05 Apr Pain Management Techniques for Spinal Stenosis
Spinal stenosis occurs when the passageways that house our spinal cord and nerves become constricted. Whether this occurs due to a herniated disc, bone spur, or another anomaly, the outcome is essentially the same. The nerves that feed our limbs become compressed, leading to the classic symptoms that we associate with nerve irritation.
What Causes Spinal Stenosis?
Typically, unless you sustain an acute injury, spinal stenosis doesn’t usually occur overnight. Instead, it’s caused by the gradual deterioration of the spine, particularly in patients older than 45. For example, common age-related causes of spinal stenosis include:
- Osteoarthritis with Bone Spurs: Osteoarthritis occurs when the protective cartilage that lines our spine begins to erode from excess friction. Without this smooth, rubbery barrier, our vertebrae knock into one another instead of gliding smoothly. Needless to say, your body doesn’t like this. In an effort to compensate for this lost cartilage, your body produces bone spurs—tiny outcroppings of bone that protrude into all the wrong places. These bone spurs often develop in the foramina, a series of holes that allow your nerves to exit from your spine. The end result: nerve impingement and chronic pain.
- Thickened Ligamentum Flavum: The ligamentum flavum, located on the posterior of the spine, allows you to stand upright. As such, this tiny structure bears a tremendous load. Over time, this structure can harden, bulging into the spinal column and pinching adjacent nerves.
- Herniated Discs & Degenerative Disc Disease: Disc degeneration is another unsavory aspect of aging. Your intervertebral discs, a fibrocartilagenous material, serve to cushion your spine from jolts and bumps. As we age, however, these discs tend to lose their flexibility and dry out (or desiccate). Ultimately, this means a higher probability of sustaining a rupture, aka a disc herniation. When an intervertebral disc ruptures, it releases its internal contents into the joint space, causing obstructions that lead to pinched nerves.
Non-Age-Related Causes of Spinal Stenosis
Spinal stenosis can also occur as the result of several conditions that don’t directly involve wear-and-tear of the spine. These may include:
- Spinal Injuries: Any abrupt trauma—whether a slip and fall, motorcycle accident, or sports injury—can lead to spine damage that creates occlusions in the spinal passageways.
- Cancerous Growths: Spinal tumors can be extradural (located outside the sheath surrounding the spinal cord) or intradural-extramedullary (located inside the aforementioned barrier). Regardless of placement, tumors take up prime real estate in the spine, often leading to nerve compression.
- Spinal Deformities: Abnormalities in the orientation of the spine (such as scoliosis or kyphosis) create unhealthy bends and twists in the spine. As the spine folds backward on itself, the nerves can suffer bending and dysfunction.
Do I Have the Symptoms of Spinal Stenosis?
Spinal stenosis has certain tell-tale symptoms, depending on the location of the nerve impingement. Common symptoms of spinal stenosis include:
- Nerve Pain: Also known as radiculopathy, nerve pain often presents itself as an icy-hot or burning sensation in the limbs. In addition to this pins-and-needles sensation, you may also experience numbness or muscular weakness in the extremities.
- Sciatica: Lumbar spinal stenosis (i.e. affecting the lower back) may or may not involve sciatica, aka pinching of the sciatic nerve. Your sciatic nerve, the largest nerve in the body, runs from your lower back all the way down to your feet. When this nerve becomes compressed, you may feel an electric jolt of searing pain from your hip to your feet.
- Cervical Radiculopathy: Cervical radiculopathy affects the neck, where spinal nerves supply sensation to the fingers and arms. Aside from a burning or tingling sensation in the arms, this can disrupt hand strength, leading to interruptions in simple tasks like gripping a coffee mug.
- Loss of Fine & Gross Motor Control: Your nerves relay signals from your brain (the site of intention and awareness) to your limbs (where we execute most of our movements). However, a pinched nerve cannot transmit these messages properly, leading to disruptions in motor control. Both fine (small muscle groups that control tasks such as buttoning a shirt) and gross (large muscle groups that coordinate activities such as walking) motor control may suffer as a result. This may even affect your balance.
In severe cases of spinal stenosis, you may even lose bowel or bladder control. This phenomenon, known as cauda equina syndrome, is considered a medical emergency. Without prompt treatment, you could suffer dire consequences like permanent leg paralysis. If you notice numbness in your saddle region—the area of your body that would touch a saddle during horseback riding—seek immediate medical attention.
Diagnosing Spinal Stenosis
So, you’re pretty confident that you have spinal stenosis. What comes next?
Your medical provider will perform a detailed analysis of your medical history and symptoms, including a visual inspection of the injured area with light palpation (or touch). Because spinal stenosis affects both balance and motor control, your doctor may ask you to perform certain simple tasks. These may include watching how you walk for any gait disruptions or an assessment of handgrip strength.
