Spinal Stenosis
Spinal Stenosis
WHAT IS SPINAL STENOSIS?
Spinal stenosis is a painful and debilitating condition, whose symptoms, if left untreated, typically worsen over time. Caused by pressure created when the passageway through which the spinal cord travels begins to narrow and compress highly sensitive spinal nerves, spinal stenosis is frequently treated with prescription drugs and surgery. Fortunately, however, there are many safe and natural methods of treatment available which also have proven effective in reducing the severe pain and impaired mobility experienced with spinal stenosis.
What Causes Spinal Stenosis?
Spinal stenosis may be caused by any number of factors.
Most Common among these are:
- Arthritis
- Bone Spurs within the spinal canal
- Ligament Hypertrophy – a condition in which toughened ligaments pull the spine closer together.
- Habitual dysfunctional motion exerting abnormal stress on the spine
- Spinal Degeneration and decrease in disc height
Other causes of spinal stenosis may include:
- Slipped or fractured vertebrae
- Trauma related injuries
- Tumors on the spine
- Heredity may also be a factor among people who have inherited an abnormally narrow spinal canal and who are subsequently more susceptible or predisposed to developing spinal stenosis, particularly at an earlier age.
- In some instances, the discs that cushion the space between the vertebrae may also begin to deteriorate leading to a decrease in disc height, disc bulge or disc herniation. Important Note: Although disc herniation causes acute spinal stenosis, these cases are referred to by the primary factor causing the spinal stenosis – disc herniation. For more information on disc herniation, please refer to our separate article on disc injury.
Most of the cases of spinal stenosis we see at Ravenswood Chiropractic and Wellness are due to spinal degeneration, disc injuries, and habitual dysfunction.
What are the Symptoms of Spinal Stenosis?
Spinal stenosis may occur at anytime and anywhere in the spine, at either a single location or multiple locations. It exhibits virtually no symptoms at its onset. However, as the narrowing of the spinal passageway becomes acute and significant pressure begins to bear down on the spinal cord or spinal nerves, symptoms become increasingly apparent and progressively severe. There are two types of spinal stenosis which can occur at three locations. Each has its own set of signifiers.
Central stenosis occurs when the central spinal canal narrows and the spinal cord becomes compressed.
Patients suffering central stenosis may experience:
- Pain, weakness and muscle spasms bilaterally – in both arms and in both legs, depending on where and how much pressure is exerted on the spinal cord.
- Walking usually becomes increasingly painful and more difficult for those with central stenosis.
- Sufferers often find they need to lean over something, like a shopping cart, to relieve pain while walking. This particular symptom is known as “the shopping cart sign.”
Lateral stenosis occurs when the spinal nerves become compressed as they exit the spinal foramen.
Patients suffering lateral stenosis often experience:
- Pain, weakness or muscle spasms unilaterally – on one side – in an arm (often shoulder blade to finger), or leg (often hip or thigh to toes).
- Weakness or muscle spasms unilaterally – on one side- in an arm (often shoulder blade to finger), or leg (often hip or thigh to toes).
Location of Spinal Stenosis
Lumbar Stenosis | Cervical Stenosis | Thoracic Stenosis
Lumbar stenosis occurs in the lower back.
It is the type of spinal stenosis we see most at Ravenswood Chiropractic and Wellness.
Cervical stenosis affects the neck.
It is the second most commonly seen form of stenosis.
Thoracic stenosis
Perhaps the least commonly seen form of spinal stenosis, which affects the upper back.
How is Spinal Stenosis Diagnosed?
Spinal stenosis should be evaluated by a qualified healthcare professional who specializes in spinal pain. A chiropractic physician is an excellent choice for the required examination. A chiropractor can accurately diagnose spinal stenosis and provide a viable course of personalized treatment to help relieve painful symptoms. In some cases, an X-ray or MRI may be necessary for providing a definitive determination as to which form of stenosis needs to be addressed.
Important Note Regarding Imaging: Patients exhibiting spinal stenosis through imaging processes may not exhibit any symptoms, and the degree of narrowing of the spinal canal may not necessarily correlate with the degree of the symptoms being presenti.
How is Spinal Stenosis treated?
