About Physiatry

About Physiatry

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Lumbar Stenosis

Condition: Lumbar spinal stenosis (LSS) is a condition that can cause low back pain with numbness, tingling, burning and/or weakness in the legs. This is due to pressure on the spinal cord or the nerves that provide feeling and strength to the legs. Physiatrists or physical medicine and rehabilitation doctors specialize in treating LSS with the goal of restoring function and avoiding surgery unless absolutely necessary.

Background: The most common cause of LSS is wear and tear in the spine, due to aging and arthritis. There are also other, less common, causes for spinal stenosis such as injury, birth defects, rheumatoid arthritis, bone disease, tumors, and herniated disks.

Risk Factors: The likelihood of having spinal stenosis increases as we age. The most common reason for spinal surgery in patients above 65 years old is spinal stenosis.

History and Symptoms: The most common symptom of LSS is pain in the low back, buttocks, thigh, calf, and groin. Patients may also experience tingling sensations, weakness, cramping, or fatigue in the legs. The symptoms are usually worse with walking or standing, and better with sitting or leaning forward, such as leaning over a shopping cart.

Physical Exam: The doctor will examine your spine in the lower back by looking for sources of pain, changes in the movement of your back and hips. Your muscle strength, sensation, and reflexes will also be tested. You will be asked to take a short walk, as the doctor looks for any balance problems. Functional surveys may be used to assess patient limitations.

Diagnostic Process: The diagnosis of LSS is based on the patient’s symptoms and not on imaging alone. Patients without symptoms may also have findings of stenosis on X-rays and MRI. Therefore, history and examination are crucial in diagnosing LSS. Commonly used imaging options include X-ray, MRI and CT imaging. Electrodiagnostic studies can also be used in combination with these other techniques.

Rehab Management: Physical medicine and rehabilitation (PM&R) physicians who are trained in spine care are experts in rehabilitation management of low back pain and spinal stenosis. Treatment includes rehabilitation exercises in physical therapy focusing on posture correction, core strengthening and hamstring flexibility. Back support braces may be used for a short period of time to provide support, but long-term use can weaken your core muscles. Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), nerve pain medications, and muscle relaxants, are options to help control the pain while participating in a rehabilitation program. Epidural steroid injections, acupuncture, and electrical stimulation can also be used for symptom relief. Surgical referral is another option, and 80% of patients report some symptom relief after surgery.

Other Resources for Patients and Families: Home exercise programs are useful for patients to maintain mobility, strength, and range of motion. Although patients may experience relief from epidural steroid injections or medications, these effects are generally temporary, and rehabilitation is essential.

For Patients and Families:

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