Spinal stenosis is narrowing of the spinal canal. It is often multi-factorial and involves wear and tear of the spine where the facet joints – the hinge joints in the back of the spine – become arthritic and have bone spurs that then encroach upon the nerves as they exit the spine. Those facet joints themselves can become painful and cause axial lower back pain. The nerves are irritated, which will cause pain going down into the leg that is usually worse with standing and walking and usually feels better with sitting.
Facet joint pain is one topic, but here we are going to about treating the leg pain from spinal stenosis. The primary features of treating spinal stenosis first is identifying where its coming from and the anatomical causes of it, and then reducing the inflammation around the nerve roots, and then addressing the biomechanics to stretch and strengthen the muscles to help take the pressure off that segment of the spine in order for the pain and the inflammation not to return.
Often this begins with physical therapy, with exercises, with stretching, with strengthening, with addressing the mechanics to unload the spine.
Along the way with that, oral medications can be very helpful in terms of helping with the pain associated with the spinal stenosis. The oral medications are not going to fix the spinal stenosis, but they can certainly help someone participate in physical therapy and help to just mitigate the symptoms as one is getting better.
Other modalities within physical therapy besides exercises include ultrasound, TENS units, manual manipulations, other passive modalities that are designed both to control the symptoms and also, ideally, to take some of the pressure off of those nerve roots that are irritated.
When the pain is not getting better with the physical therapy, or if the pain is interfering with a person’s ability to participate with the physical therapy exercises, then sometimes a targeted epidural steroid injection in order to reduce the inflammation around the nerve root can be very helpful. An epidural steroid injection is not going to change the spinal stenosis. It is not going to make the canal wider. It’s not going to mask anything either. What it’s going to do is reduce the inflammation and allow for a “window of opportunity” during which the person can participate more fully with their exercises – with physical therapy – in order to stretch, to strengthen, and ideally tweak the biomechanics so that, as time goes on, the pain and the inflammation doesn’t return because that segment of the spine is no longer seeing the same mechanical forces.
Sometimes, depending on the anatomy, depending on the person, if physical therapy and injections aren’t helping in order to take away the inflammation, its appropriate to talk to a spinal surgeon and to consider their surgical alternatives.