Mississsauga Chiropractor Presents: Lumbar Stenosis

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Here’s another blog from a Mississauga Chiropractor…

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A lumbar stenosis is the narrowing of the spinal canal causing potential neurologic symptoms due to compression of the spinal cord.  It is also knows as intermittent neurogenic claudication.  Stenosis may be central or lateral & caused by bone, soft tissue or both.

 

Demographics:

a)      Age:  usually affects the elderly (50 years old & older); incidence increases with age

b)      Gender:  Male > Female

 

History:

a)      Patients often present with an inconsistent pattern of leg & back pain that increases with activity & is relieved with rest

b)      Forward flexion may relieve the pain (this finding most suggests neurogenic claudication)

c)      Diffuse pain may be unilateral or bilateral

d)      Possible neurologic deficits

e)      Biomechanical analysis may reveal a loss of lumbar lordosis and/or posterior tilt of  the pelvis

 

Lateral Stenosis vs Central Stenosis:

Lateral Stenosis

Central Stenosis

Unilateral leg pain

Bilateral leg pain

Range    of Motion – limited in extension   due to increased pain

Range    of Motion – limited in extension   due to increased pain, flexion may   decrease pain

Lateral flexion   & rotation to the involved side increases pain

Supine straight leg   raise will cause neurogical signs

 

Comparison of Neurogenic Claudication, Vascular Claudication & Cauda Equina Syndrome:

Neurogic

  Claudication

Vascular

Claudication

Cauda Equina

Syndrome

Back Pain

Yes

No (usually)

Yes (usually)

Leg Pain

Proximal (closer to   hip)

Distal

Proximal &/or   Distal

Pulse

Normal

Decreased

Normal

Sensor/Motor

Decreased

Normal

Decreased

Tropic Changes

Muscle Atrophy   (sometimes)

Skin Atrophy,   ulcers & hair loss

Muscle atrophy (but   rare)

Imaging

x-ray:  Hypertrophic Changes

x-ray: may show   ateriosclerosis of vessels

MRI will show a   large central herniation

Activity/

Symptoms

Increased symptoms   with extension & decreased symptoms with flexion or lateral bending

Able to perform   specific activity duration before symptoms are present, followed by a   refractory period

Urinary retention,   incontinence, saddle anaesthia, loss of anal sphincter tone

 

Management:

a)      Flexion exercises should be emphasized, as they reduce lumbar lordosis & decrease stress on the spine

  1. Williams’ Flexion-Biased Exercises target increased lumbar lordosis, paraspinal/hamstring flexibility & abdominal muscles (exercises incorporate knee-to-chest maneuvers, pelvic tilts, wall-standing lumbar flexion.
  2. b.      Avoid extension movements as they will likely exacerbate the symptoms

 

b)      Lumbar distraction, bracing in a slightly flexed position

c)      Flexion/Distraction Mobilizations

d)      Massage Therapy

e)      Electrotherapy modality for pain management:  TENS, IFC

f)        Patient Education:  Positions to avoid (extension)

g)      Rehabilitation:

  1. Stretch & Strength Training – start with spine slightly flexed – core body strength

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