Spinal conditions like spinal stenosis can cause a wide range of effects felt throughout the body. When the spinal nerves don’t have enough space in the spinal canal, they can face compression, and this can lead to pain and tingling felt not just in the back, but in the body’s extremities.
Spinal stenosis is a condition that causes the spaces within the spine to narrow; this can cause uneven pressure on nerves that pass through the spine. The condition most commonly occurs in the lower back and neck as lumbar and cervical spinal stenosis. Symptoms range in severity, and treatment needs to be proactive and customized.
To fully understand how spinal stenosis affects the spine’s overall health and function, let’s first explore some basic spinal anatomy.
In a healthy spine, the vertebrae (bones of the spine) are stacked on top of one another, separated by intervertebral discs.
The spine’s intervertebral discs have a tough outer layer and a soft gel-like interior. The discs are a crucial part of the spine’s health and function; they act as the body’s shock absorbers, distribute mechanical stress evenly throughout the spine, help facilitate flexible movement, and provide the spine with structure and cushioning between the vertebrae.
Each vertebra has a hollow center, and together, the vertebrae form a canal through which the spinal cord (nerves) passes.
The brain and spine work in tandem to form the body’s central nervous system (CNS), facilitating important communication between the brain and the rest of the body.
There are three main spinal sections: cervical (neck), thoracic (middle/upper back), and lumbar (lower back).
Now that we’ve touched on some of the important parts of the spine. Let’s address the main topic of spinal stenosis.
Spinal stenosis occurs when there is a loss of space within the spine, which disrupts spinal biomechanics by introducing uneven pressure to its parts and the nerves housed within.
The condition occurs in the cervical and/or lumbar spine, and while some spinal stenosis patients don’t experience noticeable symptoms, while others struggle with pain and related muscle weakness.
Like most spinal conditions, symptoms tend to progress if left untreated, becoming more severe over time.
The two types of spinal stenosis are cervical and lumbar spinal stenosis.
The different types of spinal stenosis are classified based on their location along the spine, and while it’s more common to have spinal stenosis in one section of the spine, it is also possible to have more than one type simultaneously.
Cervical spinal stenosis is diagnosed when the narrowing of the spaces within the spine takes place in the neck (cervical spine).
Lumbar spinal stenosis involves the loss of spaces within the spine of the lower back (lumbar spine) and is the most common form of spinal stenosis.
One of the most common condition-related questions involves its causation.
As mentioned, the spine extends from the neck to the lower back, with the vertebrae forming a spinal canal that protects the spinal cord nerves within.
While some people are simply born with a smaller spinal canal, most cases of spinal stenosis occur because something has caused a narrowing of the open spaces within the spine.
Following are some common causes of spinal stenosis:
Known as bone spurs, an overgrowth of bone can intrude on the spinal canal, compressing the space it has available for the nerves within.
Bone spurs can be caused by other spinal conditions like osteoporosis, and bone diseases, such as Paget’s disease, can also lead to the development of bone overgrowths within the spine.
When the intervertebral discs start to deteriorate and dry out due to age or injury, they can lose height and become cracked.
When the durable outer layer becomes weakened and cracks, the soft gel-like interior can leak out and press against the spinal cord and/or nerves.
If the intervertebral discs become cracked and lose height, the spine’s structure is affected, and when a disc herniates and protrudes into the spaces within the spine, this can lead to the development of spinal stenosis.
Ligaments are durable cords that help give the spine structure by holding the vertebrae together.
If these ligaments get thicker over time, they can become stiff and start to bulge into the spinal canal: affecting the availability of space within.
Tumors are abnormal growths that can occur in many locations throughout the body; when they develop inside the spinal cord, either within the membranes covering the spinal cord, or within the space between the vertebrae and spinal cord, they can cause spinal stenosis.
The presence of spinal tumors can be identified via X-ray, MRI, or CT scans.
If the spine sustains an injury or trauma that causes a dislocation or fracture of one or more vertebrae, the displaced bone can damage the spinal canal’s interior.
Spinal surgery can also cause nearby tissue to become irritated and inflamed, and this can put pressure on the spinal cord nerves.
Now that we have discussed the two main types of spinal stenosis and what causes the condition, let’s talk about risk factors: factors that make people more likely to develop spinal stenosis.
Spinal Stenosis Risk Factors
Age is a big risk factor. As spinal stenosis is most commonly diagnosed in adults over the age of 50, the condition has a strong connection to gradual degenerative changes in the spine related to aging.
While degenerative changes can affect the spines of younger people, most often, other causes are involved such as trauma, injury, structural spinal conditions like congenital scoliosis, and genetic diseases that affect the body’s bone and muscle development.
Spinal imaging can help identify the causation behind spinal stenosis, but what types of stenosis symptoms indicate the need for further testing?
It’s not uncommon for people diagnosed with spinal stenosis to have reached the diagnosis somewhat by accident.
