Lumbar Spinal Stenosis (LSS) is common in those over 65, caused by the narrowing of the spinal canal or its recesses, which compresses the spine's neurovascular structures. LSS is a significant contributor to disability in the aging population, even surpassing conditions like congestive heart failure or COPD.
The Good News
We have a 90% success rate in reducing or eliminating pain and improving function.
The good news is that LSS often responds well to non-surgical treatments like exercise and manual therapy. While surgery is necessary for some, many cases can be effectively managed without it. With LSS’s slow progression, there’s ample time to explore and implement effective treatments, allowing better control and improved quality of life.
Article Index
Symptoms of Lumbar Spinal Stenosis (LSS)
Lumbar Spinal Stenosis (LSS) can be tricky, with symptoms that vary based on the severity of the condition. Here are key signs to watch for:
Lower Back, Buttock, or Leg Discomfort: This can range from dull aches to persistent pain.
Leg Weakness or Cramping: Whether on one side (unilateral) or both (bilateral), this often stems from neurogenic claudication related to nerve compression.
Difficulty Standing Upright or for Long Periods: Maintaining a straight posture or standing for extended periods can feel exhausting and painful.
Decreased Pain When Bending Forward: Known as the 'shopping cart sign,' bending forward can relieve pain—unlike typical back pain, which usually worsens in this position.
Impaired Balance: Walking or standing may feel unsteady as if you're struggling to maintain balance.
Pain Relief When Sitting: Sitting often reduces back pain with LSS, unlike regular back pain, which can worsen in this position.
Increased Pain with Standing: Standing can intensify pain, starkly contrasting typical back pain, which usually eases when upright.
Improved Leg Strength When Sitting or Lying Down: A notable increase in leg strength when changing positions, which isn’t common with ordinary back pain.
Red Flag - Loss of Bladder or Bowel Control: This serious symptom requires immediate medical attention. If you experience this, consult your doctor right away.
Understanding the Complexities of Lumbar Spinal Stenosis (LSS)
Lumbar Spinal Stenosis is like a complex puzzle, where pieces such as osteoarthritis, spinal disc damage, ligament thickening, inflammation, and even congenital traits come together to create a complete picture.
Spondylosis: Osteoarthritis of the spine can lead to disc and joint degeneration and cause bone spurs to develop. As these changes progress, the spinal canal narrows, compressing the spinal cord and nerve roots, resulting in pain. Strengthening the spinal muscles can help slow down this process and provide relief.
Spinal Disc Damage: Our once flexible spinal discs can stiffen with age and injury, leading to neurovascular compression. Regular exercise can be a powerful remedy, improving disc hydration, enhancing shock absorption, and maintaining overall disc health.
Ligament Thickening: Healthy ligaments stretch and retract easily, but when they lose elasticity, they contribute to Lumbar Spinal Stenosis. A healthy lifestyle, including proper nutrition and regular physical activity, can support ligament health and help prevent this condition.
Inflammation: Inflammation can cause swelling, restrict movement, and thicken ligaments, increasing the risk of Lumbar Spinal Stenosis. Managing inflammation through diet, exercise, and stress reduction is crucial in reducing symptoms.
Congenital Factors: Some people are born with a naturally narrower spinal canal, making them more susceptible to developing spinal stenosis.
By understanding these contributing factors, we can better navigate the challenges of Lumbar Spinal Stenosis and develop strategies to manage and combat this condition effectively.
Detective Work: Diagnosing Lumbar Spinal Stenosis (LSS)
Uncovering the cause of back pain, especially when diagnosing Lumbar Spinal Stenosis, is no easy feat. This process typically involves a thorough combination of physical examination, medical history review, and imaging tests.
Physical Examination: Your healthcare provider will act as a detective, asking detailed questions about your symptoms and performing a neurological examination to assess your leg reflexes, strength, and sensation. The goal is to gather as much evidence as possible to understand what’s happening in your spine.
Imaging Tests: To get a clearer picture of your spine’s structure, your healthcare provider may order X-rays, MRIs, or CT scans. These tests provide detailed insights into your spinal architecture and can help confirm the presence of Lumbar Spinal Stenosis. In some cases, nerve conduction studies or electromyography (EMG) might be recommended further to evaluate the health of your nerves and muscles.
The Delphi Study Checklist: The International Delphi study offers a valuable set of 7 diagnostic questions to help identify Lumbar Spinal Stenosis:
Do you experience leg or buttock pain while walking?
Does bending forward alleviate your symptoms?
Does pain decrease when using a shopping cart or bicycle?
