Spinal Stenosis Treatment

By Sally Ann Quirke, Chartered Physiotherapist | Filed under: Spinal Stenosis

Published: 06 December 2015

There are several approaches you can take to treating Spinal Stenosis, and the question often is where do you start… Treatment? Exercises? Medication? Surgery??

In this article I go through the general approach we take and some of the options available.

Treating Spinal Stenosis -

Discover the cause and Symptoms first.

When we look to treat Spinal Stenosis, we look at what the symptoms are, discover where the stenotic area is and what is causing the narrowing of that space.

I believe that once the cause and symptoms of your spinal stenosis symptoms have been correctly diagnosed - the first step that you should take is to see a physiotherapist (or physical therapist in the US) who specialises in this area. The reason I recommend this path is because the therapists’ knowledge of this complex condition is typically extensive.

Strengthening & Stretching Exercises

Your physiotherapist will then further assess your condition and review the severity and extent of your spinal stenosis. Once they are happy that all aspects have been assessed and fully diagnosed - they will typically work with you on back-strengthening exercises. These will be specific exercises to strengthen the muscles around and help support the affected (stenotic) area. They will also teach you certain back stretching exercises to loosen the tight muscles, nerves and ligaments in your back and keep them in good condition.

Mobilising the joints

If appropriate, they will also mobilise the joints that have become stiff both due to the condition and due to the poor postural habits (see what I mean by good posture) that you may have adopted as a result of your pain.

All of these methods will be directed toward reducing the nerve compression associated with spinal stenosois and your pain will be reduced. Reduction of nerve compression is the key to all treatments related to spinal stenosis.

Maintain a good weight

If you carry extra weight, your physio will also advise you on methods for losing that weight. Excess weight ane the additional pressure that it brings can be a major aggravating factor to spinal stenosis conditions. I appreciate that you find it difficult to exercise due to the pain but there are many exercises that you can do with spinal stenosis that won’t not aggravate your pain and these can reduce your weight when combined with a well balanced diet.

Medication

Anti-inflammatory medication is often required to help reduce the inflammation on your compressed nerves, as well as reducing your pain. I use anti-inflammatory drugs in conjunction with exercises with my clients - this helps them to perform exercises diligently and without pain. Your doctor will help with this aspect of treatment.

Steroid medication may be required during an acute flare up of your spinal stenosis. Steroids reduce inflammation around your nerves quite quickly. However, they are aggressive drugs which need to be used with care. Try to avoid steroids where at all possible, and discuss the side effects associated with overuse with your Doctor prior to embarking on a prolonged steroid management program.

Epidural steroid injection can also used in more severe episodes. This is where the steroid is administered directly into the spinal segment affected by spinal stenosis. Although required in certain situations, again try to avoid epidural for back pain where possible.

Surgery

Spinal stenosis surgery is normally used where all other treatments fail, or where there are severe symptoms that require immediate intervention. Be sure to exhaust all possibilities before you engage spinal surgery.

It involves removing the material that is compressing the nerve at the spinal segment affected by your spinal stenosis. This material can be bony or disc tissue. The aim of this surgery is to stabilise the unstable segment to reduce the compression effect on the affected nerves. (read more about Spinal Surgery for Stenosis here)

Spinal fusion can be an option in severe cases, however there can be complications with this surgery involving infection and instabilities so it should be discussed at length before it is performed.

Finally to finish - most of the patients I see successfully can manage their spinal stenosis without having to resort to strong medication or surgery. Some patients, where their symptoms are severely affecting their quality of life - then we look to surgery as an option and prepare for that.