It is not fun to live with pain and it is worse when you think you are stuck with the pain for the rest of your life, but that doesn’t have to be the case with stenosis. This blog will cover everything you need to know about stenosis with the most searched phrases leading you here from this list: stenosis of the neck, spinal stenosis treatment natural remedies, cervical canal stenosis, spinal stenosis physical therapy, thoracic stenosis, lumbar stenosis, neural foramina narrowing treatment, lumbosacral stenosis, who treats stenosis, will stenosis go away, what stenosis means, where does stenosis occur, can stenosis be reversed, stenosis when to have surgery, is stenosis congenital, stenosis definition, stenosis exercises, stenosis leg pain, stenosis pain relief, stenosis surgery, stenosis treatment without surgery, and stenosis treatment exercise.
What is Stenosis?
Stenosis means narrowing and can be in one of the two areas of the spine which this little bit of anatomy clarifies for you!
- Spinal Canal Stenosis: The spinal canal (see photo) is the hole in the center of the vertebrae where the spinal cord runs through. Narrowing of this canal directly affects the spinal cord and associated nerve distributions.
- Neural Foraminal Stenosis: The foramen (hole) is a tunnel created when two vertebrae are stacked on top of each other. This is where nerves stem from your spinal cord and distribute to the rest of the body. A narrowing of this space directly impacts the nerve at the level involved.
Regardless of the type of stenosis, the narrowing leads to irritation of the cord or the nerves, but in neural foraminal stenosis, the nerve distribution affected is more specific to the location of the vertebrae impacted. This means that you will have a more clear pain distribution that follows a specific nerve pattern.
Stenosis can occur at any level of the spine but is typically seen in the lumbar (lower back) and cervical (neck) vertebrae. It can also occur at just one spinal level or multiple levels. Due to the varying locations of occurrence, symptoms will vary. For example, if the stenosis is at the lumbar level, symptoms like lower back pain and pain down the legs are common. If in the cervical region, then neck/upper back pain or pain down the arms can occur.
Lumbar stenosis symptoms are commonly mistaken for Sciatica or Piriformis syndrome with a whole different treatment protocol while pain down the arm can be present from pinched nerve, stenosis, or trigger point therapy. You may want to pause and read the blog I wrote on pinched nerve. While history and exam are important, the study to rule out stenosis vs other ‘imposters’ is an MRI of the area involved.
Stenosis is a narrowing of the space where the nerve or cord goes through. Imagine a hole that is lined by ligaments with its walls made out of bones. Factors such as a lifestyle of sitting or repetitive movements, injuries, one-sided sports and so many other factors can lead to the thickening of the ligaments inside the hole for instance which leads to the actual narrowing of the hole where the nerves or cord goes through. This means the person ends up with symptoms indicative of stenosis. So stenosis does not have to be genetic and frankly, unless this hole or foramen is significantly small, no-one can guarantee that stenosis is genetic. After all, no one gets the MRI of the area at birth and monitors the size throughout the life randomly. These studies are done once the individual is symptomatic. An inflamed soft tissue such as nerves or ligaments can certainly qualify the thickening of that nerve or ligament (from inflammation) leading to symptoms that mimic stenosis.
For the sake of understanding let’s think of how callus is formed on the hand! When there is no protection and the labor is hard and repetitive, over time callus is formed. There is no such thing as callus of the spinal cord or spinal nerves but similar to the hand callus where the skin gets thickened, the soft tissue, the ligaments INSIDE the spinal canal, or the hole where the spinal nerve exit the vertebra can get thick. Typically this happens when the actual structure in that region has lost its stability due to injury, bad life-style, loss of muscle tone, or excess weight in the abdomen (lumbar stenosis) so the ligaments endure undue stress. This means that if we can somehow decrease the inflammation (which is done more often than not with injections and anti-inflammatory medicines, but not the only way to be done), the pain subsides. The issue with injection and meds is that they don’t remove the cause of the inflammation so the symptoms will come back and the condition becomes chronic.
What causes stenosis and is stenosis congenital?
So what the heck is causing this thickening mentioned above? The short answer is postural imbalances. You don’t need to be a chiropractor to see how any shift in the posture puts undue stress on not only the immediate area but the whole body. Over time, this leads to structures whose job is not to be in the first line of ‘stability’ to become the first! Imagine your task at work and then how your co-worker’s job becomes partly yours. If that is done for a short time, it is tolerable but if it becomes YOUR job, then at some point you will speak up or quit! For the human body, the strong foundation is your backbone aka spine, and the backbone is not just the lower back! So how can the structure be strong if the foundation is weak? The shifting of the center of gravity creates not only muscle tension but thickening and shifting of the ‘task at hand’ to other soft tissues including ligaments. If the ligament ‘picking up the load’ happens to be inside the canal as described above, now there is a narrowing of the canal and an increase in symptoms and the diagnosis of ‘stenosis’.
