Relieving Spinal Stenosis
(Includes Best Exercises For Spinal StenosiS)
The word “stenosis” is used in medicine to describe a narrowing of a passage of the body.
Spinal stenosis, as you may have already guessed, is the narrowing of an area of the spine.
Spinal stenosis is a condition that can more commonly affect those over 60. It can lead to various symptoms, including lower back pain, weakness in the legs or arms, numbness in the buttocks or legs, or balance and mobility issues.
The symptoms associated with this condition can make daily life difficult. However, there are many effective treatments available and by taking the right steps, YOU CAN GET RELIEF!
In this article, we are going to look at spinal stenosis and what you can do about it! (including exercises, with an exercise video that will help).
WHAT’S COVERED IN THIS ARTICLE:
Note: Do not self-diagnose based on the information in this article. If you are experiencing any of the symptoms discussed in this article, make sure you see your Doctor or Physiotherapist before coming to any conclusions.
UNDERSTANDING SPINAL STENOSIS (TO BRING RELIEF)
ABOUT OUR SPINE
To better understand spinal stenosis, a little knowledge of the spine is needed. Let’s take a look at that now.
The Regions of the Spine
Our spine is a strong structure that supports our upper body. It keeps us upright and standing straight.
It’s also a flexible structure that allows certain movements. It can bend forward (flexion), bend backward (extension), twist to each side (rotation) and bend to each side (lateral flexion).
Our spine comprises 29 smaller bones that run from our neck to our pelvis (to the tail bone).
There are seven bones in the cervical region (the neck), twelve in the thoracic region (the upper back), five in the lumbar region (the lower back) and five bones, which are fused (and don’t move), in the sacral region (the pelvis).
These bones are called vertebra or vertebrae (plural).
Between each of our vertebrae are intervertebral discs which act as little cushions and provide shock absorption.
Vertebrae, Intervertebral discs and spinal cord
The intervertebral discs also allow our spine to move.
In the middle of our spine, a column of nerves runs through these bones. This column of nerves is our spinal cord. The space in which the spinal cord sits is known as the foramen.
The spinal cord is quite delicate and it is protected by the surrounding vertebral bone and other tissues.
Nerves of the spinal cord branch off at every level of the vertebrae to allow signals from the brain to reach the rest of the body.
ABOUT SPINAL STENOSIS
Throughout life, changes to the spine can occur for various reasons.
These changes can cause the spaces the spinal nerves pass through to become narrowed (aka spinal stenosis).
Any narrowing where the nerves pass through can pinch the nerves leading to pain and neurological symptoms that can affect walking, balance and sensation, and cause paralysis.
Spinal stenosis can happen in any part of the spine but most commonly occurs in the lumbar and cervical regions.
Lumbar stenosis is the most common type of spinal stenosis.
CAUSES OF SPINAL STENOSIS
Changes to the spine that cause spinal stenosis are:
OSTEOARTHRITIS
Over the years, our joints experience wear and tear, otherwise known as osteoarthritis. Osteoarthritis is the most common cause of spinal stenosis.
Osteoarthritis can cause the spaces the nerves pass through (the foramen) to become narrowed.
The wear and tear can also lead to abnormal bone growth, called osteophytes or bone spurs, which can cause narrowing of the foramen and put pressure on the nerves.
INTERVERTEBRAL DISC ISSUES
Additionally, as we get older, the discs between our vertebrae lose height and become dehydrated (this is why we lose height as we age).
As the discs become thinner, there is now increased pressure on the spinal joints, and it can also lead to narrowing of the foramen.
The intervertebral discs can also bulge, pushing into the spinal canal, leading to spinal stenosis.
LIGAMENT THICKENING
Another cause of spinal stenosis is a thickening of the spine's ligaments, caused by osteoarthritis and inflammation. [1]
SYMPTOMS OF SPINAL STENOSIS
With spinal stenosis, the symptoms vary between each person.
The most common symptom is pain radiating down the legs. This pain is usually felt in both legs but can occur in only one.
The pain is usually aggravated when hyper-extending the back (leaning/bending backwards). See diagram below.
Position of most pain - extending.
Additionally, prolonged walking or standing also commonly increase the symptoms.
Other common symptoms of spinal stenosis are numbness and weakness in the legs, which can lead to balance and mobility issues.
On the other hand, certain positions relieve pain, which is characteristic of spinal stenosis.
Bending forward relieves the pain (e.g. leaning forward on a table when standing, or a shopping trolley, or walking aid, when walking).
HOW IS SPINAL STENOSIS DIAGNOSED
If you are experiencing any symptoms discussed above, see your doctor or Physiotherapist for an appropriate assessment and diagnosis.
Your doctor may order medical images/scans (X-ray and/or MRI).
