrae that make up the low back. These vertebrae together form the intervertebral foramen (hole), in which our lumbar nerves leave the spinal cord and make their way down the legs. These vertebrae also make up the spinal canal, which houses the spinal cord. Stenosis means narrowing; therefore, in lumbar stenosis, there is a narrowing of either the spinal canal or of the intervertebral foramen at one or more levels of the spine.

As in the pictures above, the narrowing causes decreased space for the spinal cord or nerve roots. The reduced area translates to increased pressure on the spinal cord or nerve roots. This pressure then aggravates the nerves, and our body lets us know by sending pain signals to the brain, leaving us in sometimes debilitating pain. Pain from lumbar stenosis can range from simple low back pain to radiating pain down the leg/legs to the feet.

The best analogy to this scenario is to imagine living in a studio apartment—plenty of space to do anything you may want within your given area. Suddenly, you have someone move in. That space you once had is now limited. When you need to go to the bathroom, cook, or sleep, someone else is in your way. As any normal human being would, you get aggravated someone has crowded your space. That’s what happens to the nerve/nerves when you have spinal stenosis.

Stenosis is a natural process, due to the discs dehydrating over time. Creating less space in between vertebrae and decreasing the space in the intervertebral forament. The dehydration is the culprit of losing height as we age. It's not only poor posture.

As we age, we also have normal degeneration of the joints, which eventually becomes arthritis. With these two natural occurrences, lumbar stenosis typically happens at an older age. These two factors contribute to stenosis as well as the excess stress puts on the spine due to poor mechanics, weaknesses, and lack of range of motion of and around the spine. Once diagnosed with lumbar stenosis, there is no changing the structural damage, except with surgery. Although many non-surgical, options such as an epidural, holistic healing, time and the one that has been proven to be as effective as surgery and is physical therapy as stated in the New York Times article “Why ‘Useless Surgery is Still Popular in the US” (2016). I believe surgery has its place. If you cannot walk without your leg giving out, have been in severe pain for six months, or have lost function of any part of your leg, surgery is the most probable solution.

Physical therapy is the non-invasive treatment for any bodily injury also not often used as a preventative for a breakdown in the future. Physical therapy for lumbar stenosis focuses on making sure the spine has a full range of motion with stability. Many people don’t have a full range of motion of their spine, which leads to increased pressure during movement. The reasoning is decreased surface area to distribute the force. Think of having your foot stepped on by a high heel or a sneaker. Which one would you pick? Me the sneaker because the pain will be less due to the greater surface area. In your spine and every joint greater range equals less stress.

The other way physical therapy helps is with weakness of the muscles that support the lumbar spine. Working on the core musculature ensures that you have even, stable and smooth movement when using your spine. The lumbar spine houses the body’s center of gravity and is the foundation of all movement. This being said having a stable core is essential to having proper body mechanics, as well as decreased breakdown. When we build a house without a foundation the house is bound to fall apart at some point. Physical therapists are trained to recognize where deficiencies of range of motion and strength lie and how to improve these impairments, leaving a fully supported, pain-free spine. More on posture and core in my article “Posture and the Importance of the Core” on Vocal.