Are there any motor or sensory disturbances while walking?
Are your foot pulses present and symmetric?
Is there lower extremity weakness?
Do you experience low back pain?
This comprehensive approach ensures that all potential causes of your back pain are thoroughly investigated, leading to an accurate diagnosis and effective treatment plan.
Differential Diagnosis
Diagnosing Lumbar Spinal Stenosis isn't just about recognizing its symptoms; it's also about distinguishing it from other conditions with similar presentations, such as Osteoarthritis, Herniated Disc, Trochanteric Bursitis, Peripheral Neuropathy, or Vascular Claudication.
Hip Osteoarthritis (OA): The symptoms of lumbar spinal stenosis and hip OA can overlap, causing gluteal, groin, lateral hip, and leg pain when weight-bearing. OA can lead to cartilage breakdown in the spine’s joints, potentially causing bone spurs and spinal canal narrowing. Both conditions can even coexist, complicating the diagnosis.
Herniated Disc: A herniated disc occurs when the soft inner material of a spinal disc pushes through its outer layer and presses on a nerve, resulting in back and leg pain and numbness. This can mimic the symptoms of Lumbar Spinal Stenosis.
Trochanteric Bursitis: Patients with Trochanteric Bursitis typically experience lateral leg pain, which worsens when lying on the affected side—a symptom not seen in Lumbar Spinal Stenosis, making it a key differentiating factor.
Peripheral Neuropathy involves damage to the peripheral nerves, leading to pain, numbness, and weakness in the legs and feet. While it shares some symptoms with Lumbar Spinal Stenosis, the underlying causes and treatment approaches differ.
Vascular Claudication: Caused by Peripheral Arterial Disease (PAD), vascular claudication results in leg pain due to reduced blood flow. Like Lumbar Spinal Stenosis, it causes increased pain with walking that subsides with rest. However, unlike Lumbar Spinal Stenosis, the pain from vascular claudication isn’t relieved by forward flexion (the ‘shopping cart sign’) or cycling, which helps differentiate the two conditions.
Diagnosing Lumbar Spinal Stenosis is a complex process that requires careful evaluation and a keen eye for detail to distinguish it from these other conditions.
Physical Examination
The videos below demonstrate key orthopedic and neurological examination techniques we use to identify Lumbar Spinal Stenosis. Together, we’ll explore and demystify this condition.
Low Back Examination
This video focuses on common causes of low back pain related to Lumbar Spinal Stenosis and demonstrates how to diagnose them using orthopedic examination techniques.
Hip Examination - Orthopaedic Testing This video guides you through the inspection, palpation, and assessment of active and passive ranges of motion in the hip region, helping us differentiate Lumbar Spinal Stenosis (LSS) from hip-related conditions. These orthopedic tests are crucial for accurately diagnosing LSS by ruling out hip pathologies.
Lower Limb Neuro Examination
This video demonstrates the lower limb neurological examination, a critical component in assessing motor and sensory neurons in the legs. This examination is essential for diagnosing Lumbar Spinal Stenosis (LSS) by identifying any nerve involvement affecting the lower limbs.
Peripheral Vascular Examination
This video covers the peripheral vascular examination, which is crucial for ruling out vascular-related pathologies that might mimic Lumbar Spinal Stenosis (LSS). By distinguishing between vascular issues and LSS, we can ensure accurate diagnosis and appropriate treatment, reducing the risk of cardiovascular and cerebrovascular complications.
Unlocking the Treatment Path for Lumbar Spinal Stenosis
Lumbar Spinal Stenosis is a leading cause of spinal surgeries among those over 65, but it's important to remember that surgery isn't always the first or only option.
Current evidence strongly supports combining manual therapy and exercise as the initial treatment approach. Even if surgery becomes necessary, this powerful duo can significantly improve outcomes before and after the procedure.
Here’s a look at some key manual therapy techniques for Lumbar Spinal Stenosis:
Spinal Mobilization: Slow, rhythmic movements of the spine to enhance joint mobility and reduce pain.
Soft Tissue Therapy: Manipulation of muscles and ligaments to relieve tension and improve blood circulation.
Stretching: Guided stretches to increase flexibility and alleviate symptoms.
Myofascial Release: Targeted pressure on specific areas to release tension and reduce pain.
The results can be impressive. Studies show that 33%-50% of patients with mild to moderate symptoms who undergo traditional therapy report significant functional improvements, including reduced pain, enhanced daily function, and better walking ability. For some, these improvements may be enough to avoid surgery altogether.
