April 12, 2017
When you experience neck or back pain, the cause may not always be obvious. After all, degenerative disc disease, a herniated disc, and sciatica are only a few of the many conditions that can cause moderate to severe pain around the spine. With myriad possible conditions to consider, how do you identify the definite source of your problem in order to treat it?
At Beacon Orthopaedics and Sports Medicine, Dr. Michael Rohmiller sees many of the patients who suffer from stiffness, numbness, or pain in their back. While many of his patients are already familiar with conditions like a herniated disc or sciatica, less are familiar with spinal stenosis let alone how to manage its symptoms.
The following information will help you determine if you should schedule an appointment with Dr. Rohmiller to talk about your back pain and the possibility of spinal stenosis.
An Overview of Spinal Stenosis
The spine is perhaps most recognized for the support and flexibility that it provides our bodies. After all, the spine, in combination with the various muscles attached to it, allows us to stand, sit upright and move through a full range of motion. Aside from simply providing structure, it plays another crucial role – protecting your spinal cord.
Your spine, which is also called your vertebral column, consists of thirty-three individual bones that interlock with each other. These bones, called vertebrae, are divided into four groups based on their location: the cervical curve (neck), thoracic curve (upper back), lumbar curve (lower back) and sacral curve (pelvis.) These vertebrae house and protect your spinal cord, which carries messages between your brain and body. These messages are transmitted through nerves that branch off of the spinal cord and exit through the openings between vertebrae.
In other words, the vertebral column consists of three types of space:
- The space at the center of the spine
- The canals where nerves connect to the spine
- The space between vertebrae
Spinal stenosis is the narrowing of one or more of these areas. This narrowing places pressure on the spinal cord, resulting in moderate to severe pain as well as other symptoms.
Symptoms of Spinal Stenosis
The general symptoms of spinal stenosis include:
- Back pain
- Muscle weakness
- Bladder problems
- Bowel problems
Because narrowing can develop in several different areas within the spine, there are specific forms of the disease based on these locations. Cervical spinal stenosis, which affects the neck, and lumbar spinal stenosis, which affects the lower back, are the two most common forms. Thoracic spinal stenosis, which affects the middle and upper back, is less common. In addition to the aforementioned symptoms, each form has specific symptoms.
Cervical Spinal Stenosis
Cervical stenosis is progressive narrowing within the neck region which pinches the spinal cord. This can cause numbness, weakness or tingling in the arm, hand, leg, or foot. In fact, tingling in the hand is the most common symptom of this particular condition.
Symptoms of cervical stenosis include:
- Difficulty with walking and balance
- Difficulty with fine motor skills (such as writing)
- Heaviness in the legs
- Sporadic, shooting pain in the arm or leg
Lumbar Spinal Stenosis
Lumbar stenosis occurs when the spinal cord within the lower back is compressed. Unlike the stenosis that occurs in the neck, narrowing within this region is not always progressive.
Leg pain is the primary symptom of lumbar stenosis. This pain can occur while standing for long periods of time or walking. While most individuals are able to achieve temporary relief by sitting or leaning forward, the pain often returns once they stand up again or sit up straight.
Thoracic Spinal Stenosis
Thoracic stenosis is the progressive and degenerative narrowing of the middle and upper region of the spine. Although it’s rare, it can develop on its own or even accompany other forms of the condition.
Symptoms of thoracic stenosis include:
- Pain in the ribs
- Pain in the upper and middle back
- Pain radiating in the back of legs
- Difficulty walking
Causes, and Diagnosing Spinal Stenosis
While some individuals are born with conditions that cause or lead to stenosis, it is most often the result of structural changes and inflammation due to aging. For example, as someone ages, portions of their spine may become weak. In an effort to stabilize the spine, their bones and joints may thicken and enlarge. This decreases the amount of available space for the spinal cord. Moreover, middle-aged and elderly individuals are also more likely to develop osteoarthritis, rheumatoid arthritis, or another form of inflammation that will further decrease space.
Aside from the degenerative aging process, other causes of spinal stenosis include:
- Paget’s disease of bone
- Ossification of ligaments
It’s possible to have spinal stenosis and not experience any warning signs. A physician will be able to rule out other conditions, determine the amount of narrowing that is present and advise the most appropriate treatment. Many doctors will try to solve or reverse spine problems using conservative methods like physical therapy before discussing surgical options.
Treatments for Spinal Stenosis
If your symptoms are mild, there are steps that you can take to manage them better. As with any major change to your lifestyle, you should talk to a physician first.
Staying active is one of the most important things that you can do to manage your symptoms. In fact, exercise and physical therapy are components of most treatment plans. These exercises often include slow and repetitive activities that will improve the patient’s range of motion, strength, endurance and stability. Individuals with lumbar stenosis, in particular, may find bicycle riding to be their preferred exercise since they can lean forward and temporarily relieve their pain at same time. Others may prefer the gentleness of yoga or tai chi.
Pay particular attention to your posture and movements throughout the day. Does your neck hurt from looking up at a computer screen all day? Adjust your office chair so your eyes become level with it. Does your back hurt while you are browsing the grocery aisles? Lean on a shopping cart while you walk. While these seem like minor adjustments, you likely have a number of opportunities throughout a typical day to modify your behaviors and reduce the overall stress on your back.
Professional spinal adjustments can not only provide symptom relief but also restore a patient’s range of motion. Techniques can even be used to open space within the spinal canal and relieve pressure, thereby addressing the primary issue caused by stenosis. Be sure to speak with an orthopedic specialist before beginning a chiropractic care plan since certain techniques may exacerbate or worsen your spinal condition.
As with other orthopedic conditions, surgery is often reserved for individuals whose pain is so severe that it limits their ability to live normally and who have attempted conservative forms of treatment to no avail. With that in mind, surgery can be highly effective for the right types of patients, especially when performed by an experienced surgeon and when the patient completes physical therapy.
Let Dr. Rohmiller Identify the Source of Your Pain
You can’t properly treat a problem without first knowing its source. Dr. Rohmiller provides over a decade of expertise in spine health, including pediatric spine surgery and scoliosis, adult scoliosis surgery, and minimally invasive surgery of the spine. He can identify the exact source of your back pain and develop the most effective treatment plan for you.