Spinal stenosis: what it is and how to treat it

What is spinal stenosis?

At every spinal level there’s a space available for the nerves to come out on either side, to pass to the structures they serve. Spinal stenosis is when narrowing occurs at this space, potentially irritating the nerves and causing difficulty. Most commonly stenosis is found at the neck (cervical) or the lower back (lumbar).

Above: The top view (left) shows the superior articular process of the inferior vertebra, the inferior articular process of the superior vertebra, and the narrowed spinal canal. A side view (right) shows a damaged intervertebral disc with a loss of disc height and narrowed lumbar vertebrae (top) and a normal disc (bottom).

What causes spinal stenosis?

This narrowing can occur due to a number of reasons. The most common form of narrowing occurs due to ageing, with the natural change in disc height and health, thickening of ligaments, and the laying down of bony structures (osteophytes) all encroaching on the space.

An acute disc injury and disc bulge can cause stenosis, although this normally reverses over time, and can also occur with inflammatory or infective diseases. It’s important to note that this rarely progresses to a major issue and many people live with a degree of stenosis without ever knowing about it.

What are the symptoms of spinal stenosis?

There can be a broad range of symptoms when it comes to spinal stenosis. It can be asymptomatic, and not all narrowing has to lead to symptoms. Generally when symptoms present, it’s due to irritation and compression of the nerve that passes through that space.

One can note pain in the neck or lower back, generally with referral elsewhere. When the neck is affected, pain, a burning sensation and heaviness is predominantly felt in the arm(s) and hand(s). When it’s the lower back, these same symptoms can present in the leg(s). Often people will note one particular position can cause symptoms to come on.

In severe cases there can be changes to power, sensation and neurological function. Anyone experiencing severe neurological changes should instantly seek medical help.

What is the treatment of spinal stenosis?

There’s really good research to show that physiotherapy can be effective at decreasing symptoms. In a recent study, patients engaging in physio reported a 50% improvement to their symptoms within three months. The physio will work with the patient to help improve postures and lessen the load placed on the nerve in an attempt to decrease symptoms. Activity is recommended, in a way that doesn’t irritate the symptoms.

People generally feel quite comfortable with cycling, so this is recommended quite regularly, along with the best positions to maintain and how to relieve symptoms when they’re irritated. Recent studies suggest that physiotherapy alone has as good results as surgery, so we would recommend this as the first line of approach, unless there are severe neurological deficits presented. If someone feels they may be experiencing neurological changes, it’s worth seeing a physiotherapist or a GP as soon as possible to get checked up and to decide how best to proceed.

Can you prevent spinal stenosis?

Spinal stenosis is strongly related to the process of ageing, and it’s difficult to stop it from occurring. The important take-home message is that stenosis often doesn’t cause any symptoms, and with correct management symptoms can be alleviated, allowing people to continue their active lifestyles. If someone is experiencing a degree of arm/leg pain, or a change in function, when in certain positions, it’s worth seeing a physiotherapist to learn how to manage it, prevent symptoms progressing and to see whether they require a referral to a spinal specialist.

Tom Whyatt is a physiotherapist at Six Physio St James’s

If you have any concerns at all, like with any health issue, seek medical advice from a qualified medical practitioner, whether that’s a doctor or physiotherapist.

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