Some patients have indicators for spinal stenosis that show up on an MRI or CT scan being performed for a different reason; in these types of cases, the patients are not experiencing symptoms of spinal stenosis, even though their spines have already started to lose space within.
When spinal stenosis symptoms develop, they start gradually and worsen over time, particularly in older adults also facing spinal deterioration, especially when left untreated.
Symptoms will vary depending on where the stenosis is and the extent of nerve involvement.
Before talking about the symptoms specific to each type of spinal stenosis, let’s talk generally about some common symptoms like pain, numbness, and/or weakness.
People suffering from spinal stenosis-related pain often describe it as dull and concentrated in the neck or lower back, depending on the site of the stenosis.
It can also be described as electric-like pain that radiates into one or both arms and feet.
Stenosis-related pain is also known to flare up, ranging from periods of minor intermittent pain to chronic and debilitating pain; flare-ups are often related to certain activities that put a strain on the spine or involve standing/being active for long periods.
Condition-related pain can also be more of a pins-and-needles tingling type of sensation.
It’s also important to remember that spinal stenosis doesn’t always cause pain, and while uncommon, sometimes numbness and/or weakness can be present without pain.
Numbness is understood as a reduced sensation or total numbness in an area, and when it comes to spinal stenosis, this can occur in the back, neck, or other areas of the body.
Nerves are like branches of a tree, fanning off in multiple directions, and when the spinal nerves are compressed due to a lack of space, they can cause radiating pain felt throughout the body, and far from its site of origin.
Weakness is understood as reduced strength and/or problems with coordination and balance, which can lead to changes in gait.
Stenosis-related weakness can be felt in one or both of the arms and legs, as well as other parts of the body.
When a condition is severe, this means the spinal cord or cauda equina (nerve roots located below the spinal cord) is severely compressed, and if left untreated, this can lead to bowel and/or bladder impairment.
As mentioned, there are two types of spinal stenosis, each producing its own unique symptoms:
So with such a variety of symptoms, with some people not even experiencing any, how serious is spinal stenosis?
As is the case with many spinal conditions, there are varying levels of severity ranging from mild to moderate and severe.
While uncommon, if left untreated, severe spinal stenosis can progress in severity and cause permanent issues with pain, numbness, weakness, balance issues, incontinence, and paralysis.
It’s important to understand the important role that a healthy spine plays in the overall health and function of the body; not only does the spine allow us to stand upright, practice good posture, absorb/distribute mechanical stress, and facilitate flexible movement, it also works in tandem with the brain to form the body’s central nervous system.
Any spinal condition with the potential to cause compression of the spine and its surrounding ligaments, vessels, muscles, and nerves can lead to a number of serious issues, especially if left untreated or in particularly severe cases. While work can be done to take pressure off the nerves, if left untreated, those compressed nerves can turn into damaged nerves, a condition known as neuropathy, and there is a point where nerves are damaged beyond repair, leading to permanent long-term effects.
It’s important to understand that spinal nerves are involved in virtually all working systems within the body. The 31 pairs of spinal nerves control sensory, motor, and other functions, and they are located at every section of the spine.
So is spinal stenosis a serious condition? It can be, based on the type, cause, severity level, and whether or not proactive and effective treatment is applied.
Another common condition-related question concerns exercise: are there activity restrictions for people living with spinal stenosis?
Unfortunately, while exercises and stretches can help achieve corrective results when integrated with other forms of treatment for a variety of spinal conditions, exercises and stretches are not known as particularly helpful when it comes to spinal stenosis.
In fact, some exercises can aggravate the condition, so it’s important to consult with your treatment provider regarding which exercises should be avoided. This is not to say that people with spinal stenosis should stop exercising but instead should modify and approach certain activities with caution.
In terms of overall health, both of the body and the spine, movement is key. The spine’s very design is based on movement, so leading a sedentary life is never a good thing; instead, with some modifications and research, an effective and safe exercise regime can be designed for people with spinal stenosis.
Again, the topic of exercises to avoid for people with spinal stenosis can be divided into two categories: those with lumbar spinal stenosis and those with cervical spinal stenosis.
Not exercising is never a good approach to living with a spinal condition. The spine needs movement to remain strong, flexible, and functional; however, certain exercises have to be modified or avoided in favor of types of movement that don’t increase stress on the spine.
For people with lumbar spinal stenosis, stretching in a standing position and extension stretches should be avoided.
Due to gravity, when stretching in a standing position, the spine is unnecessarily stressed.
With lumbar stenosis, the spinal cord is already exposed to extra pressure from the narrowing of the spinal canal, so stretching in a standing position increases the stress on the spine.
In addition, extension stretches, where the spine is bent backward in an attempt to increase spinal flexibility, should also be avoided; this is because the unnatural backward position collapses the spinal canal and decreases space within even more.
So stretching in a standing position and/or spinal extension stretches should be avoided because it exposes the spine to further compression and decreased space within the spinal canal.