As mentioned at the beginning of this article, there is no direct link between the severity of stenosis seen on medical imaging and symptoms. One may have severe stenosis on scans and no pain, and another can have mild stenosis on scans and severe pain.
How is this possible? Because scans CANNOT tell you what is causing your pain. Pain is caused by a variety of reasons.
Scans can, however, give an idea of what is going on in your back, which helps with recovery.
Therefore you mustn't get too caught up in the results of your scans or the diagnosis of spinal stenosis. Instead, turn your attention to applying what's required to remedy your pain.
I cover medical imaging and beliefs around pain in detail in my articles on chronic pain. You can find all these articles HERE. In Part 1 of my Pain Series articles - Pain is More than Meets the Eye we look at pain from a different angle and Part 2: The Real Causes of Pain - I demonstrate, backed with studies, that what is identified on scans is not the sole cause of your pain.
Once you have an idea of what is causing your pain, your doctor will help you decide on the appropriate treatment. A conservative, exercise and lifestyle-based approach is usually the first line of treatment for spinal stenosis.
Now let's get to what you can do to help bring relief from spinal stenosis.
GETTING RELIEF FROM SPINAL STENOSIS
We have now covered that multiple factors contribute to pain and other symptoms in spinal stenosis and other chronic, painful conditions.
I discuss these factors that usually contribute to chronic pain and other symptoms in more detail in my article: “Overcoming Pain - Empty Your Cup” - (click to read).
When symptoms from spinal stenosis are increased, the best solution is to rest and avoid what is aggravating them.
At these times, management techniques can help also. These techniques include analgesia (speak to your doctor about this), heat packs, heat rubs/creams, cryotherapy (ice), herbal remedies, TENs (Transcutaneous Electrical Stimulation), ultrasound, acupuncture, cupping, stretching, amongst many others.
Rest and analgesia are not long term solutions and will eventually lead to further issues.
Exercise, along with other lifestyle changes, on the other hand, are long term solutions!
A gradual return to movement and activity is necessary as symptoms improve.
Additionally, other factors such as changing your views surrounding pain, shifting your focus on leading a healthier life, reducing stress, sleeping better, eating healthily, getting moving/exercising and doing specific exercises (covered in the next section) will help you overcome your symptoms.
I discuss lifestyle changes in more detail in my article “Overcoming Pain - Empty Your Cup Article”. And, In Part 4 of the Pain Series articles, “Overcoming your pain”, make sure to check them out.
The articles I have linked to above will give you new ways to think about your pain and solutions to begin living a healthier life and help bring relief from your spinal stenosis.
There are also many health professionals and clinics that can help you with your condition. So speak to your doctor or Physiotherapist or seek the right Health Professional for you who can help.
Being in pain/suffering is NOT a normal part of aging. There are many things you can do to help bring relief. You do not have to put up with the symptoms of spinal stenosis.
EXERCISING TO IMPROVE SPINAL STENOSIS
When in pain, the urge may be to avoid exercise altogether. In the beginning or during a flare-up of symptoms, this is ok.
However, exercise and movement are vital to manage and help overcome spinal stenosis (and any painful, chronic condition). This will ensure you remain moving well and your muscles and joints stay strong and flexible.
I recommend seeing a Physiotherapist if you are experiencing symptoms from spinal stenosis (or any back pain for that matter) as they can determine what physical issues could be contributing to your pain and develop an individualised exercise program for you.
They will also teach you specific exercises, ensure you are doing them correctly, keep track of your progress and modify your exercises where need be.
EXERCISES THAT MAY AGGRAVATE SPINAL STENOSIS
Avoiding any body movements can lead to further issues - such as increased stiffness and weakness.
However, with all painful conditions, there may be specific movements at times that will aggravate your pain, especially when symptoms are increased.
As discussed earlier, extension movements, movements leaning backwards, are common positions that cause pain with spinal stenosis.
I am demonstrating some movements in the extension position in the pictures below.
Seated lumbar extension
An increased lumbar extension stretch - Hyperextension
On the other hand, flexion movements (covered in the next section) will help ease your symptoms of spinal stenosis.
Also, stretches in standing may increase symptoms. Seated or lying stretches may be better.
Other activities that may aggravate symptoms of spinal stenosis are strengthening exercises (free weights), other high-impact exercises (for example, dancing, jogging or certain sports) and long walks (longer distances and time).
Although you may need to avoid, limit or modify certain exercises or activities initially, it does not mean you have to avoid them for good. These activities and exercises mentioned above bring many health benefits.
Free weights can be an excellent tool for a stronger body and help with back pain, provided they are performed correctly, and you have a clearance from your doctor or Physiotherapist.
Walking is another excellent form of exercise, and exercise everyone should be doing as they are able. Start with shorter, gentle walks before progressing. For more on this, make sure to check out my article on walking HERE.