If your doctor feels confident that you might have spinal stenosis also, he or she will order a series of follow-up tests. These visualization techniques may include:
- Magnetic Resonance Imaging (MRI): An MRI uses a combination of magnetism and radiofrequency currents to generate detailed images of the body’s soft tissues. This technique is ideal for detecting issues such as spinal cord or nerve damage, herniated discs, pinched nerves, etc.
- CT Scan: A CT scan uses computer technology to combine multiple x-ray images of a body part into a 3D representation. Like an MRI, a CT scan allows for the visualization of soft tissue structures.
- X-ray:An x-ray enables your physician to obtain a closer look at the vertebrae of your spine. Because spinal stenosis is often caused by issues that affect bony anatomy—bone spurs, injuries, etc.—this simple technique can reveal quite a lot.
At-Home Treatments for Spinal Stenosis
If you’ve been diagnosed with spinal stenosis, your doctor will recommend the least invasive form of treatment that suits your situation. An estimated 85-90% of patients will improve through the use of non-surgical interventions, such as physical therapy. A rare few, however, will go on to require surgery.
Before attempting any of these self-remedies at home, please consult with your medical provider. Suggested at-home treatments for spinal stenosis may include:
- Ice & Heat Application: If you’ve ever played sports, you’re probably familiar with this technique. Applying ice to a sore area has a numbing effect that reduces tenderness and inflammation. In contrast, heat application increases the blood flow to an area, drawing healing factors in the blood directly to the site of the injury. But, don’t overdo it. As a rule of thumb, apply ice/heat for 15 minutes no more than once an hour. Alternate between these modalities as recommended by your doctor.
- Rest: Certain activities, for example, spinal extension, tend to irritate spinal stenosis. As such, your doctor may recommend modifying your activities. This could include adding forward flexion poses into your daily routine to allow your spine to rest.
- Exercise: Although your doctor will suggest pain-relieving hacks such as the above to relieve your spinal stenosis, you should not succumb to complete inactivity. An inactive spine is a stiff spine. Work with your doctor or a physical therapist to develop a regimen of exercises, including flexibility training and core work, that best suit your situation.
- NSAIDs: Taking non-steroidal anti-inflammatory drugs, such as ibuprofen or acetaminophen, can relieve mild pain and inflammation. As always, take over-the-counter medications only as directed by your physician.
Nonsurgical Pain Management Techniques for Spinal Stenosis
Sometimes, at-home remedies simply don’t cut it. Luckily, there are a plethora of empirically-proven nonsurgical treatments that you can access through your healthcare provider. Some of these interventions include:
- Physical Therapy: As we’ve already mentioned, exercise is key in spinal stenosis pain management. A physical therapist will develop exercises that enable you to augment musculoskeletal strength, enhance flexibility, and improve coordination.
- Occupational Therapy: An occupational therapist assists patients with strategies that help them to rebuild functional independence. Usually, this involves exercises, adaptations, and modifications for performing the activities of daily living, or ADLs. For instance, following a spinal cord injury, an OT may help a patient relearn how to dress or make transfers from a seated to standing position, etc.
- Chiropractic Care: Does your spinal stenosis result from misalignment of the spine or a bulging disc? If so, a skilled chiropractor may be able to help. Manual manipulation of the spine via a technique called HVLA (high-velocity, low-amplitude thrust) can relieve stress on the nerves by correcting spinal position.
- Massage Therapy: Achy muscles from spinal stenosis? Studies suggest that deep tissue massage, acupressure, and cranial-sacral therapy can provide temporary relief. For best results, repeat visits to a licensed massage therapist are recommended.
- Medication Management: If over-the-counter medications such as ibuprofen don’t provide you with sufficient relief, your doctor may suggest prescription-strength drugs. These medications, which include opioids, anti-seizure medications, and antidepressants, require careful monitoring by a licensed professional. In particular, opioids contain addictive properties that necessitate proper medication management by an ethical physician.
- Steroid Injections: Steroidal injections involve the administration of a corticosteroid via a needle at the site of irritated nerves. This technique, while effective, provides only temporary results. Follow-up shots are required to achieve ongoing relief.
Finding the Right Customizable Solution for You
When it comes to spinal stenosis, not every patient is a proper candidate for nonsurgical treatments. In some cases, surgical interventions, like decompression procedures, may be required to restore your quality of life.
But, there is some good news:
85-90% of patients will be able to manage their spinal stenosis symptoms using only conservative treatments.
Your recovery potential, however, greatly improves when you enlist a team of qualified professionals who collaborate to craft a treatment plan that best suits your specific needs.
At the Injury Care Center, our multidisciplinary team of experts includes pain management physicians; physical, occupational, and massage therapists; and chiropractors. This gives you something that other injury care centers simply don’t have: a multi-modal approach to addressing spinal dysfunction.
Give yourself the care that you deserve today. Contact one of our patient advocates at (877) 444-2422. Your back will thank you!