It's crucial to recognize that while interdisciplinary care is essential and valued, we must also rely on peer-reviewed evidence. Research does not support the use of medications like Tylenol, NSAIDs, opioids, neurogenic pain medications, muscle relaxants, and epidural steroid injections as primary treatments for Lumbar Spinal Stenosis. Despite this, these medications are often used as the first line of defense.
We strongly believe in collaborating with the medical community—it's not just important, it's essential. While we prioritize evidence-based treatments, medication still plays a vital role. In cases of severe pain, sleep disturbances, or when pain hinders exercise, medication can provide the necessary relief. The goal is to manage pain effectively so patients can sleep, perform prescribed exercises, and benefit from manual therapy, all of which are crucial for long-term management.
Manipulation & Mobilization: The Joints
Spinal Manipulation and Mobilization can be incredibly beneficial for those with Lumbar Spinal Stenosis. Think of the spine—from neck to lumbar—as a single, interconnected system that needs optimal mobility to distribute load effectively. When your neck and upper back are mobile, flexible, and strong, your entire spine shares the workload more efficiently.
That’s why we encourage patients to focus on the symptomatic lumbar region as well as other areas of spinal tension. The following videos demonstrate various manipulation and mobilization techniques that can be highly effective. We customize our recommendations and treatments based on each patient's unique needs.
Joint Mobilization - Lumbar Spine
Improving joint mobility is a critical step toward relieving pain when managing lumbar spinal stenosis. Our ability to move freely depends on the health and integrity of our joints, and no joint functions in isolation. An issue in one joint can lead to biomechanical compensations in nearby or even distant joints, creating a ripple effect of discomfort and dysfunction. By focusing on restoring mobility in the lumbar spine, we can help alleviate pain and prevent further compensatory issues, allowing you to move with greater ease and comfort.
Soft Tissue Therapy: An Essential Component
The following videos showcase common MSR techniques we frequently use with our Stenosis patients. The condition of your soft tissues is crucial in determining both the pain level you experience and your overall ability to function. We can significantly improve your comfort and mobility by addressing these soft tissue issues.
Lumbar and Thoracic Spine Fascial Release
In treating Lumbar Spinal Stenosis, the thoracolumbar fascia (TLF) often plays a crucial role in addressing chronic low back pain. The TLF is a vast area of connective tissue that supports the spine, and releasing tension in this region can be key to relieving pain and improving mobility in those with LSS.
Resolve Chronic Low Back Pain
In managing Lumbar Spinal Stenosis, it's essential to focus on the deep paraspinal muscles (transversospinalis). These muscles often atrophy in chronic low back pain cases, contributing to ongoing discomfort and reduced spinal stability. Strengthening and rehabilitating these muscles can be key to resolving chronic pain and improving overall function in LSS patients.
Fascial Expansion: MSR Low Back Pain Protocol
Fascial expansions offer an effective approach to managing lumbar spinal stenosis by integrating modern insights into fascia, kinetic chain relationships, and core principles of acupuncture and traditional Chinese medicine. In this video, Dr. Abelson, the developer of Motion Specific Release (MSR), demonstrates how fascial expansions can alleviate low back pain associated with LSS, enhancing overall treatment outcomes.
Treatment Frequency Recommendations
Effective management of Lumbar Spinal Stenosis requires pain relief, improved function, and slowing the degenerative process. Maintenance care is crucial in achieving these goals, as all spinal conditions are progressive.
Initial Treatment Phase:
MSR Manual Therapy: 2 sessions per week for three weeks, or one 30-minute session per week if that fits your schedule better.
Home Exercises: Daily functional exercises as prescribed.
Response Assessment (After Three to Four Weeks):
Positive Response:
MSR Manual Therapy: Reduce to 1 session per week.
Home Exercises: Continue daily, adjusting as needed.
Persistent Symptoms:
MSR Manual Therapy: Continue with 2 sessions per week, reassessing weekly.
Home Exercises: Modify as needed to ensure effectiveness.
Ongoing Therapy:
Improvement: Continue therapy if symptoms are improving and goals haven’t been met.
Plateau: If progress stalls, reconsider the treatment plan.
Maintenance Phase:
MSR Manual Therapy: Monthly sessions to maintain progress and slow degeneration.
Home Exercises: Daily routines to sustain improvements and prevent worsening.
Regular care is essential to slow the condition's progression, not just manage pain and function.
The Essential Role of Exercise
Regular exercise is a powerful tool against spinal stenosis, and studies show that those who stay active are less likely to suffer from this condition. While exercising during pain might seem counterintuitive, it's an effective strategy.
