As we age, our bodies go through many changes associated with aging. We often find that we are unable to do the things that we could do even just 10 years ago. It is normal as we get older to not be as strong or agile as we used to be. We may not walk as steady as when we were younger, or we may have difficulty controlling our bladder. We may begin having aches and pains that we haven't had before, or it may be more difficult to stand up straight.
All of these can be perfectly normal and there may be nothing to do except adjust to the changes. But, what if there was something to do? What if some of these conditions could be reversed? Wouldn't you want to be able to stand up straighter, walk farther, and have less pain?
No, I am not talking about a fountain of youth, but many of the signs and symptoms of spinal stenosis are often accepted as normal. Consequently, they are never evaluated or treated until they become severe.
Spinal stenosis is a condition that squeezes the nerves within the spinal canal or as they exit the spinal canal. This may occur when arthritis in your back causes bone spurs to grow and press on nerves. Another common cause is overgrown ligaments, from a lifetime of lifting and bending, crowding into the space for the nerves. A third possibility is a bulging disk pushing on nerve.
Most people with spinal stenosis have some combination of these three things compressing one or more nerves, most commonly in the lumbar spine. Symptoms may be seen in whatever dermatome or area those nerves serve.
If the nerves that control your bowels or bladder are affected you may have difficulty controlling your bowels or bladder. If the nerves that control the muscles in your legs are being crushed, you may have weakness or cramps or difficulty controlling your legs. If the stenosis is affecting the sensory nerves you may have numbness or tingling in your lower extremities.
The severity of the symptoms will generally be proportional to the severity of the stenosis. Severe stenosis will cause dramatic symptoms, but mild stenosis may cause symptoms that develop so gradually they are recognized as normal for your age.
The most common symptom of spinal stenosis that causes people to seek treatment is pain. Often there is low back pain radiating down into your legs. The pain of sciatica is often described as a deep severe ache in the buttock and thigh on one or both sides. The pain may radiate into the lower leg and foot.
The sciatica pain of spinal stenosis may be worse when you try to walk, and quickly relieved by bending forward or sitting down. Many people with stenosis find that they can ride a bicycle for 30 minutes or more, but they are unable to walk for 5 minutes without pain.
The most common symptom of spinal stenosis may be pain, but there can be many other subtle signs. The changes caused by spinal stenosis can be very variable and affect anything in the lower half of your body that is controlled by nerves.
You may have difficulty rising from a chair or stepping up onto a curb because of mild weakness in your legs. You may begin developing urinary tract infections because you are unable to completely empty your bladder, or you may become unsteady on your feet because you are unable to feel the floor.
You may walk forward flexed because standing up straight puts pressure on the nerves and causes pain. You may find yourself shuffling or dragging your feet and tripping over small objects such as a garden hose or a door threshold. You may leak a little urine, or occasionally soil your underwear without knowing it.
Anything that is controlled by your nerves can be affected by spinal stenosis. It develops over years, or even decades, and the symptoms may develop so slowly that you hardly notice the change. The best time to fix spinal stenosis is when your symptoms are mild and not yet debilitating. If you wait until your symptoms are severe, treatment is more difficult, and complete relief is less certain.
The best treatment for your spinal stenosis will depend on exactly what is causing your stenosis. Early on, symptoms may respond to something as simple as physical therapy and postural correction. Physical therapy can teach you exercises to strengthen your core and help you lose weight, as well as correct your posture.
If your symptoms do not improve with conservative treatments, your doctor may talk to you about more aggressive therapies such as steroid injections. Sometimes steroid injections around the nerves can reduce swelling and relieve the pressure that is causing the problem. The response to these is often very variable, with some people getting complete relief and others getting no relief. Most people get at least partial relief, and many times more than one injection is required.
Persistent symptoms that are severe enough to limit your lifestyle may require more invasive therapy such as surgery. Surgery for spinal stenosis usually involves removing the bones or ligaments that are pressing on the nerves. Modern techniques and equipment have been devised to accomplish this through small incisions with limited damage to the muscles and other tissues.
When spinal stenosis is diagnosed before it is severe, there is often a complete resolution of the symptoms and return to full activity. But when symptoms are allowed to persist for months or years, the nerves become more dysfunctional, the muscles become more deconditioned and weak, and complete relief is less certain.
To be fair, it must be said that many other diseases and conditions can cause each of these signs and symptoms. But when they occur together, spinal stenosis is one of the most common causes, and they are not the unavoidable result of being another year older.
As we age it is important to see the doctor and discuss any changes or problems that we may be having. You do not have to always accept the limitations of aging. It may not be the fountain of youth, but recognizing and treating the signs and symptoms of spinal stenosis can allow you to stay active for many more years.
David L Stevens PA-C
www.living-with-back-pain.org