What is spinal stenosis?

The spinal cord, nerves and arteries are surrounded by the spine, which acts like a hard electrical casing to support and protect these vulnerable structures. The spine has a hollow column that allows the spinal cord to run from the brain all the way to the tail bone. At each spinal segment, a spinal nerve branches out to supply the muscles and skin of the body. There is also an intricate network of small veins and arteries that provide blood to the spinal cord and vertebrae, providing them with the nutrients they need.

Spinal stenosis is characterized by a narrowing of the spaces where the nerves travel out of the spinal canal. A variety of factors can cause spinal stenosis, however overwhelmingly it is caused by degenerative changes to the spine as we age. The narrowing of the canal causes pressure or compression of the nerves by the bones and usually the discs. Many people over the age of 60 will have spinal stenosis; however, not all will have pain. Clinically, spinal stenosis is used to describe the painful symptoms of this condition rather than just the narrowing itself.

What are the symptoms?

Pain with walking or standing that radiates into the hips, thighs and even feet is the hallmark of spinal stenosis. Usually, this pain will be reduced with rest and forward movements of the spine. Spinal stenosis is a progressive condition and symptoms will gradually increase over time.

The pain is often described as a deep radiating ache and can be associated with:

• fatigue,
• heaviness,
• weakness, and
• numbness.

It can affect just one leg, however more often will be felt in both legs.  There will often be associated back pain; however, leg pain is usually the most severe issue.

How can physiotherapy help?

There are many conditions that need to be excluded before a diagnosis can be made. Your physiotherapist is able to conduct a thorough examination and accurately diagnose this condition. In some cases with severe symptoms, imaging may be requested. As mentioned earlier, many people have stenotic spinal changes without symptoms. Surgery to decompress the restricted nerves and stabilize the spine are only used in very severe cases, with the majority of people responding well to conservative treatment. 

For mild to moderate cases of spinal stenosis, physiotherapy can be extremely beneficial.  Your physiotherapist can help you manage your pain through a combination of hands-on techniques and by providing a targeted exercise program.  Our major objective when assessing someone with the symptoms described above is to determine what movements aggravate the pain and what movements or positions ease the pain.  This can help us to determine what your direction preference is and then tailor exercises towards the direction that will reduce symptoms.  For example someone who gets sore when standing or reaching overhead but gets relief from sitting or touching their toes is going to have a preference for exercises that are in a flexion direction.