Lumbar Stenosis
Lumbar Stenosis is a narrowing of the holes in the spine called foramen. This can occur at any combination of the foramen from the central to lateral or both. Lumbar stenosis can be either primary or secondary. Primary stenosis comes from birth or developmental abnormalities whereas secondary or acquired comes from degenerative changes, trauma, infection or surgery. Degenerative changes come from long term stress causing discs to thin, ligament hypertrophy, facet hypertrophy or any combination.
Approximately 3-14% of the population with back pain have stenosis. (1) However, to date there is no known association between an MRI finding of stenosis and the severity of a patient’s pain. (2)
Spinal stenosis presents with long term low back pain that is typically on both sides that usually has some sensation or pain traveling into the legs. This pain is often made better with sitting and worse with any form of prolonged standing or walking.
Goals for conservative care include restoring mobility and function, decompressing neural structures and releasing perineural adhesion. (3) Rehabilitation programs often include manual therapy, stretching, endurance strengthening exercises, and manipulation. (4,5)
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Spinal Stenosis. Accessed 9/28/13 from: www.spinalstenosis.org.
Burgstaller JM, Schüffler PJ, Buhmann JM, Andreisek G, Winklhofer S, Del Grande F, Mattle M, Brunner F, Karakoumis G, Steurer J, Held U. Is there an association between pain and magnetic resonance imaging parameters in patients with lumbar spinal stenosis?. Spine. 2016 Sep 1;41(17):E1053- 62.
Murphy DR, Hurwitz EL, Gregory AA, Clary R. A non-surgical approach to the management of lumbar spinal stenosis: a prospective observational cohort study. BMC Musculoskeletal Disorders. 2006 Dec;7(1):16
Whitman JM, Flynn TW, Fritz JM. Nonsurgical management of patients with lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy. Physical Medicine and Rehabilitation Clinics. 2003 Feb 1;14(1):77-101.
Minetama M, Kawakami M, Teraguchi M, Kagotani R, Mera Y, Sumiya T, Nakagawa M, Yamamoto Y, Matsuo S, Koike Y, Sakon N. Supervised physical therapy vs. home exercise for patients with lumbar spinal stenosis: a randomized controlled trial. The Spine Journal. 2019 Apr 12.