Have you been suffering with lower back pain over the last few years? It is a dull ache in your back? Are you thinking “it’s not that bad, I'll live with it”, Has that dull ache got worse and now you have pain running down your leg? Pins and needles and numbness running down your leg? Have you recently been told you have spinal stenosis and don’t know what it is and what to do with it? Read on because I'll tell you! Have you been suffering with neck pain over the last few years? It is a dull ache in your neck? Are you thinking “it’s not that bad, I'll live with it”, Has that dull ache got worse and now you have pain running down your arm? Pins and needles and numbness running down your arm? Have you recently been told you have spinal stenosis and don’t know what it is and what to do with it? Luckily if you read on I will educate you and help guide you through spinal stenosis and what you can do to help it.
What is spinal stenosis?
According to the Mayo clinic “ Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck. Some people with spinal stenosis may not have symptoms. Others may experience pain, tingling, numbness and muscle weakness. Symptoms can worsen over time.”
So now knowing what it is, let’s look at the anatomy of the spine. In the picture above, you can see the spine is made of bones called vertebrae, each vertebrae has a space at the back of it where the spinal cord can pass through. The spinal cord is protected by a piece of bone that extends out the back of the vertebrae called a spinous process. The spinous process is what you feel when you like on a hard surface. Spinal stenosis is when the space where the nerve passes freely narrows and this results in the nerve being irritated, see picture below. With clients I have seen with this condition, it starts with a dull ache and if left untreated it progresses to muscle weakness, tingling, numbness, pain down the arms and legs. It can get very serious very quick!
Why does spinal stenosis happen?
Two simple reasons:
2: You walk forwards not backwards.
Gravity: Gravity is something that your body has to deal with everyday, you have to fight to keep yourself upright against gravity. Think of someone you know with good posture. You think of them as someone who naturally has good posture, I think of them as someone who is good at dealing with gravity. Your body learned from a young age how to deal with it, when you were a child, you fell when trying to walk. It had nothing to do with bad balance, it was just you learning how to deal with gravity. As we get older certain muscles if untrained can decondition and we get worse at dealing with gravity and we start to go downhill. Why do you think people walk around like a hunchback and are facing towards the ground? Gravity is winning, it’s pushing them down and their body doesn’t have the strength in the right places to push against it. Why do you think kids have great posture but as we age we get stopped and start going forward and down, Gravity is winning.
You walk forwards not backwards: So as humans we walk forwards not backwards. I have never seen anyone walking backwards along Patrick street in Tullamore, why? our legs are designed to push us forward and that's why we walk forwards.
So let’s add the two together, you have to deal with gravity everyday and your walking forwards. What do you think happens if your body is struggling to deal with that gravity but still has to walk forward? Something has to push forward to try and keep you upright! something has to arch to keep you upright! Your spine starts to move forward and arch more at the two places it can, Your neck and lower back and that’s why the Mayo clinic wrote “Spinal stenosis occurs most often in the lower back and the neck”. In picture below, you can see a normal lumbar spine on the left with a small arch and then a lumbar spine that is forward and can’t deal with gravity on the right, has a large arch. Do you remember the nerve is at the back of the spine, do you remember the space at the back has been narrowed causing pain, numbness, tingling down your arms and legs. By looking at this picture C can you guess which way I would have to push the spine to narrow the space at the back further, narrow the space where the nerve comes out? You guessed it, push it forwards into more of an arch!
In picture below, you can see a condition called forward head posture, this is where the spine is pushed forward and in turn the head is pushed forward. This movement of the spine and head being pushed forward will cause an increased arch and narrow the space at the back of the neck, where the nerve is and cause a spinal stenosis. Pretty much the same thing happens in the lumbar spine and the neck! It’s common that I can have a client of mine with stenosis at the neck and lower back.
How do I help my spinal stenosis?
Easiest option: Physiotherapy and training
You have to teach the spine to move backwards. This is not easy to teach as none of you reading this made a conscious decision in allowing your body to lose it’s battle with gravity, let the spine move forward, narrow the space at the back of your vertebrae, cause your nerve to be irritated, have numbness, pins and needles and pain running down your arms and legs, to then only realise that you have spinal stenosis. This happens without us knowing, your body automatically adapts to a challenge of gravity and decides to take the easiest course possible, which is to push the spine forward. So the hardest course is teaching the spine to push back, and it’s not as simple as increasing your steps, going for a swim, following along a pilates or yoga class on youtube. It needs a lot of hands on coaching and cueing to teach you how to get control of your spine again and teach it to move back. It can be done and me and my team do it every week, as soon as we have someone pain free we train them on our reformer pilates bed to get their body back to full health.
To finish, if you have been diagnosed with a spinal stenosis, you need to take action now as it only gets worse. Don’t waste your time, don’t wait for it to get worse, you can help yourself with the right guidance. Remember you can “get back, get back to where you once belonged” the Beatles
As always I hope this helps,
Tommy Conway, Chartered Physiotherapist and Director at OneHealth