Spinal stenosis

Spinal stenosis means that a narrowing occurs in the spinal canal, which can put pressure on the nerves. The condition is common, especially in people over the age of 60. Symptoms may develop gradually in some individuals, while others experience more pronounced problems. To receive the right treatment, it is important to recognize the signs of spinal stenosis early.

Common symptoms of spinal stenosis

Below are common symptoms that occur with spinal stenosis and what is typical for the condition.

• Lower back pain – often experienced as dull, aching, or burning.
• Radiating pain in the legs – especially when walking or standing still.
• Numbness or tingling in the legs and feet.
• Muscle weakness – for example, difficulty lifting the foot (this is called “foot drop”).
• Difficulty walking – it may be hard to walk, and you may need to stop frequently or lean forward to reduce pain that occurs during walking.
• Impaired balance – especially noticeable during longer walks.

3 typical characteristics of spinal stenosis

1. Symptoms worsen with load-bearing activities such as walking or standing for long periods.
2. Pain is often relieved when sitting down or bending forward.
3. It is common for both legs to be affected, even though symptoms may be one-sided.

When should you seek medical care?

You should contact healthcare services if you experience or have problems with the following:

• Numbness, weakness, or walking difficulties that affect your daily life.
• Pain that does not improve with self-care and exercises.
• Loss of bladder or bowel control (this is an emergency condition – seek medical care immediately).

What happens in the body with spinal stenosis?

In spinal stenosis, the space within the spinal canal becomes narrower. This often occurs due to age-related changes such as thickened ligaments, disc bulges, or bony overgrowths. When this happens, pressure may be placed on the spinal cord or nerve roots, leading to the symptoms described above.

Central spinal stenosis

In central spinal stenosis, the narrowing occurs in the central part of the spinal canal. This can affect several nerve roots at the same time and often causes symptoms in both legs. Common problems include difficulty walking, muscle weakness, and pain that worsens with exertion – a condition known as neurogenic claudication.

Foraminal narrowing (lateral stenosis)

Foraminal narrowing means that the nerve exit openings (intervertebral foramina) become narrower. This often causes one-sided symptoms, such as pain or numbness radiating down one leg. This type of stenosis is often caused by disc degeneration, bony overgrowths, or vertebral slippage that compresses the nerve root.

Treatment of spinal stenosis

If you have spinal stenosis, your treatment is tailored to how severe your symptoms are. The goal of treatment is to reduce pain and improve mobility.

• Physiotherapy: Exercise programs focusing on strengthening the back and abdominal muscles.
• Pain relief: Medications such as paracetamol, NSAIDs, or muscle relaxants may be recommended.
• Lifestyle adjustments: If needed, weight loss, assistive devices, or walking aids may be part of the treatment.
• Injections: Corticosteroid injections may also be offered to reduce inflammation around the nerves.

In more severe cases, or when the above treatments do not help, surgery may be considered:

• Decompression: This involves removing the structures that are compressing the nerves.
• Stabilizing surgery: In some cases, decompression is combined with spinal fusion to stabilize the spine.

The advantage of surgery is that it often provides good symptom relief, especially if you have severe walking difficulties or muscle weakness.

Exercises can reduce symptoms

To reduce symptoms of spinal stenosis, it is important to perform the right type of exercise. The focus should be on:

• Strengthening the core muscles, including the back and abdomen
• Improving posture and walking pattern
• Increasing mobility in both the hips and the lower back

5 good exercises for spinal stenosis

1. Supine lumbar flexion: Start by lying on your back and then pull both knees toward your chest. Hold for a few seconds and repeat 10 times.
2. Cat–Cow stretch: Get on all fours with your hands and knees on the floor or an exercise mat. Alternate between rounding and arching your back. Be cautious with the arched position—do not go too deep and stay longer in the rounded position than in the arch. If it feels uncomfortable, you can perform only the “cow”-position, meaning rounding of the back.
3. Pelvic lift (bridge): Lie on your back with your knees bent, lift your pelvis, and hold for 5 seconds.
4. Air cycling: Lie down and perform cycling movements with your legs to promote circulation and nerve mobility.
5. Walking in a slightly forward-leaning position: For example, using a walker or leaning on a shopping cart.

Stop the exercises immediately if symptoms in the back or legs worsen.

Avoid the following with spinal stenosis

• Running or jumping exercises that increase load on the spine.
• Heavy lifting and activities that require backward bending (extension) of the lower back.
• Prolonged static standing without the opportunity for breaks.
• Back exercises that increase lumbar arching.

How can you find out if you have spinal stenosis?

Diagnosis is made through a medical evaluation that begins with a clinical examination by a physician, who assesses your symptoms, reflexes, walking pattern, and sensation in the legs. If spinal stenosis is suspected, the physician usually refers you for diagnostic imaging, most commonly:

• MRI (Magnetic Resonance Imaging): An lumbar spine MRI examination is the best method for visualizing narrowing of the spinal canal and nerve involvement.
• Computed Tomography (CT): This method may be used if MRI is not possible and is often performed with contrast.
• X-ray: Shows changes in bone structures but not soft tissues or nerves.

A correct diagnosis is made when the clinical symptoms match the findings on imaging.