When we are already misaligned, any other negative factor added to this picture can push you to the point of experiencing symptoms. These factors include:
- Weight gain
- Prolonged sitting
- Prolonged standing
- Increased use of technology
- Weight lifting with bad form
- One-sided sports
- Car accident
- Postural decline
- Contact sports
Not that these lifestyle factors directly cause stenosis, but these major factors place you on the road to developing stenosis or in making stenosis become painful. Overall it’s really poor posture and weak stabilizing muscles that get you into trouble. Any weakness in the musculature, core or not, plays a big role in symptoms associated with Stenosis. This weakness compromises the ability of your body to stabilize the various joints in your body, in this case, the spine.
So how do we regain this stabilization? It’s not by doing abdominal crunches, nor using weight, isolating the symptomatic area(s) and stretching, it is not by adjustment either! Some of the lifestyle contributory factors can be eliminated to give you a better chance, but what’s missing in most treatments is Functional Movement and Postural Neurology.
Stenosis Pain Relief and Treatment
If you have stenosis, don’t ever feel that you are stuck with this pain and need to learn to deal with it for the rest of your life. Don’t make yourself into a walking pharmacy and don’t think surgery is your only solution; frankly, it is far from the solution! Chiropractic adjustments won’t help you long term either because adjustments or spinal manipulations simply activate your nervous system just as a teacher walking in announcing that she had exciting news makes the students become curious and attentive. If there is hardly any news, the students lose interest and go back to the state they were at. When you get physical therapy, movement is introduced; there is some relief because movement IS what we are to do, but when the area or nearby areas are addressed and when the pain is decreased, the patient is released of care, we are not finishing what we started.
Movement is a concert and the body parts are the metaphoric musicians; the brain is the conductor and the map of the movement and sensation called Homunculus (we are born with it but it is fine-tuned the first few years of life) is the musical notes. Going after a musician or two to try to improve their performance, expecting the concert to be ideal is not the right answer. We need to make sure all factors IMPACTING the concert, including when the musicians chime in and fade out are involved and need to be looked at. Now we are talking about Postural Neurology and Functional Movement.
The map, homunculus, is directly impacted by our lifestyle and needs. If you don’t use or overuse part(s) of your body, this map gets modified. So for instance, if you sit too much, the part of your brain with the command upright against gravity does not get to ‘practice’ therefore becomes smaller in size and performs less and less. Now, unless you make a conscious effort to stand or sit upright, you don’t do it naturally. We both know what happens when you get distracted! That’s right, you slouch again! That is because it was not your brain, the master coordinator, that sent that command and it did not do that because your lifestyle and decisions directly influence the homunculus.
In the case of Stenosis, typically by the time patients come to my office, they have exhausted so many options and are almost hopeless. The major joints in movement, not necessarily the spine are impacted due to the chronic nature of stenosis before patients get to the ‘real answer’ so functional rehab therapies such as ART or Active Release Techniques need to be performed for a few visits.
While many request Cold Laser Therapy, it is not as effective as it would have been at the initial presentation of the condition. Cold Laser Therapy will NOT make Stenosis go away nor make its symptoms disappear forever!
Through postural neurology assessment, the neurology behind your posture, we can see what parts of the brain are not up to par, and just like anything that is weak and gets worked out, we see improvement, by exercising those parts of the brain that were weak, we start seeing improvement in the ‘map’ when it comes to movement and sensation. But we are not done there YET!!
Now we need to have our ‘mock concert’ and mini practices to make sure the concert is outstanding just as the design of our body is outstanding. The best part of it all is that you don’t have to memorize anything!We are designed to move that way and are born with the blue print to do so. Have you noticed how every newborn is so weak and needy but somehow despite our difference on the surface, all babies have the same developmental stages? That is because we automatically follow how we are designed to move (biological patterns of movement). Watch this video which explains it more!
Please understand that we thankfully won’t die from stenosis or issues with our movements; we all can move from point A to B but when the biological patterns of movement become pathological, due to the modification of the Homunculus, the aches and pains, injuries and re-injuries and the change in our activities begin. Here is a great video on the very issue:
By correcting the pathological patterns of movement you have developed and reestablishing the correct patterns in the brain, we have what it takes to not only treat your pain but prevent further damage, which brings me to the next question..
Can stenosis be reversed?
Stenosis is present and will not go away but it can certainly become ‘less loud’ with the right treatment and most importantly, you can learn how to prevent it from getting worse by learning a bit more about movement and the do’s and don’ts of movement.
Symptom-free stenosis can be achieved by activating your stabilizing system to reestablish that strong foundation we talked about and just like the first thing we do when we are born, this starts with breathing! With the exception of professional singers, no-one in my practice breathes the right way and that includes the competitive athletes that I treat. Here is what I mean by that!
With the correct breathing pattern, we can continue to build on that foundation adding other movements and loads. You can check out my YouTube channel under the playlist Functional movement and Postural Neurology to better understand what these exercises look like.
Stenosis, when to have surgery
Surgery should not even come to mind unless you have tried Postural Neurology and Functional Movement. If you don’t want to put in the work, then this blog is not for you because even with surgery, the same principles have to be implemented or you will have pain and misery coming your way. Watch this video to understand what I am talking about.
It is not fun to live with pain, but that does not have to be your story and unless you like taking meds and having surgery, Stenosis is treatable. Remember, you are the Designer and the Director of your own life so design and direct it the way you wish to live it.
Yours for better health, always,
Mamak Shakib, DC