Physical Therapy in Venice for Lower Back

Welcome to FYZICAL Venice's patient resource about Lumbar Spinal Stenosis.

According to the North American Spine Society (NASS), spinal stenosis describes a clinical syndrome of buttock or leg pain. These symptoms may occur with or without back pain. It is a condition in which the nerves in the spinal canal are closed in, or compressed. The spinal canal is the hollow tube formed by the bones of the spinal column. Anything that causes this bony tube to shrink can squeeze the nerves inside. As a result of many years of wear and tear on the parts of the spine, the tissues nearest the spinal canal sometimes press against the nerves. This helps explain why lumbar spinal stenosis (stenosis of the low back) is a common cause of back problems in adults over 55 years old.

This guide will help you understand:

• how the problem develops
• how doctors diagnose the condition
• what treatment options are available

What part of the back is involved?

The human spine is made up of 24 spinal bones, called vertebrae. Vertebrae are stacked on top of one another to create the spinal column. The spinal column gives the body its form. It is the body's main upright support.

Spinal Column

The back portion of the spinal column forms a bony ring. When the vertebrae are stacked on top of each other, these bony rings create a hollow tube. This bony tube, called the spinal canal, surrounds the spinal cord as it passes through the spine. Just as the skull protects the brain, the bones of the spinal column protect the spinal cord.

Bony Ring

Spinal Cord

The spinal cord only extends to the second lumbar (low back) vertebra. Below this level, the spinal canal encloses a bundle of nerves that go to the lower limbs and pelvic organs. The Latin term for this bundle of nerves is cauda equina, meaning horse's tail.

Cauda Equina

An intervertebral disc fits between each vertebral body and provides a space between the spine bones. The disc normally works like a shock absorber. It protects the spine against the daily pull of gravity. It also protects the spine during heavy activities that put strong force on the spine, such as jumping, running, and lifting.

An intervertebral disc is made up of two parts. The center, called the nucleus, is spongy. It provides most of the ability to absorb shock. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it. Ligaments are strong connective tissues that attach bones to other bones.

Two Parts of Intervertebral Disc

Related Document: FYZICAL Venice's Guide to Lumbar Spine Anatomy

Why do I have this problem?

In the lumbar spine, the spinal canal usually has more than enough room for the spinal nerves. The canal is normally 17 to 18 millimeters around, slightly smaller than a penny. Spinal stenosis develops when the canal shrinks to 12 millimeters or less. When the size drops below 10 millimeters, severe symptoms of lumbar spinal stenosis occur.

There are many reasons why symptoms of spinal stenosis develop. Some of the more common reasons include:

• congenital stenosis (being born with a small spinal canal)
• spinal degeneration
• spinal instability
• disc herniation

Congenital stenosis: Some people are born with (congenital) a spinal canal that is narrower than normal. They may not feel problems early in life. However, having a narrow spinal canal puts them at risk for stenosis. Even a minor back injury can cause pressure against the spinal cord. People born with a narrow spinal canal often have problems later in life, because the canal tends to become narrower due to the effects of aging.

Degeneration: Degeneration is the most common cause of spinal stenosis. Wear and tear on the spine from aging and from repeated stresses and strains can cause many problems in the lumbar spine. The intervertebral disc can begin to collapse, and the space between each vertebrae shrinks. Bone spurs may form that stick into the spinal canal and reduce the space available to the spinal nerves. The ligaments that hold the vertebrae together may thicken and also push into the spinal canal. All of these conditions cause the spinal canal to narrow.

View animation of degeneration:

Spinal instability: Spinal instability can cause spinal stenosis. Spinal instability means that the bones of the spine move more than they should. Instability in the lumbar spine can develop if the supporting ligaments have been stretched or torn from a severe back injury. People with diseases that loosen their connective tissues may also have spinal instability. Whatever the cause, extra movement in the bones of the spine can lead to spinal stenosis.

Spinal Instability

Disc herniation: Spinal stenosis can occur when an intervertebral disc in the low back herniates (ruptures). Normally, the shock-absorbing disc is able to handle the downward pressure of gravity and the strain from daily activities. However, if the pressure on the disc is too strong, such as landing from a fall in a sitting position, the nucleus inside the disc may rupture through the outer annulus and squeeze out of the disc. This is called a disc herniation. If an intervertebral disc herniates straight backward, it can press against the nerves in the spinal canal, causing symptoms of spinal stenosis.

Disc Herniation

What does the spinal stenosis feel like?

Spinal stenosis usually develops slowly over a long period of time. This is because the main cause of spinal stenosis is spinal degeneration in later life. Symptoms rarely develop quickly when degeneration is the source of the problem. A severe injury or a herniated disc may cause symptoms to develop immediately.

Patients with stenosis don't always feel back pain. Primarily, they have severe pain and weakness in their legs, usually in both legs at the same time. Some people say they feel that their legs are going to give out on them.

