Spinal stenosis describes a narrowing of the spaces within the spinal canal, which can put pressure on the spinal cord and the nerves that branch out from it. Non-surgical treatments are a primary approach for managing spinal stenosis symptoms. This article explores various non-surgical methods.
Understanding Spinal Stenosis
Spinal stenosis involves the constriction of the spinal canal, the protective tunnel housing the spinal cord and nerve roots. This narrowing occurs due to age-related wear and tear on the spine, such as osteoarthritis, which can lead to the formation of bone spurs. Degenerative changes in intervertebral discs and the thickening of ligaments within the spine also contribute to this compression.
When the spinal canal narrows, it can compress the spinal cord or nerve roots, causing symptoms. These include pain, numbness, tingling, or weakness in the affected areas, such as the back, neck, arms, or legs. People with lumbar (lower back) spinal stenosis experience pain that worsens with prolonged standing or walking and may find relief by sitting or leaning forward, a phenomenon sometimes called the “shopping cart sign.”
Physical Therapy and Targeted Exercises
Physical therapy (PT) plays a role in managing spinal stenosis by enhancing strength, flexibility, and posture. A physical therapist can design a program that includes exercises to improve spinal function and alleviate pressure on spinal nerves. This aims to reduce pain, improve mobility, and support daily activities.
Core strengthening exercises are incorporated to support the spine and improve alignment. Examples include the cat-cow stretch, performed on hands and knees by arching and rounding the back, and planks, which build abdominal and back strength while promoting stability. These exercises help create a more resilient spine by strengthening the muscles that support it.
Flexibility exercises, particularly lumbar flexion movements, are beneficial as they can temporarily increase space within the spinal canal. The knees-to-chest stretch, lying on the back and pulling knees to chest, is an example that can decompress spinal nerve roots. Seated lumbar stretches, bending forward while seated, can offer relief by opening up the narrowed canal.
Postural training is another component of physical therapy, teaching individuals how to sit, stand, and move in ways that minimize pressure on the spinal nerves. Learning to maintain proper spinal alignment can reduce strain and help manage symptoms throughout the day. Consistent practice of these targeted exercises can lead to sustained improvements in pain and mobility.
Medications and Procedural Injections
Medications are used to manage the pain and inflammation associated with spinal stenosis. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are a primary treatment to reduce both pain and inflammation. For more severe discomfort, prescription-strength NSAIDs may be recommended.
Muscle relaxants, like cyclobenzaprine, can be prescribed to alleviate muscle spasms that accompany spinal stenosis for additional pain relief. Neuropathic pain medications, such as gabapentin or pregabalin, are used to target nerve-related pain by stabilizing overactive neurons. Oral corticosteroids, like prednisone, can be prescribed for short-term use to reduce inflammation and nerve irritation.
Beyond oral medications, procedural injections offer targeted pain relief. Epidural steroid injections involve injecting a combination of corticosteroids and a local anesthetic directly into the epidural space around the spinal nerves. This procedure aims to reduce inflammation and swelling of irritated nerve roots, reducing pain.
During an epidural steroid injection, a local anesthetic is applied to numb the skin, and the needle is guided into the epidural space with the aid of live video X-rays for precision. While immediate pain relief may be felt due to the anesthetic, the steroid takes effect within 24 to 72 hours, with peak benefits around two weeks. The duration of pain relief can vary, lasting from weeks to several months, but these injections are used to provide temporary relief to allow participation in physical therapy.
Lifestyle Adjustments and Complementary Approaches
Adopting certain lifestyle adjustments can support the management of spinal stenosis symptoms. Maintaining a healthy weight is beneficial as excess body weight can increase pressure on the spinal structures, worsening symptoms. Regular low-impact exercises, such as swimming or walking, help to strengthen spinal support muscles and promote spinal health without stress.
Ergonomic adjustments in daily environments, such as using chairs with proper lumbar support or adjustable workstations, can help maintain spinal alignment and reduce strain. Avoiding prolonged periods of standing or walking can lessen discomfort, as these activities exacerbate symptoms in lumbar spinal stenosis. Utilizing assistive devices like canes or walkers can provide additional support and help individuals maintain a forward-bent posture, which can relieve pressure on the nerves while walking.
Complementary therapies can serve as adjuncts to primary treatments. Acupuncture, an ancient practice involving the insertion of thin needles into specific body points, stimulates the release of natural pain-relieving chemicals and reduces inflammation. Individuals may report reduced pain and improved function with acupuncture for spinal stenosis.
Chiropractic care focuses on spinal adjustments and manipulations to improve alignment and relieve nerve pressure. It can offer temporary relief, but it is important to seek care from a licensed practitioner. Massage therapy can help relax tense muscles, reduce discomfort, and improve circulation in the affected areas, contributing to overall pain relief and stress reduction.