PT Tip of the Month

Lumbar Spinal Stenosis (LSS)

What is lumbar spinal stenosis?

Lumbar spinal stenosis (LSS) is a condition where there is narrowing of an area(s) in the spine usually due to bony changes to the lumbar facet joints or enlargement of one of the ligaments in the spine called the Ligamentum flavum. Other causes can be due to a disc herniation or spinal instability. The two most common areas to find stenotic changes are in the neck and low back. These narrowed areas can put pressure on the spinal cord that is housed there, and as a result, the spinal nerves can become compressed. Depending on which spinal nerves are compressed, LSS can result in pain, numbness, weakness, loss of coordination, or decreased sensation among your extremities, neck, back, or shoulders. Others experience cramping in the legs after standing or walking for long periods of time, and experience more relief with bending forward at the hips and low back or sitting down. These positions create space in the low back, taking pressure off of the area that is affected. More severe symptoms include changes in bowel and bladder function. If these last two symptoms are present, it is important to see a doctor right away!

Many people who show evidence of LSS on X-rays are asymptomatic. However, once symptoms of LSS begin, they progress and worsen over time. Typically, the preferred imaging test for diagnosing LSS is an MRI, which can detect changes to the vertebral discs and show any changes or pressure areas on the spinal cord due to narrowed areas in the spinal canal. Imaging is helpful to rule out other sources of back pain or hip pain.

Risk factors

People over the age of 50 are at higher risk for LSS due to age-related degenerative changes. Another risk factor is a congenital defect where the spinal canal is smaller than normal. This means there is less room for the spinal cord, and these people are at increased risk for LSS.

Anatomy

The spinal cord is a long, thin bundle of nervous tissue that extends from the brain to the low back and is housed in the area through the vertebraes in your spine called the spinal canal. The brain and spinal cord together are referred to as the central nervous system. If there are bony or ligamentous changes at a section of the spine, these can put pressure at that level of the spinal cord, leading to the signs and symptoms of LSS stated above.

At each level of the spinal cord, there are a pair of spinal nerves that exit from the each side of the cord. Different spinal nerves allow a person to feel sensation in different areas of their body and move certain muscles. Thus, depending on what spinal nerve is compressed in a person with LSS will affect which areas experience sensory or motor changes.

Treatment

Research has indicated that people with LSS should be treated with conservative management such as physical therapy prior to considering more drastic options like surgery. Statistics report that just over a decade ago, LSS was the most common diagnosis associated with spinal surgery in patients over 65 years old, with a total annual inpatient expense of about 1 billion dollars for more than 30,000 surgeries performed. Current research on LSS indicates that about one half to two thirds of patients treated with conservative management improved or did not decline in function.

A recent study by Whitman et al. (2006) concluded that patients with LSS can benefit from physical therapy interventions which included: lumbar flexion exercises, participation in a progressive treadmill walking program, and subtherapeutic ultrasound. Other patients also experienced relief with manual therapy consisting of joint mobilizations to the spine and pelvic region and stretching, as well as specific strengthening exercises and exercises to enhance coordination and improve mobility.

If you feel that you are experiencing early signs or symptoms of lumbar spinal stenosis, and you would like to schedule an evaluation, call 617-232-PAIN for our Brookline office, and 617-325-PAIN for our West Roxbury office. If you are experiencing changes in bowel and bladder function, obtain medical assistance immediately.

References

  1. Whitman JM, Flynn TW, Childs JD et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis. Spine. 2006;31(22):2541-49.

For previous PT Tips of the Month, visit the archive.

33 Pond Avenue, Suite 107B Brookline, MA 02445 Tel: (617) 232-PAIN (7246) Fax: (617) 232-5196
1208B VFW Parkway, Suite 202 West Roxbury, MA 02132 Tel: (617) 325-PAIN (7246) Fax: (617) 325-7282