The Therapist is in...Spotlight on Stenosis: Q&A

The Therapist is in...
Spotlight on Stenosis: Q&A
by Shannon Murphy, MPT

What is stenosis? Is it the same thing as arthritis?
The term stenosis (sten-OH-sis) is derived from Greek and Latin words meaning, "narrow". In the case of spinal stenosis, the narrowing occurs around areas around the spinal cord and nerve roots. Frequently, this happens as arthritis and osteoporosis cause the spine to break down. As a result, the nerves get pinched more easily - which can cause pain in the back and legs (or neck and arms).
How can I tell the difference between stenosis and other problems like discs and 'sciatica'?
Stenosis is often present alongside other problems, particularly bulging and degenerated discs. Imaging studies, like x-rays and MRIs, can help show the specific type of damage at different spinal levels. That said, it is hard to say from pictures alone how "much" a condition should hurt someone - people are very different from one another. An office exam is very important and the information you tell a doctor or therapist provides a lot of clues.
Stenosis, for example, tends to bother people most with prolonged standing or walking, often leading to the legs hurting or becoming very tired, and gets better with sitting. Disc problems and sciatic pain, on the other hand, are often a bit better with upright movement. This is why it is important to take good mental notes of your condition and become a good "historian" at medical visits.
How is stenosis treated?
A variety of options area available, including physical therapy, pain management, 'alternative therapies' and surgery. The severity of your pain and function determines "where" you might start in these lists of options - they are not mutually exclusive. Weakness, balance problems, and problems controlling bowel/bladder functions can indicate serious nerve damage that requires surgery to prevent permanent injury.
In non-emergency cases, other efforts can make the symptoms less intense. Physical therapy focuses on making the body work better, while pain management can coordinate things like injections and medication. Adjunctive measures like acupuncture and (careful) chiropractic care can have positive effects, as well. A multi-disciplinary approach generally works better than any one effort alone.
Is flexibility important?
Very. The majority of patients who seek treatment for stenosis are extremely stiff in muscles that promote spinal extension and joint compression- specifically back extensors, hip flexors and calves. This makes it difficult to "escape" the pain. The reason that stenosis feels worse with standing and walking is because the spine is more extended...which is a more naturally "closed" position for the nerve openings to begin with. When you add muscle stiffness and postural imbalance to that situation, it adds fuel to the fire.
Physical therapists perform specific techniques to address those stiff areas, unload the spine and teach patients how to manage their symptoms with exercises, posture, and devices. Weight management is essential (beer bellies make stenosis much worse) and water-based exercise is a helpful medium for many.
As with any condition, a pro-active approach can prevent a large degree of suffering and prevention through healthy lifestyle is worth its weight in gold.... Just one more reason to keep those New Year Resolutions on your "do" list!

This series of columns are by Shannon Murphy, MPT, Owner/Director of BodySense PT. 9 Saint Paul St, 3rd Floor, Boonsboro, MD 21713. 301-432-8585 phone, 301-432-1987 fax,