Patients diagnosed with spinal stenosis should consider a variety of issues before deciding on a course of treatment. These include one’s current quality of life and degree of pain, the type, cause and extent of stenosis and the presence of other symptoms currently being experienced, as well as, any additional coexisting health issues.
Consider a paper published (2010) in the Journal of The American Medical Association: “Diagnosis and Management of Lumbar Spinal Stenosis” which concluded….
“Contrary to commonly held perceptions, available evidence suggests that spinal stenosis is a stable disorder. Patients who develop serious disability and neurological deficit usually do so over time, and the decline is not predicted by pain levels or imaging abnormalities. Accordingly, treatment choices should be based on current pain and disability, not on anticipation of future pain or complications.”
What about Prescription Drugs and Surgery?
Depending on the degree of stenosis present and one’s pain level, some patients may choose epidural cortisone injections or surgery to relieve the symptoms of spinal stenosis. However, while injections may ease the pain in the short term by reducing inflammation, and surgery, may reduce pain by temporarily expanding the spinal canal and relieving pressure, neither is a cure.
As a general treatment plan, pain medications, which may be useful at times “should not be the primary intervention for spinal stenosis….at best, drugs relieve only about 30% of chronic pain. In older patients, the use of powerful pain medications may increase the risk of falls, cognitive deficits, constipation, bladder dysfunction, and adverse drug reactions.iii.”
At present, data is limited and inconsistent regarding the efficacy of epidural corticosteroids injections, which may have side effects, such as infection, nerve damage, or a decrease in immunity. The number of epidural shots a patient may receive is also limited, as they may weaken and necrose muscle and tissue causing further medical issues. At some point, they will no longer be an option.
Surgery offers another option in treating spinal stenosis, especially in instances of arthritis and bone spurs. Unfortunately, surgery may lead to spinal fusion, the complication of other health issues and ultimately the possibility of additional surgeryiv.
Research on long-term out-comes of surgical versus nonsurgical management of spinal stenosis
Research has shown that at the “8-10 year follow-up, low back pain relief, predominant symptom improvement, and satisfaction with the current state were similar in patients treated surgically or non-surgically “ii. Furthermore, the same long-term study concluded that “patients reluctant to undergo surgery may elect conservative care, knowing that their symptoms will likely remain stable, and long-term outcomes are similarii“.
Additionally, conservative care out-comes largely depend on the patient’s symptoms at exam presentation. Symptoms may recur with either approach.
Physical Medicine | Conservative Care Options
Here at Ravenswood Chiropractic & Wellness Center, we provide pain reducing treatment options that address the causes of spinal stenosis. We share a widely held belief that conservative management for indicated patients should be a first line therapy for spinal stenosis. We are experts at diagnosing and treating spinal stenosis due to disc bulge, disc herniation, habitual dysfunction, spinal degeneration and ligament hypertrophy, and we can help relieve pain due to stenosis caused by arthritis. We can correct the reasons spinal stenosis has developed and help prevent further spinal degeneration. Our Physical Medicine options offer safe and effective alternatives to prescription drugs and surgery.
Our Spinal Stenosis Treatment Plan Basics Include the Following Goals:
1) Create more space for the nerves and spinal fluid to “live and breathe”
2) Reduce pain and restore activities of daily living
3) Fix the dysfunction that is causing the degeneration and slow the degenerative process to help prevent further damage
Chiropractic for Spinal Stenosis
Chiropractic is a safe and natural method for treating spinal stenosis. At Ravenswood Chiropractic and Wellness, we can offer several different treatment options.
Spinal adjustments, using a gentle, non-invasive technique, can help keep your spine properly aligned to improve your range of motion and help prevent further injury. Traction methods help stretch back muscles, widen the spaces between vertebrae and decompress the discs in the spine. Another technique, called flexion-distraction, can help alleviate pain by opening the space in the spinal canal and relieving pressure on the discs of the spinal column to help increase disc height and disc hydration. Chiropractic therapies can also help reduce adhesions and ligament thickness by restoring normal function. This also will decrease pain and inflammation. If spinal stenosis is caused by disc herniation, we are also experts at resolving disc injuries.