It is important to have a healthy outlook on your pain. Aim to return to your previous levels of activity, and then eventually moving beyond that and doing more types of exercise as your symptoms and movement improve over time.
EXERCISE CHOICES FOR SPINAL STENOSIS
There are always alternate exercise options if you cannot do certain activities or exercise due to your pain or other symptoms.
One of those options is swimming or exercising in water (hydrotherapy).
Although swimming puts you in a more extended position, most people experience less or even no symptoms due to the non-weight bearing, low impact nature.
Swimming allows you to exercise your body with decreased stress/impact.
Additionally, if you are having difficulty doing exercises due to pain, exercising in water (known as hydrotherapy) can allow you to exercise your body without increasing symptoms due to your increased buoyancy (or decreased weight-bearing) in the water.
Furthermore, heated pools can help relax muscles and reduce pain, which will make the exercises more manageable and allow a greater range of movement compared to when out of the water, leading to more benefits.
After some time exercising in water, land-based exercise will begin feeling easier.
Other types of exercise that may help with your pain include smaller walks (building this up over time), yoga, pilates, or riding a stationary bike.
BEST EXERCISES FOR SPINAL STENOSIS
5 BEST EXERCISES FOR LUMBAR STENOSIS
Here are the best exercises you can do to help bring relief from your symptoms of spinal stenosis. There is an exercise video in the next section, which you can follow. The video will make it all easier.
If you have trouble getting up or down off the floor, I recommend doing these exercises on a firm bed.
Aim to complete these exercises once per day.
Go at your own pace and repeat for the repetitions stated below.
As you continue with the exercises, gradually increase the repetitions, time and sets over time.
Note: Remember to consult your Doctor or Physiotherapist to ensure these exercises are appropriate for you. If these exercises cause an increase in pain or other symptoms, stop the exercise and make sure to speak to your Doctor or Physiotherapist.
1. KNEE TO CHEST FLEXION STRETCH (DOUBLE)
How To:
Lie on your back, with your body comfortable and relaxed.
Bring both your knees to your chest and hug them, keeping your spine relaxed throughout.
Hold this position for 10 seconds and then slowly lower the legs.
Repeat 5 times.
2. SINGLE KNEE TO CHEST FLEXION STRETCH
How To:
Similar to the exercises above, this time drawing one leg up at a time.
Lie on your back, with your body comfortable and relaxed and legs extended.
Bring one knee to your chest and then bring it closer to your chest by placing your hands either at the back of the thigh or just below the knee.
Hold this position for 5 seconds and then slowly lower the leg, and alternate legs.
Repeat 5 times each side.
3. LUMBAR ROTATIONS
How To:
Lie on your back, with your arms by your side and with your knees bent at 90 degrees,.
To begin keep both feet flat against the floor.
Slowly rotate the knees to the left side as far as you can, then slowly rotate the knees to the right side.
The soles of your feet will lift off the ground when doing this exercise.
Repeat this for 5 repetitions each side.
4. BRIDGE
How To:
Lie on your back with knees bent at 90 degrees , your arms by your side and palms against the floor.
Squeeze your buttocks and raise the hips off the ground to bring the torso into a straight diagonal line.
Hold this position for 5 seconds then slowly lower your bottom back to the ground.
Repeat 5 times.
5. SEATED LUMBAR FLEXION
How To:
Sit in a firm chair with both feet on the floor.
Slowly bend yourself forward and reach towards the floor.
Hold the fully bent position for 5 seconds.
If you need to increase the pressure, hold your ankles and move into the stretch a little more.
After holding for 5 seconds, release and return to the full, upright seated position.
BEST EXERCISES FOR LUMBAR STENOSIS (VIDEO)
3 BEST EXERCISES FOR CERVICAL STENOSIS
Exercises for cervical spinal stenosis also work to improve the strength and flexibility of the neck and upper back.
Here are some upper back and neck exercises for spinal stenosis.
1. BACKWARD SHOULDER ROLLS
How To:
Sitting up nice and tall in your chair with your feet flat on the ground.
Lift your shoulders up toward your ears and then roll them back and down.
Now relax into the starting position.
Repeat this rolling motion.
Complete for 10 repetitions.
2. SEATED SHOULDER SQUEEZES
How To:
Sitting upright in your chair in good posture.
While seated, draw your shoulder blades together, hold for a second or two, and then lower back to the start position
Repeat for 10 repetitions.
3. CHIN TUCKS
How To:
Sitting upright in your chair in good posture
Maintaining this upright posture retract your chin out and slowly tuck your chin all the way in.
Do not move your head up or down during this movement.
Ensure you maintain the upright seated posture
Repeat for 10 repetitions.
SOURCES
Spinal Stenosis. https://www.ncbi.nlm.nih.gov/books/NBK441989/