Stenosis
Pathology: It is a congenital or acquired degenerative condition that involves the narrowing of any of the spinal canal and/or spinal foramen.
Demographics:
Spinal stenosis is typically associated with individuals above the age of fifty.
Spinal stenosis is a disease manifest by one, or a combination, of the following:
- Tingling
- Cramping
- In more severe cases, weakness of the lower extremities
In addition to the contributing factors listed above, faulty habitual postures can also contribute to this disorder by placing additional stress on some structures and reducing or increasing tension on other structures.
Clinical Presentation: Typically, this individual will present with a postural deviation of trunk flexion to help alleviate any pain or radicular symptoms associated with spinal stenosis. Chief complaints may include pain, numbness, and/or cramping in the legs with or without low back pain. This individual may state that prolonged standing and walking increases symptoms due to these activities placing the lumbar spine in extension; thus decreasing the room in the spinal canal and increasing the pressure placed on the affected nerve roots. On the other hand, activities such as sitting and walking while leaning over a shopping cart may alleviate the symptoms by placing the lumbar spine in flexion; thus increasing the room in the spinal canal and taking pressure off of the compressed nerve roots. The extent of symptoms depends on the degeneration present and each individual’s activity level. The history of onset of symptoms is typically a gradual onset due to the progressive degeneration that occurs as an individual ages.
Differential Diagnosis: Medical imaging may be done to detect/confirm spinal stenosis. The therapist should ask the individual any “red flag” associated questions during the exam that relate to cauda equina syndrome or cord compression with radicular symptoms referring to that area. It is also important to differentiate various spinal conditions from other severe conditions such as metastatic cancer, fracture, infection, and rheumatologic disorders (Humphreys, 1999).
Specific areas to assess during PT examination include:
claudication. The patient would be place on a stationary bicycle and would start to pedal. If the
patient’s symptoms were relieved when he/she bends forward toward the handlebars, then the
therapist could infer that this individual has neurogenic claudication. If the patient’s symptom were
not relieved when he/she bends forward toward the handlebars, then the therapist could infer that
this individual has vascular claudication. Since neurogenic claudication is commonly associated with
spinal stenosis, this patient would be likely to have his/her symptoms relieved when bending forward
during this specialized test (Dutton, 2008).
Clinical Bottom Line: Treat, Treat and Refer, or Refer Out depending on clinical presentation and any potential red flags present.
Demographics:
Spinal stenosis is typically associated with individuals above the age of fifty.
Spinal stenosis is a disease manifest by one, or a combination, of the following:
- Low back pain
- Pain and/or numbness in the lower extremities
- Neurogenic claudication of the lower extremities
- Tingling
- Cramping
- In more severe cases, weakness of the lower extremities
In addition to the contributing factors listed above, faulty habitual postures can also contribute to this disorder by placing additional stress on some structures and reducing or increasing tension on other structures.
Clinical Presentation: Typically, this individual will present with a postural deviation of trunk flexion to help alleviate any pain or radicular symptoms associated with spinal stenosis. Chief complaints may include pain, numbness, and/or cramping in the legs with or without low back pain. This individual may state that prolonged standing and walking increases symptoms due to these activities placing the lumbar spine in extension; thus decreasing the room in the spinal canal and increasing the pressure placed on the affected nerve roots. On the other hand, activities such as sitting and walking while leaning over a shopping cart may alleviate the symptoms by placing the lumbar spine in flexion; thus increasing the room in the spinal canal and taking pressure off of the compressed nerve roots. The extent of symptoms depends on the degeneration present and each individual’s activity level. The history of onset of symptoms is typically a gradual onset due to the progressive degeneration that occurs as an individual ages.
Differential Diagnosis: Medical imaging may be done to detect/confirm spinal stenosis. The therapist should ask the individual any “red flag” associated questions during the exam that relate to cauda equina syndrome or cord compression with radicular symptoms referring to that area. It is also important to differentiate various spinal conditions from other severe conditions such as metastatic cancer, fracture, infection, and rheumatologic disorders (Humphreys, 1999).
Specific areas to assess during PT examination include:
- Posture
- AROM
- PROM
- Functional movement
- Muscle length
- Screen above and below the joint
- Neurological screen
- Neuro-dynamics
- Palpation
- PAIVMs/PPIVMs
- Special tests
claudication. The patient would be place on a stationary bicycle and would start to pedal. If the
patient’s symptoms were relieved when he/she bends forward toward the handlebars, then the
therapist could infer that this individual has neurogenic claudication. If the patient’s symptom were
not relieved when he/she bends forward toward the handlebars, then the therapist could infer that
this individual has vascular claudication. Since neurogenic claudication is commonly associated with
spinal stenosis, this patient would be likely to have his/her symptoms relieved when bending forward
during this specialized test (Dutton, 2008).
Clinical Bottom Line: Treat, Treat and Refer, or Refer Out depending on clinical presentation and any potential red flags present.
