A Guide to Physical Therapy for Spinal Stenosis
If you are one of the millions of Americans who suffer from spinal stenosis, you may be wondering if physical therapy is the right treatment for you.
In this guide, we will discuss what spinal stenosis is, its causes and symptoms, and how physical therapy can help manage your symptoms.
Lumbar spinal stenosis is the most significant cause of back surgery in the people over 65. It is also a major contributor to disability in this population.1
- Understanding Spinal Stenosis
- Symptoms of Spinal Stenosis
- Causes of Spinal Stenosis
- Diagnosing Spinal Stenosis
- What to Expect: Physical Therapy for Spinal Stenosis
- Do I Need Surgery for Spinal Stenosis?
- Preventing Spinal Stenosis
- Effectively Managing Spinal Stenosis with Physical Therapy
Spinal stenosis is a condition that occurs when the spinal canal (made by the vertebrae) starts to narrow. This narrowing puts pressure on the spinal cord, known as central stenosis, and/or nerves, known as lateral stenosis. The extra pressure can lead to the neural symptoms, as we will discuss in the symptoms section below.
It's important to note that narrowing of the spinal openings is a normal part of aging, and is present in a large percentage of the population over 60 years of age. Thus, spinal stenosis is only a concern — and is diagnosed as such — when narrowing and symptoms are present.
Spinal stenosis is most prevalent in the lower back (lumbar spine). It is also common in the neck (cervical spine) which is a bigger concern due to the effects it can have on the spinal cord and basic bodily functions.
The symptoms of spinal stenosis can vary depending on the location of the narrowing and how much it is affecting the spinal cord or nerves. In general, symptoms may include:
- Pain, numbness, or weakness in the arms, legs, or back
- Difficulty walking or standing for long periods of time
- Reduction of symptoms with sitting, resting and forward bending
- Loss of balance or coordination
- Problems with bladder or bowel control
When the neck is involved, you can expect symptoms to be more localized to the upper body; while lower back involvement will result in more symptoms affecting the legs.
If you notice a sudden onset or change in symptoms, particularly loss of bowel or bladder control, bladder retention, inability to urinate, or saddle anesthesia, seek medical attention immediately to rule out cauda equina syndrome (CES) and other serious neural injuries.
The most common cause of spinal stenosis is the aging process (beyond what is considered normal). As we age, there are changes in tissue extensibility and quality that can lead to a narrowing of the spinal canal from changes like bone health, disc height, and ligamentous structure. Other causes include:
- Spondylolisthesis: When one vertebra slips forward on another, causing the spinal canal to narrow.
- Osteoarthritis: The deterioration of cartilage that leads to bone-on-bone contact can also cause the spinal canal to narrow.
- Herniated Disc: When the inner disc material (nucleus pulposus) leaks out through a tear in the outer layer (annulus fibrosis), it can compress the spinal cord or nerves.
- Tumors: Both benign and cancerous tumors can cause the spinal canal to narrow.
- Infection: Infection of the spine can also lead to spinal stenosis secondary to inflammation.
- Inflammatory disease: Including rheumatological diseases like ankylosing spondylitis and RA, that compromise joint integrity.
- Congenital causes: Some people are born with a small spinal canal, which can lead to problems later in life.
- Ligamentous changes: Thickening of the ligaments or ossification of the posterior longitudinal ligament (the main ligament in the front of the spinal canal) can cause stenosis.
- Trauma: A traumatic event — like a car accident or fall — can cause changes that lead to stenosis.
Spinal stenosis rarely leads to severe neurological symptoms.2 Thus, conservative treatment will always be the first line of defense in managing symptoms. A CityPT therapist can help diagnose your functional deficits and work with you to create a comprehensive program to manage your symptoms quickly and effectively.
If you are experiencing symptoms that may be caused by spinal stenosis, your physical therapist will likely talk to your physician about ordering imaging tests to confirm the diagnosis and rule out other spine-related diagnoses. These imaging tests may include:
- X-ray: To look for changes in the bones, such as arthritis or spondylolisthesis.
- MRI: To look for changes in the soft tissues, such as herniated discs or tumors.
- CT scan: To get a more detailed look at the bones and soft tissues.
- Myelogram: An X-ray of the spinal cord after a dye is injected into the space around it. This can help to show if the spinal cord is being compressed.
- Your doctor may also order a nerve conduction study or electromyography (EMG) to check for nerve damage.
The goal of physical therapy for spinal stenosis is to reduce pain and improve function to help you get back to all the activities you love. Your physical therapist will work with you to:
- Reduce pain
- Improve flexibility
- Strengthen the muscles around the spine
- Improve balance and coordination
- Improve your ability to walk
- Educate you on how to manage your symptoms
Specific treatment options will include:
- Hands-on therapy: Joint mobilization, massage, and other hands-on techniques to temporarily reduce pain and improve range of motion
- Neuromuscular and stabilization exercise: Specific exercises to improve spine flexibility, core strength, and coordinated movement.
- Modalities: Heat, cold, electrical stimulation, and other physical modalities to reduce pain and help with tolerance for initial exercise.
- Education: Learning about your condition and how to manage your symptoms long-term.
- Biomechanical and ergonomic training: Learning how to move and position your body to reduce pain, maximize tissue health, and prevent further injury.
Except for a medical emergency like cauda equina, spine surgery for cervical or lumbar spinal stenosis is considered elective. This is because the goal of surgery is to improve overall function rather than prevent neurological impairment.2
If you make an informed decision to have surgery, working with a CityPT physical therapist prior to surgery and after will maximize your outcomes.3
There is no guaranteed way to prevent spinal stenosis, but there are some things you can do to optimize your spine health:
- Maintain a healthy weight: Excess weight can put extra strain on the spine.
- Exercise regularly: This will help to maintain a healthy weight, keep your spine flexible, and keep the muscles around the spine strong.
- Quit smoking: Smoking increases your risk of developing inflammatory diseases, like rheumatoid arthritis (RA), and compromises tissue health.
- Manage medical conditions: Conditions like diabetes, high blood pressure, and high cholesterol can all lead to changes in the spine tissue health.
- Make healthy lifestyle choices: Eating a healthy diet, getting enough sleep, and managing stress can all help to reduce your risk of developing stenosis.
If you are at risk for developing stenosis or have already been diagnosed, working with a CityPT physical therapist can help to prevent the condition from progressing and significantly improve your quality of life. You don't have to suffer through or write off your symptoms to "old age."
Book an appointment today to experience what's possible with modern physical therapy.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Raja A, Hoang S, Patel P, et al. Spinal Stenosis. [Updated 2022 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441989/ ↩
Physiopedia. Lumbar Spinal Stenosis. Physiopedia.com. Accessed September 12, 2022. https://www.physio-pedia.com/Lumbar_Spinal_Stenosis ↩ ↩2
McGregor AH, Probyn K, Cro S, Doré CJ, Burton AK, Balagué F, Pincus T, Fairbank J. Rehabilitation following surgery for lumbar spinal stenosis: a Cochrane review. Spine. 2014 Jun 1;39(13):1044-54. ↩