Lumbar Spinal Stenosis – Everything You Absolutely Need To Know

In this video, I’m going to share with you everything that you need to know about lumbar spinal stenosis. Specifically, I’ll be talking about the causes and symptoms of lumbar spinal stenosis, and make sure you watch the end of the video because then I’ll be talking about the treatments that are available for lumbar spinal stenosis.

My name is Dr. David Middaugh, and I’m a specialist physical therapist at El Paso manual physical therapy. And this channel is dedicated to helping people stay healthy, active, and mobile while avoiding unnecessary surgery, injections, and pain medications. Please consider subscribing to our channel so that you don’t miss out on any of the helpful videos that we post each and every week. So let’s get to it.

What is a lumbar spinal stenosis? So I’ve got my spine here just to give you some more information about this. And now what you need to know about spinal stenosis is there’s two types. The first is central stenosis, which is the more serious one. And what that means is the inside of the spinal canal.

So if you open up the spine here, there’s holes within there through which the nerves travel. And on the very inside deepest part of the spine here, that would be central stenosis, meaning it’s a central part of the spine and the nervous system. And so it’s your spinal cord that lives in there. When we’re talking about stenosis, we’re talking about a narrowing of a space. So central lumbar spinal stenosis means that you’re narrowing the space on the spinal cord inside of the spine.

That’s the more serious one. And the reason for that is because it’s the spinal cord, which controls a lot of the bodily functions, which I’ll talk more about here in a minute in the symptoms. Now the second type of lumbar stenosis is a lateral stenosis, meaning on the sides laterals on the sides. So what that means is on the outside side part of the spine here where this yellow thing is the hole where the nerve comes out, that’s where you’re getting the stenosis or the narrowing of the hole where this where the nerve root comes out. And you can get this at any level of the spine.

So if you hear your doctor talk about you having stenosis you do need to clarify is this central stenosis or lateral stenosis or possibly both? Now let’s answer the question. What are the symptoms of lumbar spinal stenosis, the number one symptom of lumbar spinal stenosis has got to be some sort of leg pain.

More often than not, I see clients here in the clinic that have a lumbar spinal stenosis diagnosis. And they really don’t have a ton of back pain, maybe some, maybe some that comes and goes nothing that necessarily bothers them immensely. But what is more bothersome is pain into the legs, usually both sides, especially with central stenosis, the first kind that I mentioned, but it can be just on one side, meaning it’s a lateral stenosis.

Usually, in addition to pain in the legs, you might also have numbness and tingling. And these symptoms can act a lot like sciatica symptoms, and it is possible to have both sciatica and stenosis happening at the same time because both problems share the same root cause this typically happens in people that are over 50 years old. I usually see people in their 60s with this problem every now and then we get somebody younger than their 60s. And when people are older than their 60s, when they’re into their 70s and 80s.

They’ve usually been managing it they’ve been dealing with it because they got it back in their 60s. For some reason I don’t typically see very many seven eight year old get it for the first time and not know that they had some version of stenosis in their spine. And let’s talk extreme symptoms. If you’re stenosis is really bad, especially if it’s central stenosis, because the spinal cord right here controls a lot of bodily functions like your bowel and bladder, meaning you’re pooping your P functions, you can have accidents.

Now if you are having accidents, and you think you have stenosis, have you never been seen by a doctor, it is a medical emergency, and you need to immediately get to a hospital, you need to get attention like right now. I mean, stop this video. And if you’re having leg weakness, and you can’t even stand and walk, call an ambulance and get to the hospital or get yourself to medical attention immediately. And you begin the process of getting X ray MRI to whatever imaging needs to be done to determine the next best step for you.

But the reason why it’s a medical emergency is because if that spinal cord stays pinched because of the narrowing for long enough then you can have some permanent damage, including even paralysis or loss of use of everything below that level of your spine. So that means you won’t be able to control your bowel and bladder at all or your legs you won’t have any feeling in there. It is potentially a serious thing. And there is serious treatments for this which I’ll get to in just a minute.

