Spinal Stenosis Pain Management

What is Spinal Stenosis?

One in every two hundred people over sixty have spinal stenosis, causing pain and limiting their quality of life. If you're dealing with spinal stenosis, you may have explored various treatment options, from medications to surgery. This post dives into the intersection of chiropractic treatment and spinal stenosis. We'll explore how chiropractic adjustments can alleviate symptoms, enhance mobility, and improve the overall quality of life for individuals with this often debilitating condition.

Your spine, or backbone, is a series of 24 bones called vertebrae that support the body. These vertebrae also house the spinal cord in a channel called the spinal canal. Openings down either side of the spine allow the spinal nerves to exit the spinal canal. These openings are called intervertebral foramen or IVF.

Spinal stenosis is a condition where the IVF’s narrow, putting pressure on the spinal nerve roots. The narrowing of these spaces causes irritation and inflammation to the nerves. If left untreated, the pain and symptoms only get worse over time, and nerves can become scarred and suffer loss of function.

Symptoms of Lumbar Stenosis

Understanding the symptoms of lumbar stenosis is crucial for identifying and managing this condition effectively. Symptoms can vary based on the location and severity of the stenosis, often impacting daily activities. Here are the common symptoms specifically associated with lumbar stenosis:

• Back Pain: A prevalent symptom that ranges from mild discomfort to severe, sharp pain. It may be localized to the lower back or radiate through the hips and legs, often worsening with prolonged standing or certain activities.

• Weakness in a Foot or Leg: This can result from nerve compression, affecting your ability to stand or walk. Muscle weakness can impair balance and coordination, making movement challenging.

• Cramping in One or Both Legs: Often occurring after standing for a prolonged period, this symptom may ease when sitting down.

• Pain in One or Both Legs: Pain experienced while standing that diminishes upon sitting is a common sign, indicating nerve involvement due to spinal stenosis.

• Difficulty Walking: Individuals may experience leg fatigue or heaviness, limiting their ability to walk long distances without discomfort. This is due to nerve compression affecting the legs.

Detailed Symptom Analysis

What symptoms you experience, and their severity depends on where they are located and how severely the space in the intervertebral foramen has narrowed. The symptoms may come on gradually over time or may have a sudden onset. Symptoms may worsen with specific activities such as running or lifting heavy objects. Symptoms may include:

Pain

The most common places for spinal stenosis are in the cervical spine (neck and shoulders portion of the spine) and the lumbar spine (lower back). The symptoms range from mild to severe. It may start as a dull and localized discomfort between the shoulders or just in the lower back. For some, the pain is an intense, sharp, electrical pain that shoots through the hips and legs or into the arms. Pain may worsen with certain activities or improve with others.

Loss of Sensation or Tingling

In rare cases, patients do not experience any pain with spinal stenosis. Instead, they may have numbness and tingling in the affected areas. Numbness and tingling can accompany pain and most commonly affects the site around the stenosis and the limbs. Moreover, patients may experience difficulty walking long distances without feeling leg fatigue or heaviness due to nerve compression from spinal stenosis.

Weakness

Your bones help give the body structure, but what keeps you standing and allows you to move are your muscles. To maintain balance and coordination, your brain has to be able to send and receive messages from those muscles. When the nerves are damaged or not functioning correctly, it prevents the brain from receiving this information. This results in muscle weakness and difficulty with movement or bearing weight. A series of nerve roots in the spine also control bladder and bowel functions. Compression of these nerve roots can result in urinary or bowel incontinence.

By understanding and recognizing these symptoms, individuals can seek appropriate medical attention and management strategies to improve their quality of life.

Symptoms of Cervical Stenosis

What symptoms you experience, and their severity depends on where they are located and how severely the space in the intervertebral foramen has narrowed. The symptoms may come on gradually over time or may have a sudden onset. Symptoms may worsen with specific activities such as running or lifting heavy objects. 

For cervical stenosis, common symptoms include:

• Neck Pain: Persistent discomfort in the neck, often spreading to the shoulders.
• Tingling or Numbness: Sensations or lack thereof in the arms, legs, feet, and/or hands.
• Balance Problems: Difficulty maintaining stability, leading to an increased risk of falls.
• Problems Walking: Challenges with mobility, potentially leading to a shuffling gait.
• Urinary Urgency or Incontinence: An increased need to urinate or loss of bladder control.

Pain

The most common places for spinal stenosis are in the cervical spine (neck and shoulders portion of the spine) and the lumbar spine (lower back). The symptoms range from mild to severe. It may start as a dull and localized discomfort between the shoulders or just in the lower back. For some, the pain is an intense, sharp, electrical pain that shoots through the hips and legs or into the arms. Pain may worsen with certain activities or improve with others.

