Stenosis is a medical word for narrowing. In this case, it refers to narrowing of the spinal canal—a passage formed by the vertebrae (spinal bones) that allows space for the spinal cord to run down the middle. As you age, your spinal canal naturally becomes more narrow. In some arthritic conditions such as osteoarthritis and rheumatoid arthritis, the canal becomes so narrow that the blood supply to the nerves in your spinal cord reduces. This can be associated with pain, numbness and weakness in both legs. While it sounds scary, spinal canal stenosis is reasonably common. In many cases, people who have signs of spinal canal stenosis on an X-ray or MRI have no symptoms whatsoever. It most commonly affects people over the age of 60.
--What causes spinal canal stenosis?
Spinal canal stenosis can be exacerbated by conditions such as osteoarthritis (having less cartilage or ‘shock absorbing’ material in your joints) and rheumatoid arthritis (inflamed joints). These conditions cause swelling and extra bone growth than can reduce the size of the spinal canal. Very rarely, vertebrae can move forward ever so slightly on each other and this can cause the spinal canal to become narrow. This condition has a big name: ‘spondylolisthesis’. Andre Agassi famously won Wimbledon with a spondylolisthesis.
--How do I know if I have spinal canal stenosis?
Symptoms associated with spinal canal stenosis are usually better with sitting and worse with standing and walking. One hallmark is said to be the ‘shopping trolley sign’ where symptoms are rapidly relieved by leaning forward, for example, onto the handles of a shopping trolley. Your physiotherapist is trained to distinguish between spinal canal stenosis and other causes of low back pain and leg pain. They will do this by asking you a series of questions about your pain and examining your back. They might do some special tests such as check the reflexes, sensation and strength of your legs.
--How can physiotherapy help with spinal canal stenosis?
The management of spinal canal stenosis is similar to that of radicular pain. That is, it is recommended to have a trial of conservative treatment for at least six weeks before undergoing any further tests or invasive treatment (injections or surgery). A physiotherapist can help confirm that you have spinal canal stenosis and rule out other conditions that do require additional testing and treatment. Once a diagnosis of spinal canal stenosis is suspected, they can help you decide on how to manage it. Your options might include self-management techniques, education, exercises or a combination of these.
--How effective is physiotherapy for spinal canal stenosis?
Few studies have tested whether physiotherapy treatment is effective for treating spinal canal stenosis. Most studies compare physiotherapy to surgical treatment. There is no clear benefit of having surgery for spinal canal stenosis compared to non-surgical options such as rehabilitation.
--What can I do at home?
It is best to discuss this with your GP and physiotherapist so you can get a specific program best suited to you. Some of the key things are education on spinal canal stenosis, advice on self-management, exercise and careful monitoring of your medicines and condition by your GP.