Now to back away from that extreme example, some less extreme symptoms, but still kind of extreme, our sexual dysfunction, and numbness and loss of sensation and feeling in control of your feet. Some people can experience a foot drop, which is a symptom of a stroke, which means that when you walk, you lose your ability to pick up your toes so that you don’t trip on the ground and kick the ground. And so there’s an increased amount of tripping in these people, the muscles that that move your toes up and down your ankle up and down, just like that don’t work anymore, so your foot stays kind of pointed down.

And when you go to take steps, you drag your toes. And this can be potentially dangerous for other reasons, obviously tripping and falling and causing different injuries. So next, let’s answer the question of What Causes lumbar spinal stenosis. Now lumbar spinal stenosis is kind of a combination of many things happening in the spine, it’s definitely related to osteoarthritis, because you have changes bony changes in the structure of the spine, meaning the bones actually change the discs in the spine change.

And those changes cause the narrowing some sort of obstruction going in towards the nerves. Some common findings on X rays and MRIs will be bone spurs that are pushing in on the nerve, disc herniations, that could be pushing on the nerve in arthritis, that severely progressed to where the joints have thickened quite a bit. And that thickening of the joints is now causing compression onto the nerves.

And as far as central or lateral stenosis, you know, what’s the cause of each one, it just depends which part of the body gets most compressed, the central part of the spine or the outside part of the spine. Another way to get stenosis is if you have one of the vertebrae, one of the bones here is starting to shift forward, which is called a spinallisthesis.

But when that shifts forward, because of the structure of the spine, the way the holes are lined up, if you just imagine a vertebrae like this, and with the spinal canal going right there, and then the other vertebrae above or below it, the holes have to line up in order for the nerve to pass through. But if one of those bones starts to shift forward, like so, then the whole relatively decreases in space, and you can start to pinch the nerve that way.

And that only does a whole string that way. But the way that the holes on the side, for the lateral part, the way they’re formed is there’s two openings on the vertebrae above, it opens like this, and the vertebrae below it opens like this. And so if you start getting the bone shifting, you can also shift the hole on the side of the spine, causing lateral stenosis there. Now, if you ask your doctor, your surgeon, how lumbar stenosis typically happens, the answer you’re usually going to get from the doctor is going to be oh, this comes on with age, and it just happens to affect some people worse than others.

Now, I disagree with this mostly. And the reason is, I think things do happen as we age, there are definitely changes. But you do have some control over this, you can limit the progression or stop it completely. If you’re doing the right things, it’s not just a matter of the older you get, the worse this is going to get no matter what you do. It’s my belief that the root problem is coming from spinal muscle imbalances.

And what I mean by that if just to put it really simply on your spine, here, you’ve got muscles that run up and down the back, those would be your back muscles, the ones that you typically think about whenever you’re extending backwards, and then the muscles that counteract that muscle that that are imbalanced or shouldn’t be imbalanced. With the back muscles here we call them para spinales.

In the medical field, the muscles that should be imbalanced with it would be the abdominal muscles. And there’s other muscles, I’m very much simplifying this, the spine is quite complex. But with the abdominal muscles when those get weaker, which often happens in our society in our culture, especially if you’re more sedentary, then the back muscles get stronger. So in order to get stability for this part of the body, because if you look at it, there’s just five bones here, you don’t have much else above here you have ribs, and a whole bunch of muscle attachments.

 And down here you have the big strong pelvis, the ring of bones down here and then you have hip joints out here. So there’s a lot of stability down here and a lot of stability up here, but relatively in the middle. You don’t have much bony stability, it’s got to come from muscles. So if you don’t have proper balance from all the muscles that support and stabilize the lumbar spine, the lower back as you do your daily activities as you move through life as you do any sort of exercise.

If you don’t have balance, then inevitably you’re going to put bad forces on the spine, which over time cause disc herniations joint arthritis a bony overgrowth like bone spurs and other problems like the vertebrae starting to slip. One of the most common problems that I See, as a physical therapist specializing in helping people avoid surgery and medications is that these back muscles get way too dominant, they get way too strong, they’re very hard, very thick, very thick for the individual.

If you’re a bodybuilder, then I would expect you to have very big back muscles along with strong abdominal muscles. But if you’re somebody in their 60s and 70s, who isn’t, wouldn’t call themselves a bodybuilder. Maybe you do some exercise here and there, but by no means are you lifting very heavy weights, then you should not have massive back muscles. So just to hint and preview at what the solution would be here is we got to get the weaker muscles stronger.