Loss of Sensation or Tingling

In rare cases, patients do not experience any pain with spinal stenosis. Instead, they may have numbness and tingling in the affected areas. Numbness and tingling can accompany pain and most commonly affects the site around the stenosis and the limbs. Moreover, patients may experience difficulty walking long distances without feeling leg fatigue or heaviness due to nerve compression from spinal stenosis.

Weakness

Your bones help give the body structure, but what keeps you standing and allows you to move are your muscles. To maintain balance and coordination, your brain has to be able to send and receive messages from those muscles. When the nerves are damaged or not functioning correctly, it prevents the brain from receiving this information. This results in muscle weakness and difficulty with movement or bearing weight. A series of nerve roots in the spine also control bladder and bowel functions. Compression of these nerve roots can result in urinary or bowel incontinence.

What Causes Spinal Stenosis?

Degenerative conditions most typically cause spinal stenosis. These include:

Vertebral Subluxations

Subluxation is a medical diagnosis (recognized by insurance companies) used to identify abnormal biomechanics and neuroarticular dysfunction in the joint space. It can happen in any joint in the body. The word subluxation is derived from the Latin words meaning somewhat or slightly (sub) and to dislocate (luxate). When this happens in the spine, the misaligned vertebrae create pressure and irritation on the spinal nerves, eventually leading to pain. Subluxations also impact ligaments, surrounding musculature, and spinal discs. As time passes and the uncorrected subluxation settles, the damage to the nerve and degenerative changes in the disc get progressively worse, and different stages of subluxation degeneration set in.

Spinal or Neurogenic Claudication

Spinal or neurogenic claudication is not due to lack of blood supply, but rather it is caused by nerve root compression or stenosis of the spinal canal, usually from a degenerative spine, most often at the "L4-L5" or "L5-S1" level. This may result from many factors, including bulging disc, herniated disc or fragments from previously herniated discs (post-operative), scar tissue from previous surgeries, osteophytes (bone spurs that jut out from the edge of a vertebra into the foramen, the opening through which the nerve root passes). In most cases neurogenic claudication is bilateral, i.e. Symmetrical.

Osteoarthritis

Osteoarthritis affects the cartilage in the spine, causing the formation of osteophytes (bone spurs). These bone spurs can also put pressure on the spinal nerve roots.

Degenerative Disc Disease

There is a disc between each of the vertebrae in the spine. A healthy, well-hydrated disc will contain a great deal of water in its center, known as the nucleus pulposus, which provides cushioning and flexibility for the spine. Much of the mechanical stress that is caused by everyday movements is transferred to the discs within the spine and the water content within them allows them to effectively absorb the shock. At birth, a typical human nucleus pulposus will contain about 80% water. However natural daily stresses and minor injuries can cause these discs to gradually lose water as the annulus fibrosus, or the tough outer fibrous material of a disc, weakens. Because degenerative disc disease is largely due to natural daily stresses, the American Academy of Orthopaedic Manual Physical Therapists have suggested it is not truly a "disease" process.

This water loss makes the discs more flexible and results in the gradual collapse and narrowing of the gap in the spinal column. As the space between vertebrae gets smaller, extra pressure can be placed on the discs causing tiny cracks or tears to appear in the annulus. If enough pressure is exerted, it is possible for the nucleus pulposus material to seep out through the tears in the annulus and can cause what is known as a herniated disc.

As the two vertebrae above and below the affected disc begin to collapse upon each other, the facet joints at the back of the spine are forced to shift which can affect their function.

Additionally, the body can react to the closing gap between vertebrae by creating bone spurs around the disc space in an attempt to stop excess motion. This can cause issues if the bone spurs start to grow into the spinal canal and put pressure on the spinal cord and surrounding nerve roots as it can cause pain and affect nerve function.

As the discs between vertebrae become dehydrated or break down, the spaces between bones become smaller, putting pressure on nerves as they exit the spine. Degenerative disc disease also contributes to bulging discs that can compress the nerve roots or spinal cord.

Ligament Thickening or Buckling

With some conditions, ligaments that surround the spine (ligamentum flava) can thicken or harden into bone. When these ligaments harden or thicken, they can compress the spinal cord and nerve roots.

In addition to these degenerative factors, spinal stenosis can also arise from other causes:

Congenital Factors

Some individuals are born with a smaller than average spinal canal, which can predispose them to stenosis.

Trauma and Injury

Spinal stenosis may develop following traumatic incidents, such as:

• Car Accidents
• Skiing Injuries
• Sporting Accidents

Such events can lead to spinal fractures that displace the spine and damage the canal. Moreover, surgery-related tissue swelling can exert pressure on the spinal cord.

Growths and Bone Overgrowth

Growths within the spinal column, whether benign or cancerous, can contribute to this condition, though they are less common. Bone overgrowth due to osteoarthritis or conditions like Paget's disease can also narrow the spinal canal.

