Spinal stenosis is one of the most common causes of back pain in older adults. Affecting millions of people from their fifth decade on, stenosis is one of the chief causes of pain and loss of physical function.
The diagnosis of spinal stenosis is made both clinically and through imaging studies such as an X-ray or an MRI. Spinal stenosis presents very differently from other low back disorders and is easy to spot to a trained clinician.
The treatment for spinal stenosis differs appreciably from other low back disorders, so accurate diagnosis is essential when starting the rehabilitation process. If you've been wondering why your back and legs have been hurting, or if you have suspected this problem in the past, here are the top seven signs of spinal stenosis that may help you diagnose the disorder.
1 If you walk bent over, you may want to get checked out. Spinal stenosis forces the spine into a flexed or "bent forward" position. The load assumed through the spine, especially during walking, surpasses what the vertebrae and discs in the back are able to support. This causes a bending of the spine — an attempt by the back to un-weight some of the pressure. The most common example is the "grocery cart" sign. People who normally have trouble walking can walk much further than usual when they can lean on a grocery cart.
2 If your back gets heavy, spinal stenosis may be the problem. Spinal stenosis causes a pinching of the sensitive nerves in the back. These nerves control everything from sensation to vital motor function of the legs. When the nerves are compromised from the pressure of spinal stenosis, the back will take on a heavy feeling, forcing you to change positions or even sit down.
3 If you prefer sitting down to standing up, you should consider that spinal stenosis may be the reason why. Most forms of mechanical low back pain are eased with some movement and upright postures. Spinal stenosis is one of the few diagnoses that is alleviated with sitting down. Other pathologies such as disc bulges and herniations are made worse with sitting. If you're always looking around for the nearest chair, you may want to make the next chair you sit in be at your doctor's office.
4 If the reflexes in your ankles and knees are absent, you should get checked out. Spinal stenosis (usually, but not always) presents with a high degree of symmetry on both sides of the back. Because it occurs symmetrically, both legs are often affected and one of the first signs to show is a loss of reflexes - typically the ankle before the knee.
5 Do your legs feel weak and heavy? If so, that's a sign your nerves are getting pinched. The nerves in your back directly control the function of your legs. Any pinching of these nerves will alter the sensation in your legs and also cause strength loss. You may feel like your knees want to give way or that it's hard to pick up your feet when you walk. While this occurs in more severe cases, the onset of these problems is gradual, so get checked out at the first sign of trouble.
6 If your doctor has told you in the past that you have significant arthritis, it may have progressed to stenosis. Stenosis is arthritis - its just significantly advanced compared to the general population and to what is considered normal spine anatomy. If you're experiencing any other signs and you know you have 'bad arthritis' it wouldn't hurt to be examined by a spine clinician.
7 If straightening your back makes your legs go to sleep, you most likely have significant spinal stenosis. Extension of the lumbar spine further compromises the holes where the nerves exit the spinal cord. During back extension (straightening), these holes are closed and in some cases, shut. A normal spine can accommodate periods of closing without issue, but a stenotic spine won't tolerate extension for more than a few moments.
Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He writes "On the Mend" weekly. Questions may be submitted to Joe by e-mail: email@example.com.