But there’s more on that in other videos here on our channel, go down to the links in the description below to see exercises that we posted here about lumbar stenosis. Now let’s answer the question how is a lumbar spinal stenosis diagnosed? Well, if you go to your doctor’s office for this problem, the first thing they’re going to do is X ray you and then get an idea for how high the discs are in your spine.

Discs don’t typically show up on the X ray the bones do, but they can judge the space between the bones as figuring out how high the discs are. So if the space between the bones is less relative to other areas of the spine, then you’ve probably got some disc height loss. degenerative changes can also show up in an x ray and bone spurs are usually visible in an x ray as well. And there’s other factors that can cause a lumbar stenosis, like ligament thickening, which comes from muscle imbalances that your ligaments help to connect your bones together. And if you’ve got too much tension or stress on a ligament it thickens in response to that stress.

Just like a muscle thickens when you stress it with exercise, ligaments are not visible in an x ray. So your doctor may choose for you to have an MRI to look at all those other soft tissues like the ligaments, the spinal cord as well, and other structures that could be compressing it on the spine, like the discs in other tests that your doctor might recommend.

Depending on how affected your legs are is an EMG study and electromyography study. This is a test done to see how well connected your nerves are to your muscles. Because if there’s a problem with that, then your doctor can begin to identify the extent of your stenosis problem to build the case. We’re for whether or not you need extreme intervention for your problem.

Which brings me to the next question how is lumbar stenosis treated? Well the first thing your doctor is probably going to do is recommend his pain medication, they may recommend low level pain medication like over the counter stuff. Depending on how severe your issue is. If it’s minor you know over the counter pain medication might be not enough to reduce some of the symptoms.

Prescription strength pain medication is another option that’s obviously stronger than over the counter medication. injections are done for this like cortisone injections epidural injections as well to get pain relief into in an effort to bring down inflammation as well. And your doctor could also recommend things like massage and using natural treatments like ice and heat for pain reduction.

But all of these things are only going to be temporary relief and extreme treatment that your doctor will probably offer is going to be surgery. Now let’s talk about surgery for just a minute because there’s different types of surgeries offered for spinal stenosis depending on what is compressing the nerves and which part of the body is involved as far as if it’s the central stenosis and the spinal cords involved.

Or if it’s the lateral stenosis, where the nerves the nerve roots is what they’re called the nerves that come out on the side if those are involved. Now if it’s a disc, if it’s determined that a disc is causing the stenosis that’s pushing on your nerve, then a surgery called the discectomy might be recommended a diskectomy is a disk obviously meaning disk and then ectomy means removal of and so they’re doing a disk removal surgery, they’re not removing your entire disk when they talk about this unless they literally tell you a replacing your disk which can happen.

But a typical diskectomy is they’re shaving off the edge of the disk that’s impinging on the nerve. Now you can have a bulging disc on the side right here that pushes on the nerve directly. And you can have a bulging disc right in the middle of this of the canal pushing directly backwards onto the spinal cord.

Obviously the central disc herniation is going to be a more involved treatments than the one on the on the outside that one that one is more accessible and now it’s typically done with what your doctor will call a non invasive surgery. And what they mean by that is you’re still going in and doing major surgery.

It’s just that the incision is tiny, and they even put a Band-Aid on it afterwards just to make it seem like it’s not that big of a deal but it’s still surgery on your spine. And the more intense surgeries that are done for this depending on what you need. You do a lot Anatomy. Now lamina means the back part of the spine right here the bone. And ectomy means removal. So they will actually go in and cut this chunk of your spine bone off and remove it depending on where the stenosis is.

And that’s done in an effort to decompress the spine in that area. And these surgeries are done all the time. And patients actually do pretty well. I’ve been impressed when I see these done. But it is kind of strange. And there’s got to be some side effects. In my opinion, whenever you remove a chunk of bone in the spine, what I think happens is people lose stability, because you lose a lot of ligament attachment points.