“a treatment approach focusing on Distraction Manipulation and Neural mobilization may be useful in bringing about clinically meaningful improvement in disability in patients with Lumbar Spinal Stenosis “
2016: A Non-surgical Approach to the Management of Lumbar Spinal Stenosis: A prospective observational cohort study | BMC Musculoskeletal Disorders.
Physical Therapy for Spinal Stenosis in Chicago
Physical therapy provides another safe and effective treatment option for spinal stenosis sufferers. An appropriate personalized exercise plan will be designed for you using information gained through an initial in-depth evaluation of your condition. This plan will be aimed at achieving an individualized set of desired end-goals. It will likely consist of stretching and other exercises designed to increase your range of motion, as well as, strengthening exercises that are easily done at home and may aid in further reducing strain and pain at targeted areas. Learning proper exercise techniques from our knowledgeable staff will help maximize results.
Other types of therapies such as heat, ice, or ultrasound, which can increase circulation and reduce inflammation, may also be utilized.
Massage for Spinal Stenosis
Massage therapy may also be helpful in the treatment of spinal stenosis, especially when used in conjunction with other treatments such as chiropractic, physical therapy, and acupuncture. At Ravenswood Chiropractic and Wellness, your massage therapist will assess your condition and recommend a personalized treatment plan for you. Many of our spinal stenosis patients have responded particularly well to Swedish massage and myofascial release massage therapy. Your massage therapist may work your back, shoulders, hips, and legs to help reduce tension in muscles that might be compressing your spine and constricting your spinal column.
Even if you have undergone spinal decompression surgery, you might want to consider massage therapy to further reduce spinal stenosis pain. Massage therapy has been shown to be useful in helping the body heal even after surgery for spinal stenosis. Increased flexibility after massage therapy may also help in your ability to walk longer distances.
Acupuncture for Spinal Stenosis
Acupuncture may be another option to consider in relieving spinal stenosis pain. Acupuncture increases blood flow to help relax muscles and reduce inflammation associated with spinal stenosis, which may lead to noticeable pain relief. Studies on acupuncture have shown that changes in blood pressure and blood flow resulting from acupuncture treatment can have a substantial impact on the symptoms of lumbar spinal stenosis. Other research has found that electro-acupuncture therapy for spinal stenosis patients saw a reduction in lower limb pain and an increase in walking distance.
Get Help for your Spinal Stenosis Today!
Spinal stenosis is a common painful condition, but luckily there are plenty of treatment options available. Don’t assume surgery and cortisone injections are better than more conservative treatment options like chiropractic, physical therapy, massage, and acupuncture. Why not start with natural non-invasive treatments?
If you are suffering from lower back pain and believe you may have some form of spinal stenosis, please call Ravenswood Chiropractic & Wellness Center, Chicago at 773.878.7330 to set up your initial consultation appointment and start down the path toward relief!
References and Additional Information
i deSchepper MD. MS., Evelien I. T. et al. Diagnosis of Lumbar Spinal Stenosis Spine 2013; volume 38, Number 8, pp E469-E481.
ii Atlas MD, MPH, Steven J. et al. Long-Term Outcomes of Surgical and Nonsurgical Management of Lumbar Spinal Stenosis: 8 to 10 Year Results from the Main Lumbar Spine Study Spine 2005; volume 30, Number 8, pp 936-943
iii Haig, Andrew J., Tomkins, Christy C., Diagnosis and Management of Lumbar Stenosis JAMA; 2010; 303(1): 71-72
iv Wu-A-M, Zhou et al. Interspinous Spacer versus Traditional Decompressive Surgery for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis. PLOS One 2014; e97142
Inoue M, Hojo T, Yano T, Katsumi Y., (2005), Effects of lumbar acupuncture stimulation on blood flow to the sciatic nerve trunk – an exploratory study, Acupunct Med. 2005 Dec; 23(4): 166-70.
Inoue M, Hojo T, Nakajima M, Kitakoji H, Itoi M, Katsumi Y., (2008), Pudendal nerve electroacupuncture for lumbar spinal canal stenosis – a case series, Acupuncture Med. 2008 Sep; 26(3):140-4.
Keller, Glenda. The Effects of Massage Therapy after Decompression and Fusion Surgery of the Lumbar Spine: a Case Study. Int J Ther Massage Bodywork. 2012; 5(4): 3-8.