Think of exercise as a natural anti-inflammatory. It boosts circulation, removes waste, delivers oxygen to injured areas, and helps reduce pain. The formula is simple: less inflammation equals less pain.
Beyond reducing inflammation, exercise also improves the flexibility of ligaments and fascia, making them less likely to compress nerves. It also helps reduce swelling, further easing discomfort.
Aerobic Exercise: The Heart of the Matter
Activities like walking, swimming, or cycling are easy on the spine and vital for cardiovascular health and endurance.
The real power of aerobic exercise lies in its ability to boost aerobic capacity, improve circulation, and enhance energy production. By increasing muscle capillary density and enhancing mitochondrial function, aerobic exercise accelerates nutrient absorption for repair and speeds up waste removal.
For those with Lumbar Spinal Stenosis, aerobic exercise isn't just helpful—it’s essential. It can be the difference between constant pain and a more comfortable, symptom-free life.
Finding Your Aerobic Zone
Exercise within your aerobic zone to maximize benefits—your optimal heart rate range for recovery. Here’s how to calculate it:
Subtract your age from 220. For example, if you’re 40: 220 - 40 = 180.
Find the lower limit by multiplying the result by 0.6: 180 * 0.6 = 108.
Find the upper limit by multiplying the result by 0.7: 180 * 0.7 = 126.
Your aerobic heart rate zone is between these numbers. Staying within this zone is key to recovery—exceeding it can increase injury risk while staying below it might limit your progress.
Phased Approach to Aerobic Exercise
Phase 1: Start with 5 to 10 minutes, 3 to 5 days a week (preferably cycling or swimming).
Phase 2: Increase to 15 to 20 minutes, 4 to 7 days a week.
Phase 3: Aim for 30 to 60 minutes, 5 to 7 days a week.
Tip: Consider using a heart rate monitor to track your progress, which can help you optimize your workouts and catch any potential cardiovascular issues early. If you don’t have a monitor, here’s a simple rule: if you’re working hard enough to keep a conversation going with someone beside you barely, you’re likely in your aerobic zone. This ensures you push yourself enough to get the benefits without overdoing it.
Walking
Lumbar Spinal Stenosis can make walking painful and challenging; for many, it may not be the best exercise option. Reaching your aerobic zone through walking alone can be difficult; alternatives like biking or swimming might be more effective.
However, don’t dismiss walking altogether! It’s essential to keep walking as a ‘baseline test’ to increase your pain-free walking distance gradually. Walking, being low-impact, can improve cardiovascular health, boost endurance, and reduce symptoms for some.
This is a key reminder that if your legs feel weak, avoid pushing yourself with long walks. Overdoing it can worsen your symptoms and lead to further weakness.
Daily Exercise Routine
The video below highlights exercises we frequently recommend for Lumbar Spinal Stenosis, which strongly focuses on improving hip mobility. Enhancing hip mobility through these exercises and manual therapy can often mean distinguishing between walking comfortably and experiencing pain with every step. And don’t forget to include aerobic exercise in your routine—balancing mobility and cardiovascular fitness is key to managing your symptoms effectively.
5 Best Exercises For Spinal Stenosis
If you're dealing with Lumbar Spinal Stenosis, these exercises can make a big difference in managing your symptoms. Check out the video below to see how to perform each one:
01:10 Pelvic Tilts
02:08 Single Leg Pull
03:10 Fall Over Rotations
04:30 Cat-Cow
05:38 Wide Leg Child’s Pose
These targeted movements relieve pain and improve mobility, helping you stay active and comfortable.
General Recommendations
To better manage Lumbar Spinal Stenosis, combine exercise and therapy with these key strategies focused on avoiding pain triggers. Remember, activities that aggravate your condition can lead to prolonged discomfort, lasting hours after you’ve finished.
Steering Clear of Activities That Induce Pain
Patients often know which activities trigger their pain but continue to engage in them, worsening their condition and prolonging discomfort. A common example is the effort to maintain an upright posture, which can be especially painful for those with Lumbar Spinal Stenosis (LSS).
People with LSS often adopt a stooped, forward-bending posture to relieve pressure. Despite the pain, many force themselves to stand straight, making things worse. I advise my patients to avoid forcing an upright posture until inflammation and swelling have subsided. This approach reduces pressure on the spine, allowing for a more comfortable and pain-free transition to standing straight. Forcing an upright posture too soon can increase spinal cord pressure and weaken the legs.