And that sets up another problem later on like a disc herniation if you don’t already have one. And then the big surgery that people talk about getting for this type of problem would be a spinal fusion surgery. And that’s when they’re installing hardware, rods and screws into your spine to fuse one vertebrae bone to the other vertebrae bone, and not allow any more motion there. And that that’s done in an effort to stabilize the bones. And to preserve the discs, sometimes we’ll do a disc implant as well, to make sure that the disc height doesn’t shrink, it stays the right height.

Now, this is typically done when you have that that spinal listhesis When the bone is shifting forward, so that it’s pulled back into position. And then it’s, it’s really screwed on essentially with rods and screws. So that isn’t going anywhere, this surgery does tend to have some good benefits. As far as pain relief, it is very invasive, they’re drilling hardware into your bones in your spine, and the right by your spinal cord and all that.

But you know, if your symptoms are severe enough, it may be warranted and may be the right thing to do. But when this is done, I just caution you on making sure you take great care of your spine health, leading up to the surgery, and especially afterwards, because what I typically see is people that have a spinal fusion surgery, it’s just a matter of time before a level above or below wherever the fusion was done, needs to be operated because that part becomes damaged. And going back to the root problem, that imbalance that I mentioned.

If that isn’t addressed, and you have surgery, you probably still have an imbalance and it’s only going to get worse after surgery if you aren’t directly affecting it. So doing proper exercise, it really is the cure really is the root problem that you need to address. And because of that thinking, I would think that a spinal surgery is not really a long term fix. It’s a short term fix.

It’s got longer lasting benefits, then, you know, pain medication or an injection, obviously, and it’s got definitely permanent effects as far as the structure of your spine. But if you don’t fix that root problem, it’s just a matter of time, before you’re imbalanced muscles start to compress different areas of your spine and cause another problem somewhere else. And your doctor might also recommend physical therapy, especially before going to the surgical route if there isn’t super severe symptoms that are visible on yourself and on any imaging.

Now physical therapy can be extremely beneficial. What I would just caution you on is choosing the right physical therapist for your stenosis problem. If you’re looking to avoid surgery, then you definitely want to find a physical therapy clinic and or physical therapist that specializes in avoiding surgery. And now physical therapists all don’t always tell patients this directly.

So you as a consumer as a patient will have to go in and ask the clinic or ask the therapist and just look around to you know, ask the clinic in this in the therapist if they specialize in helping people avoid surgery. Or if they tend to treat people that have just had surgery, a simple way to ask is what do patients typically come in for.

And if they tell you all a lot of them have had hip surgery, back surgery, knee surgery, shoulder surgery, then it’s probably not a clinic that specializes in helping people avoid surgery. Because by and large, most physical therapists help treat people who have just gotten out of surgery, and they’re recovering their motion back and they’re strengthening, getting back to walking. And that’s a different specialty than helping prevent getting into that situation.

So when you want to when you talk to a clinic or a physical therapist, you definitely want to ask these types of questions to try to get yourself in the right position. And the reason for this is because if you end up in a clinic that does specialize in helping people after surgery, then you’re probably going to end up doing a lot of similar exercises and movements that somebody who would have had surgery has done and that may not help you get the recovery that you need.

We see people come into our clinic all the time that have mistakenly gone into other clinics that and gotten treatment that wasn’t appropriate for them but the therapist is isn’t trained in that area so they wouldn’t know to do something different and they’ve gotten worse. And then people leave those clinics saying physical therapy didn’t work for me Doctor, let’s go ahead and do surgery. And that’s just if you’re just not there yet need to get to a clinic that does specialize in helping people avoid surgery.

So what I recommend looking for is a manual therapist, especially one that’s gone through advanced training and sort of has certifications in manual therapy, because then you can be more certain that you’re going to get the right help that you need for your lumbar stenosis problem. And if you’re looking for some exercises to start in your lumbar stenosis problem, drop down into the description below.

Hit that See More button if you’re on your mobile device and scroll down read the description there and you’ll find a video link for a lumbar stenosis exercise routine that you can begin to do every day to begin to help your problem.

Hey, thanks for watching. I hope this video was a benefit for you. Please give us a thumbs up and share it with somebody that you think needs to hear this. I’ll catch you in the next video friends bye