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1st Apr

2010

Back and Leg Pain in the Aging Population

This newsletter issue will be addressing a common condition affecting the low back, termed “spinal stenosis”, which refers to wear and tear changes causing narrowing of the central canal in the spine and compression of spinal nerve roots. If additionally the holes where the nerves exit the spine are narrowed, the term “foraminal stenosis” is used. Spinal stenosis typically affects people in their 50s and on, and becomes more prevalent with advancing age.

SYMPTOMS WITH SPINAL STENOSIS

Typical symptoms are stiffness or pain in the low back, buttocks or legs; numbness in the legs; or a cramping, tiredness or weakness feeling in the legs. Most commonly, these symptoms come on or increase with prolonged standing and walking, in particular if holding the trunk erect, or if having to arch the back, e.g. if reaching up to do overhead work.

This is because the spinal canal and exiting passages (foramina) narrow, and start to clamp down on the spinal nerves. There may also be pain stemming from the arthritic spinal joints (facet joints) and degenerated discs, adding to symptoms.

Symptoms are usually relieved by bending forward, leaning on counters, and by sitting down. Such postures open up the nerve passages, and therefore relieve compression on these nerves.

DEGENERATIVE CHANGES IN THE SPINE

With this condition, the spinal discs are degenerated and have lost height, the facet joints on each side have become compressed and developed arthritic bone spurs, and ligaments that run from joint to joint have thickened, further narrowing the canal and foramina. As a result, there is less room for the spinal nerves, which become compressed.

However, nerves have a remarkable ability to adjust to compression, if it develops slowly and gradually over many years, which is usually what occurs with spinal stenosis, and tissue degeneration in general. So, these conditions are not always symptomatic, just like arthritis and e.g. degenerative partial rotator cuff tears and meniscus tears do not always cause pain either.

CONSERVATIVE TREATMENT THE FIRST CHOICE

If these conditions become painful enough that daily activities are being affected, it is recommended to see a physician and physical therapist. If there is severe enough nerve pain, certain pain medications may be prescribed.

The physical therapist can teach you techniques to relieve stenosis pain, such as to regularly bend over to lean on the thighs, lean on grocery carts in the store, temporarily squat down, or sit down for a period of time, before you proceed with the walk. This allows the nerves to recuperate sufficiently to be able to continue the walk or standing. It is important to understand that we do not want to stop walking, since that can have a negative impact on our general stamina and health.

In physical therapy, we can also teach people appropriate exercises, performed with the spine flattened or bent a little, both to improve mobility and circulation in the spine, and to increase endurance and strength of muscles which support the spine, such as deep muscles in the back and abdomen. Manual therapy techniques may also provide some pain relief, by increasing mobility in the lower back, positioning the spine to relieve nerve compression, and to improve soft tissue and muscle flexibility. A regular home exercise program, combined with regular walking or for some bicycling, is also instrumental to be able to stay active with less pain and effort.

Surgery, to decompress the spine and relieve nerve compression, should be an option only in very severe cases, where conservative treatment has failed.

Many of you have remained readers for some time, and I would really like to hear your ideas for future newsletters.

Best wishes for an enjoyable spring and continued good health,

Gunnar

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