Instead, stretching while sitting or lying down can be less strenuous on the back. Knee stretches performed while lying down are known as safe and helpful for people with spinal stenosis.
Knee stretches can be performed by lying on the back, gently pulling a bent knee up to the chest, and holding the pose for a few seconds. Repeating this motion with the other leg, and then bringing both knees up together is a type of flexion exercise that can open up the spinal canal, relieving pressure and related symptoms.
Lifting Free Weights
Free weight lifting is another activity that people with lumbar spinal stenosis should avoid because weight lifting compresses the spine.
When the spine is compressed, the intervertebral discs become flatter, which can further compress nearby nerves.
While people with healthy spines can handle the amount of spinal compression caused by lifting weights, people with spinal stenosis are particularly vulnerable to its effects; instead, a weight machine is said to be more appropriate as it’s designed to provide the body with support while working on a specific muscle group.
With a weight machine, while lifting weights with the arms, the back is better supported and stabilized, and this can help reduce the potential harm done to the spine.
High-impact exercises that involve exposing the spine to repeated shocks on a hard surface, such as running, are also not ideal for people with spinal stenosis.
Unfortunately, walking for long periods of time can also irritate stenosis by stressing the back with repetitive impact.
Exercises deemed appropriate for people living with lumbar spinal stenosis include an elliptical machine, swimming, and cycling.
Swimming can be particularly beneficial as it works a broad range of muscles symmetrically and facilitates gentle stretching while exercising and in a gravity-free environment.
So what about people living with cervical spinal stenosis?
For people whose stenosis is located in the neck, modifications should be made to ensure that the neck and upper back is protected and not exposed to any additional stress.
Arm-strengthening weight lifting that involves lifting the weights over the head should be avoided due to the large amount of strain this puts on the cervical spine’s intervertebral discs, which can exacerbate the condition.
Circular Motion and Flexion
Exercise that involves moving the neck in a circular pattern or flexion of the neck should also be avoided as they add pressure to the neck, which is already compromised.
Instead, exercises that stretch and strengthen the upper-back muscles are encouraged, such as light strength training (that doesn’t involve lifting weights above the head), and as with lumbar stenosis, swimming and cycling are safe low-impact exercises known to be helpful for those living with a narrowing of the cervical spine.
Again, be sure to consult with your treatment provider for guidance on which activities should be avoided, and which are safe.
For those who have recently received a spinal stenosis diagnosis, the most important question is how to treat it moving forward.
When it comes to spinal conditions, many people assume that surgery is the best treatment option, but this is not the case; in fact, less than 5 percent of patients with spinal conditions are in need of surgical intervention.
Here at the Scoliosis Reduction Center, I have experience treating a wide range of spinal conditions, stenosis included.
As always, one of my treatment goals is to help patients avoid the need for invasive surgical procedures, and through a combination of different forms of treatment, in most cases, this can be achieved.
Through different types of physical therapy, such as inactive and therapeutic exercise, I work closely with patients to help relax muscles, increase spinal strength, flexibility, and provide the spine with optimal support and stabilization by increasing nearby muscle strength.
As each case is unique, a highly customized treatment plan is necessary. Physical therapy plans can also include alternating heat and/or ice packs, ultrasound, electrical stimulation (to stimulate nerves and muscles), and massage.
These different treatment types help prepare the patient for active therapy by relaxing tight and sore muscles, so they are more responsive to treatment, not to mention easing related discomfort and pain.
Therapeutic exercise can include condition-specific custom-prescribed stretches and exercises to help stabilize the spine and increase its strength, endurance, and flexibility; these things help take pressure off the spine, its discs, and the nerves within.
Treatment for spinal stenosis can also involve prescribing anti-inflammatory medication/injections to help reduce inflammation and ease condition-related pain and discomfort.
Spinal stenosis is commonly diagnosed in older adults experiencing spinal degeneration and a narrowing of the space within the spinal canal.
The spinal canal contains the spinal cord consisting of nerves, ligaments, fat, and blood vessels.
As the spine and brain work together to form the body’s central nervous system, spinal conditions have the potential to cause a myriad of effects felt throughout the body.
With two types of spinal stenosis, lumbar and cervical, the condition develops in the lower back or neck, and symptoms will vary based on the type and a number of important patient/condition characteristics.
As spinal stenosis involves a loss of space in the spinal canal, this can cause compression of the intervertebral discs and important spinal nerves, leading to symptoms of pain and tightness in the affected area, and sensations of tingling and/or numbness in the body’s extremities.
As mentioned, nerve pain is commonly felt far from its source of origin, so even a spinal condition like spinal stenosis can cause issues in the hands, feet, arms, and legs.
While there are never treatment guarantees, when it comes to proactive treatment for spinal stenosis, here at the Scoliosis Reduction Center, I work closely with my patients to customize an effective treatment plan that combines a number of different therapies to increase muscle and spinal strength, take pressure off impacted nerves, and provide the spine with optimal support and stabilization.