Lumbar Spinal Stenosis

Lumbar Spinal Stenosis refers to a deteriorating condition involving narrowing of the lateral and central vertebral canals, which leads to compression or ischemia, or both, of the lumbosacral nerve roots.

Ammendolia et al. state that this could be the result of the osteoarthritic thickening of the articulating facet joints, infolding of the ligamentum flavum and/or degenerative bulging of the intervertebral discs.

Neurogenic claudication is one of the primary characteristic symptoms of the condition, which can be described as limping or cramping lumbar pain that radiates into the legs primarily during walking.

This pain is further exacerbated upon walking or standing and can greatly affect an individual’s quality of life by limiting mobility and independence, particularly in the elderly population.

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The pathophysiology of neurogenic claudication, according to Jon Lurie and Christy Tomkins-Lane, involves the ischemic theory or the venous stasis theory which are both based on the mechanical compression of nervous and vascular structures during lumbar extension.

Backstrom et al. prescribe a consistent four-fold approach to the physical therapy management of the patient with lumbar spinal stenosis – patient education, manual therapy, exercise and aerobic training.

The authors emphasis on the treatment of all elements of the musculoskeletal system and manual therapy that focuses on thrust and non-thrust mobilisation or manipulations to the lumbar and pelvic region.

Rehabilitative programmes need to include individualised exercises specific to the condition such as unweighted walking or cycling, spinal mobility and lumbar flexion exercises, hip mobility exercises, hip strengthening, and core strengthening.

The role of MASS4D® customised foot orthotics in treatment modalities for lumbar spinal stenosis would be as a preventative tool to protect the individual from recurrences by addressing biomechanical discrepancies that could further stress the affected regions.

These will also help promote optimal functionality in the lower limbs so as to eliminate any abnormal movements of the lower extremity such as an excessive anterior pelvic tilt resulting from hyperpronated feet, that could increase strain on the lumbar spine.

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Related Links
Facet Joint Syndrome
Core Stability – How It Affects The Lower Extremity
The Influence of Foot Posture On The Lumbar Spine

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References:

1. Lurie, J., Tomkins-Lane, C. (2016) Management of lumbar spinal stenosis. BMJ 2016: January 2016. DOI: 10.1136/bmj.h6234
2. Ammendolia, C., Stuber, K.J., Rok, E., Rampersaud, R., Kennedy, C.A., Pennick, V., Steenstra, I.A., de Bruin, L.K., Furlan, A.D. (2013) Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane database of systematic reviews: August 2013, No. 8. DOI 10.1002/14651858.CD010712
3. Backstrom, K. M., Whitman, J. M., Flynn, T. W. (2011) Lumbar spinal stenosis-diagnosis and management of the aging spine. Manual Therapy: March 2011, Vol. 16, pp. 308-317. DOI: 10.1016/j.math.2011.01.010
4. Siebert, E., Prüss, H., Klingebiel, R., Failli, V., Einhäupl, K. M., Schwab, J. M. (2009) Lumbar spinal stenosis: syndrome, diagnostics and treatment. Nature Reviews Neurology: July 2009, Vol. 5, pp. 392-403. DOI: 10.1038/nrneurol.2009.90

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