Symptoms mainly affect sensation in the lower limbs. Nerve pressure from stenosis can cause a feeling of pins and needles in the skin where the spinal nerves travel. Reflexes become slowed. Some patients report charley horses in their leg muscles. Others report strange sensations like water trickling down their legs.

Symptoms change with the position of the low back. Flexion (bending forward) widens the spinal canal and usually eases symptoms. That's why people with stenosis tend to get relief when they sit down or curl up to sleep. Activities such as reaching up, standing, and walking require the spine to straighten or even extend (bend back slightly). This position of the low back makes the spinal canal smaller and often worsens symptoms.

How do health care providers diagnose the problem?

Diagnosis begins with a complete history and physical examination. When you visit FYZICAL Venice, our Physical Therapist will ask questions about your symptoms and how your problem is affecting your daily activities. This will include questions about your pain or if you have feelings of numbness or weakness in your legs. We will also want to know whether your symptoms are worse when you're standing up or walking and if they go away when you sit down, as this helps us to rule in or our other conditions.

Our Physical Therapist will do a physical examination to see which back movements cause pain or other symptoms. Your skin sensation, muscle strength, and reflexes will also be tested. Gait analysis and other special clinical tests can also be done.

Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the Physical Therapists at FYZICAL Venice have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.

FYZICAL Venice provides services for Physical Therapy in Venice.

Non-surgical Rehabilitation

Unless your condition is causing significant problems or is rapidly getting worse, spinal stenosis is first addressed with nonsurgical treatments. Up to one-half of all patients with mild-to-moderate lumbar spinal stenosis can manage their symptoms with conservative (nonsurgical) care. Neurologic decline and paralysis in this group is rare.

When you begin Physical Therapy at FYZICAL Venice, we may prescribe ways to immobilize the spine. Keeping the back still for a short time can calm inflammation and pain. Patients may find that curling up to sleep or lying back with their knees bent and supported gives the greatest relief. These positions flex the spine forward, which widens the spinal canal and can ease symptoms.

We may recommend a lumbar support belt or corset, though their benefits are controversial. Lumbosacral corsets do not appear to offer any long-term benefits. The support provides symptom relief only while you are wearing it. The support can limit pressure in the discs and prevent extra movement in the spine. But it can also cause the back and abdominal muscles to weaken. Some Physical Therapists have their patients wear a rigid brace that holds the spine in a slightly flexed position, widening the spinal canal. When its use is appropriate, we may have patients wear a corset for one to two weeks.

Our Physical Therapist may also suggest using traction. Traction is a common treatment for stenosis. It gently stretches the low back, taking pressure off the spinal nerves. Hands-on treatments such as massage and specialized forms of soft-tissue mobilization may be used initially. They are used to help you begin moving with less pain and greater ease.

The Physical Therapists at FYZICAL Venice also guide patients in a program of exercise designed to widen the spinal canal and take pressure off the spinal nerves. After evaluating your condition, we can assign positions and exercises to ease your symptoms.

It is important to improve the strength and coordination in the abdominal and low back muscles. Our Physical Therapist will create a program to help you regain back movement, strength, endurance, and function. We may also suggest strengthening and aerobic exercises. Strengthening exercises focus on improving the strength and control of the back and abdominal muscles. Aerobic exercises are used to improve heart and lung health and increase endurance in the spinal muscles. Stationary biking offers a good aerobic treatment and keeps the spine bent slightly forward, a position affording relief to many patients with lumbar stenosis.

Our therapist can also evaluate your workstation or the way you use your body when you do your activities and suggest changes to avoid further problems. Although each individual recovers as a different rate, as a guideline, our lumbar stenosis patients are normally seen a few times each week for one to two months. In severe cases, patients may need a few additional weeks of care.

Post-surgical Rehabilitation

After surgery, surgeons may have their patients work with a Physical Therapist or occupational therapist. Patients who've had fusion surgery normally need to wait two to three months before beginning a rehabilitation program. Although recovery time is different for each person, you will probably need to attend post-surgical Physical Therapy sessions for six to eight weeks and should expect full recovery to take up to six months.

When you begin your Physical Therapy program after surgery, our Physical Therapist may use treatments such as heat or ice, electrical stimulation, and massage to help calm pain and muscle spasm. We will also instruct you in how to move safely with the least strain on your healing back.

As your rehabilitation program evolves, we will suggest increasingly challenging exercises. Our goal is to safely improve strength and function. As your Physical Therapy sessions continue, we will focus on helping you get back to the activities you enjoy. We will provide guidance on how to change the way you go about certain activities and which activities are safe. Ideally, you will be able to resume your normal activities.

When recovery is well under way, your regular visits to FYZICAL Venice will end. Although we will continue to be a resource, you will be in charge of doing your exercises as part of an ongoing home program.

FYZICAL Venice provides services for Physical Therapy in Venice.