What is Spinal Stenosis
Spinal stenosis is a condition in which there is pressure on the spinal cord or nerve roots. For some people, it is related to an abnormally narrow spinal canal. For most, the symptoms which arise from pressure on the spinal cord or nerve roots are brought on and/or made worse by age related changes, poor fitness and inflammation. It can occur in the low back or the neck, but is most common in the low back.
The most common symptom of lumbar spinal stenosis is low back pain and buttock pain which extends into the back of the thigh; and which worsens with standing and walking. As pressure on the spinal cord and nerves increases, numbness, cramping and weakness of the leg may develop. Similar symptoms may be seen in the arm(s) with spinal stenosis in the neck.
Lumbar spinal stenosis is often associated with intermittent claudication - muscle pain which comes on with activity and is relieved by rest. It may be related to pressure on nerves or blood vessels, but either type is associated with spinal stenosis. The classic example of this is the difficulty some of our clients have when they go for a walk…leg pain develops, severe enough that they must sit for just a few minutes until they can stand and continue walking.
In so many ways, spinal stenosis is the ‘end of the line’ presentation of ordinary back pain. It may start without fanfare, as with the occasional ‘stiff and sore’ that many people experience with long sitting or driving, and develop progressive degenerative changes earlier than expected for biological age. At some point inflammation increases pressure on the vulnerable spinal cord and nerves, and symptoms ramp up. A surgical procedure called laminectomy has been the standard treatment for advanced spinal stenosis. However, an increasing number of research reports and reviews are documenting poor results from this surgery. Medical recommendations are increasingly favoring conservative management of this condition, including physiotherapy exercise.
At our clinic we anchor care with physiotherapy: a good physical assessment to identify associated muscle issues and misalignments, motor control strategies to help clients to correctly replicate corrective exercise, and an effective home exercise program which is modified over time to accommodate changing function. We recommend a care plan that includes any or all of laser therapy, massage therapy and acupuncture. Collaborative care improves the treatment experience, extends the course of therapy, and allows best use of insurance benefits.
Laser therapy, aka low intensity laser, aka photobiomodulation is a key recommendation for spinal stenosis treatment plans. It settles the inflammation in the stenosed area, which alleviates the pressure on the spinal cord and spinal nerves. This improves mobility and function. Laser provides effective pain relief for most people, allowing our clients to reduce their use of pain medication. Finally, laser stimulates cell function and can slow down the progression of degenerative changes. At our clinic we use the Bioflex laser system, which offers the sophisticated technology capable of providing the light energy needed to create the photobiomodulation effect.
The complex structure of the spine protects sensitive nerves, but it also presents a challenge in accessing these tissues for treatment. Longer treatment times are required to allow the light energy to penetrate deeply and saturate the involved tissues with the light energy. A Laser treatment will take about an hour in order to fully infuse the stenosed area; this reflects the bi-phasic dosage phenomenon of laser therapy. Too much power blocks the ability of tissues to absorb light energy, whereas low power enables absorption and photobiomodulation.
A collaborative treatment approach which includes laser and is anchored by physiotherapy is our best recommendation for the treatment of spinal stenosis, whether in the neck or the low back.