Conventional Treatment Approaches

When it comes to managing spinal stenosis, conventional medical approaches often include medication, physical therapy, and, in severe cases, surgery. Medications may be prescribed to help relieve pain and reduce inflammation. While they can offer temporary relief, they often come with side effects and do not address the root cause of the problem.

Physical therapy and exercises are commonly recommended to improve flexibility, strengthen the supporting muscles, and enhance overall mobility. However, progress may be gradual, and some individuals may find it challenging to perform specific exercises without exacerbating their symptoms. In more severe cases, when conservative treatments fail to provide relief, surgery may be considered. Surgical interventions aim to decompress the affected area and create more nerve space. However, surgery comes with risks and is typically seen as a last resort.

The Role of Chiropractic Care in Spinal Stenosis Management

Chiropractic plays a crucial role in improving spinal health by addressing the underlying causes of spinal stenosis. When a person experiences spinal stenosis symptoms such as pain, numbness, or weakness in their arms or legs due to nerve compression caused by misalignments (subluxations) or degenerative changes in the spine, chiropractors can address these issues through gentle manipulation techniques and non-invasive methods. This approach not only alleviates immediate symptoms but also contributes to long-term improvements in spinal health for individuals dealing with spinal stenosis without invasive procedures such as surgery or reliance on pharmaceuticals.

Chiropractic adjustments alleviate pain, improve mobility, and enhance the body's healing ability by restoring proper spinal alignment and articular function. During these adjustments, chiropractors use a controlled and precise force to realign vertebrae and reduce nerve impingement caused by vertebral subluxations.

Chiropractic adjustments can also increase the height of the disc that has lost height with age by restoring normal motion to the joint, allowing the disc to come back to life and resorb the lost fluid due to that lack of motion. This makes chiropractic care a perfect match for spinal stenosis.

How Effective is Chiropractic Treatment for Spinal Stenosis, and How Quickly Can Patients Expect to See Improvement?

Chiropractic treatment has shown to be a highly effective alternative for individuals suffering from spinal stenosis. Research indicates that many patients experience significant relief from symptoms such as pain, numbness, and reduced mobility.

Effectiveness:

• High Efficacy: Studies published in journals such as The Spine Journal have demonstrated that chiropractic adjustments can alleviate symptoms in a majority of cases.
• Safety: Chiropractic care is a non-invasive treatment option, making it a safer alternative to surgical interventions.

Timeline for Improvement:

• Initial Relief: Most patients report noticeable improvement in their symptoms within the first several weeks of treatment.
• Long-Term Benefits: Consistent chiropractic care over a few months can lead to substantial and lasting relief.

By focusing on spinal adjustments and physical therapy, chiropractic treatment can provide a viable path to managing spinal stenosis without the need for surgery.

Effective Lifestyle Changes and Prevention Strategies for Managing Spinal Stenosis

Living with spinal stenosis requires adopting several lifestyle changes and preventive strategies to effectively manage symptoms and improve quality of life. Here’s what you can do:

Engage in Regular Physical Activity: Focus on exercises that enhance back support. Opt for low-impact activities that lessen the strain on your spine. Ideal exercises include:

• Walking on flat surfaces

• Stationary biking

• Aquatic exercises

• Light resistance training

Your chiropractor might advise avoiding activities such as walking uphill or traditional bicycling, as these could exacerbate your condition. Instead, maintaining physical activity through gentler options can help prevent further deterioration of the muscles supporting your spine.

Improve Your Posture: Proper body alignment can reduce pressure on your spine and alleviate pain. Practice techniques that enhance your sitting, standing, and walking postures.

Choose the Right Mattress: Invest in a mattress that supports the natural curves of your spine. Look for one that offers a combination of comfort and support.

Safe Handling and Lifting Techniques: Learn and apply safe methods to lift and handle heavy objects. Avoid bending from the waist. Instead, bend and lift from the knees.

Weight Management: Keeping your body within a healthy weight range is crucial. Excess weight can increase the burden on your spine, exacerbating pain and discomfort.

By incorporating these strategies into your daily routines, you can help manage and potentially alleviate the symptoms of spinal stenosis. Regular consultations with healthcare providers are also essential to monitor your condition and adjust your strategies as needed.

Summary

Spinal stenosis is a condition that involves unresolved nerve compression that leads to pain, which gets worse with time. Many factors, including vertebral subluxations, osteoarthritis, and herniated discs, cause spinal stenosis. The go-to solution for spinal stenosis is typically a very intrusive surgery. Before considering surgery for spinal stenosis, it's crucial to explore non-invasive options such as chiropractic care. Chiropractic can often relieve symptoms without the potential risks and recovery time associated with surgical intervention.

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