Stenosis is a word that a lot of people have heard of and might even relate it to some sort of spinal condition, but it is not often well understood. In short, the word stenosis means “narrowing.” In the lumbar spine, it implies the narrowing of a canal where either the spinal cord itself runs or where the spinal nerve exits the spine to travel down into the leg. The canals that these neural structures run through can become narrowed either by overgrowth of the bone that makes up the canal or by a nearby bulging disc. It is not the stenosis itself that causes symptoms, but the pressure that the narrowed canal puts on the nerves. That pressure can cause pain, numbness, tingling, or weakness in the back and legs, or disturbed bowel or bladder function. Symptoms often worsen with prolonged standing or walking and may improve when sitting or bending forward. It occurs most often in people over the age of 50 and can have a significant impact on the quality of life.
In my practice stenosis is a particularly concerning finding, because it often discourages people from being active since they can’t walk or be on their feet for any significant length of time. It engenders inactivity, which further perpetuates poor health and physical fitness, which in turn lead to more back problems. The beauty of this study is that it gives hope to those who suffer from lumbar spinal stenosis. What I like about it is that it advocates a multimodal approach, attacking the problem from multiple directions to produce a long term, effective solution. It is similar to the way we approach each of our patients’ concerns – through education , simple, progressive home care stretches and exercises, and effective chiropractic adjustments and manual therapies. We believe that the best results are achieved when both the healthcare provider and the patient take appropriate action to treat pain and prevent further injury and disability and this study is a fantastic example of this approach.
This study adds to the preponderance of evidence that chiropractic care is both a.) viable and effective as an initial option for conservative treatment of lumbar disc herniations, and b.) safe. Now, I’m not selling chiropractic as a magic bullet, one hit wonder, walk in the park, sure-fire quick fix for disc herniations. I try to give my patients realistic expectations and goals. The discs between your vertebrae do not heal quickly. They, like other ligamentous tissue, do not have a great blood supply, therefore they heal predictably slower than other tissues of the body. Thus recovery is inherently not as quick as most people would like. It is not realistic to expect a few adjustments to reduce a bulging disc or put a bone back into place and for all to be well again. Recovery is a process that involves multiple aspects, such as:
1. Education: Spine-sparing strategies are taught in order to avoid movements and positions that create more strain on the injured disc(s). This aspect of treatment is extremely important. When you have a herniated disc and a pinched nerve, there are some stretches that feel good in the short term, but in the long term are inhibiting the healing process. The first step is to educate to remove any barriers to a successful outcome.
2. Passive care: Passive care includes any external interventions, or those that don’t involve any effort on your part. This includes chiropractic adjustments (only one tool in our bag), joint mobilizations, traction, electrotherapy, low level laser, and kinesiotaping. Passive therapies are effective (as shown in the study above), but have their limitations and are not always as powerful as #1 and/or #3.
3. Active care: This includes anything that requires effort on your part, which is basically any of the stretches and exercises that you will be taught to perform in the office and at home to complement the passive portion of your treatment. This can make or break your recovery from lumbar disc herniation. No matter what condition we see in the office, the patients who see the best results and are happiest with the outcome of their treatment are those who are the most involved in their care and the most consistent with active care.
In this month’s research update we review a study that compares the success of spinal manipulation (chiropractic adjustments) vs that of surgery for sciatic pain. Sciatic pain is nerve pain that courses down the back of your leg due to a pinched nerve in your low back. The nerve is often pinched by a bulging or herniated disc and can cause severe pain, numbness, tingling, and weakness in your leg. If you have any of these symptoms and show up at your doctor’s office, you could end up undergoing a whole spectrum of treatments and tests. A common protocol is to treat a problem like this with conservative care first, unless immediate surgery is warranted. Then consider surgery as a last option if all else fails. As this study demonstrates, “conservative care” can mean any number of things. From the medical perspective, a course of conservative care can go as follows: Oral pain medications, muscle relaxants, and a physical therapy referral. If this fails, steroid injections may be ordered as a final “conservative” approach prior to surgery.
The beauty of this study is that the group that underwent chiropractic treatment had already received at least three months of other conservative treatments that had failed to resolve their pain. After all was said and done, chiropractic care out performed the other non-operative treatments and showed very similar results as surgery, as shown in the graph above. This demonstrates that, while not the only option, chiropractic care should be considered as a valid first option in the treatment of sciatica. Surgery can be quite effective, but one should note the potential risks and failure rate associated with surgery. If there is another option, it should be taken, especially if it is natural and has fewer potential risks and side effects. Be an educated consumer and patient. Advocate for yourself and ask your doctor what other options there are besides drugs and surgery. If those are necessary options, then ask what the risks and side effects are so you are clear about what you can expect.