Extension Intolerance and LSS
Extension-intolerant Lumbar Spinal Stenosis (LSS) is a condition where extending the lower back triggers pain and numbness. Common in older adults due to spinal degeneration, this subtype of LSS makes forward-bending (flexion) exercises and treatments more effective than those involving backward bending (extension).
The key to managing LSS is avoiding activities that require backward bending, which can narrow the spinal canal and worsen symptoms. For example, reaching overhead for an item can lead to hours of discomfort.
Braces: A Supportive Aid for Lumbar Spinal Stenosis
Much like elastic corsets, braces can offer significant relief during Lumbar Spinal Stenosis flare-ups. By limiting side-to-side bending and repetitive motions, braces help reduce nerve root irritation, which can cause radiating pain. They also support staying active while minimizing the risk of re-injury and can improve sleep quality by keeping the spine in a neutral position.
Walking Aids: Temporary Support, Not a Permanent Crutch
Many patients hesitate to use walking aids like walkers or canes, fearing dependency. However, this concern is often misplaced. Using a walker or cane during severe flare-ups or for just a few days can provide substantial pain relief. These aids can also prevent falls and potential injuries, especially in the morning or late at night. Once you’re feeling stronger, you can easily set them aside.
Optimizing Sleep Positions for Lumbar Spinal Stenosis
Finding the right sleep position is crucial for reducing pain and improving sleep quality when dealing with Lumbar Spinal Stenosis. Here are some positions that can help:
Side Sleeping with a Pillow Between Your Knees: This alignment reduces stress on the lower back and keeps your spine in a neutral position.
Back Sleeping with a Pillow Under Your Knees: This position alleviates pressure on the lower back and promotes proper spinal alignment.
Reclined Sleeping: Ideal for those who find lying flat uncomfortable, this position reduces lower back pressure.
Avoid sleeping on your stomach, as it can increase stress on the lower back and worsen symptoms.
Why Choose Our Approach for Lumbar Spinal Stenosis (LSS)
While Lumbar Spinal Stenosis (LSS) cannot be fully cured, our approach consistently achieves a 90% success rate in reducing pain and improving function. Here’s why our method is so effective:
Established Expertise: With over 30 years of clinical experience, Dr. Brian Abelson developed the MSR methodology, successfully treating more than 25,000 patients. You’ll benefit from a proven approach tailored to LSS care.
Thorough Assessments: We conduct detailed evaluations to identify all contributing factors, including nerve compression and muscle imbalances, ensuring a comprehensive understanding of your condition.
Advanced MSR Procedures: Our Motion-Specific Release (MSR) techniques precisely target areas of fascial restrictions, joint dysfunctions, and nerve entrapments, providing effective and lasting relief.
Customized Exercise Programs: We design individualized exercise plans to improve spinal mobility, strengthen supporting muscles, and enhance overall function, helping you regain the ability to live fully and comfortably.
Logical, Evidence-Based Approach: Our treatment protocols integrate manual therapy, exercises, and supportive strategies, ensuring a comprehensive and lasting solution for managing LSS.
References:
Bussières, A., Cancelliere, C., & Ammendolia, C. (2021). Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline. J Pain, 22(9), 1015-1039. doi: 10.1016/j.jpain.2021.03.147.
Anderson, D.B., Luca, K., Jensen, R.K., et al. (2021). A critical appraisal of clinical practice guidelines for the treatment of lumbar spinal stenosis. Spine J, 21(3), 455-464. doi: 10.1016/j.spinee.2020.10.022.
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Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ, 352, h6234. doi: 10.1136/bmj.h6234.
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Schneider, M.J., Ammendolia, C., Murphy, D.R., et al. (2019). Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis. JAMA Netw Open, 2(1), e186828.
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Ammendolia, C., Stuber, K., de Bruin, L. K., Furlan, A. D., Kennedy, C. A., Rampersaud, Y. R., Steenstra, I. A., & Pennick, V. (2012). Nonoperative treatment of lumbar spinal stenosis with neurogenic claudication: a systematic review. Spine, 37(10), E609-E616.
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
Join Us at Motion Specific Release
Enroll in our courses to master innovative soft-tissue and osseous techniques that seamlessly fit into your current clinical practice, providing your patients with substantial relief from pain and a renewed sense of functionality. Our curriculum masterfully integrates rigorous medical science with creative therapeutic paradigms, comprehensively understanding musculoskeletal diagnosis and treatment protocols.
Join MSR Pro and start tapping into the power of Motion Specific Release. Have access to:
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Integrating MSR into your practice can significantly enhance your clinical practice. The benefits we mentioned are only a few reasons for joining our MSR team.
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