Spinal stenosis is a condition in which the spinal cord or spinal nerve roots are compressed by abnormal bone growth, disc herniation, fat deposits, and hypertrophy of the ligaments that support the spine. Spinal stenosis most commonly occurs in the lumbar or cervical spine. Spinal stenosis can occur in three different locations inside the vertebrae of the spine and compress different structures.
Before we discuss those different areas where stenosis can occur, let's look at the structure of the spine.
Before we discuss those different areas where stenosis can occur, let's look at the structure of the spine.
Lumbar vertebrae with anatomical labels.
Same lumbar vertebrae as shown above, but with the spinal cord and nerve roots shown.
In a healthy spine, there is room in the spinal foramen for the spinal cord and cerebral spinal fluid to flow unimpeded. There is also room for the spinal nerve roots to exit the sides of the vertebrae without impingement. This allows normal function of the spinal cord and nerves without interference.
In spinal stenosis as described above, structures of the spine start to impinge on the spinal cord or nerve roots (or both) and this narrowing can cause pain and impaired function. The three places stenosis can occur are described and shown below.
In spinal stenosis as described above, structures of the spine start to impinge on the spinal cord or nerve roots (or both) and this narrowing can cause pain and impaired function. The three places stenosis can occur are described and shown below.
Three types of stenosis
First, the central canal (central stenosis) which contains the spinal cord (in cervical stenosis) or caudal equine (in lumbar stenosis) can be compressed which can also lead to decreased cerebral spinal fluid flow. In central stenosis, the spinal cord can be compressed by disc herniation, disc degeneration, bone spurs, or ligament thickening.
The second area that can be compressed is the neural foramen (foraminal stenosis), which are the lateral openings where the nerve roots exit the spinal cord. Foraminal stenosis is caused by disc herniation, hypertrophy of the facet joints and ligaments, or spondylolisthesis or retrolisthesis which is the slipping of the one vertebrae forward or backward on the one below it.
The third and last area that can be compressed is the lateral recess of the lumbar spine (lateral stenosis) which is the area along the pedicle before the nerve exits the foramen. In lateral stenosis, the nerves can be compressed by disc degeneration, bone spurs, or ligament thickening.
The following video is a good visual demonstration of spinal stenosis and the build up of bone or ligament into the nerve space causing pain. Most people with spinal stenosis do not need surgery as Dr. Cantor explains. Exercise therapy should always be done first to see how much relief you can get, which often is a lot of relief.
The second area that can be compressed is the neural foramen (foraminal stenosis), which are the lateral openings where the nerve roots exit the spinal cord. Foraminal stenosis is caused by disc herniation, hypertrophy of the facet joints and ligaments, or spondylolisthesis or retrolisthesis which is the slipping of the one vertebrae forward or backward on the one below it.
The third and last area that can be compressed is the lateral recess of the lumbar spine (lateral stenosis) which is the area along the pedicle before the nerve exits the foramen. In lateral stenosis, the nerves can be compressed by disc degeneration, bone spurs, or ligament thickening.
The following video is a good visual demonstration of spinal stenosis and the build up of bone or ligament into the nerve space causing pain. Most people with spinal stenosis do not need surgery as Dr. Cantor explains. Exercise therapy should always be done first to see how much relief you can get, which often is a lot of relief.
But what causes stenosis?
Disc herniation, disc degeneration, bone spurs, ligament thickening, and spondylolisthesis all are caused by something, and that something is postural misalignment and dysfunctional movement patterns of the spine.
If we use the example of lumbar stenosis, the lumbar spine is balanced on top of the pelvis and supported by the sacrum and two ilium. We of course have two legs and two sides to our pelvis but only one spinal column. When our legs and pelvis are not positioned and working symmetrically, it causes imbalance in the sacrum and lumbar spine. One leg/hip might be stronger and more stable than the other side which will cause a shifting of the pelvis and sacrum and create an uneven platform for the lumbar spine. It might show up as the pelvis shifted to one side, higher on one side, or rotated forward on one side. Any of these imbalances will create compensation in the lumbar spine, thoracic spine, and cervical spine along with shoulders. These imbalances create unequal loading on the lumbar discs which can create disc herniations, degeneration, and bone spurs over time which can all lead to stenosis and pain. The only way to decrease the pain, is to rebalance the hips, pelvis, spine and torso.
Another major cause of lumbar spinal stenosis is an imbalance in how the muscles are supporting the spine. In a healthy person, the multifidus, iliocostalis, longissimus, spinalis, psoas, and all abdominal muscles work in coordinated fashion to stabilize and move the spine. Spinal stenosis is caused by an imbalance in how these muscles are working - in particular weakness in certain muscles and overwork in other muscles. This muscular imbalance creates compression and friction in the spinal structures and leads to bone spurs and degeneration over time.
We must also remember that the spine is a unit from the base of your skull to our pelvis and it is designed to work together. When part of our spine loses the ability to move (flex, extend, rotate, laterally flex) another part of the spine has to move excessively which over time will lead to arthritis developing in response to the increased friction in that area. Arthritis is in response to friction which is from excessive motion or increased compression and will cause excess bone growth into the joints in an attempt to stabilize the vertebrae and stop the motion/friction.
If we use the example of lumbar stenosis, the lumbar spine is balanced on top of the pelvis and supported by the sacrum and two ilium. We of course have two legs and two sides to our pelvis but only one spinal column. When our legs and pelvis are not positioned and working symmetrically, it causes imbalance in the sacrum and lumbar spine. One leg/hip might be stronger and more stable than the other side which will cause a shifting of the pelvis and sacrum and create an uneven platform for the lumbar spine. It might show up as the pelvis shifted to one side, higher on one side, or rotated forward on one side. Any of these imbalances will create compensation in the lumbar spine, thoracic spine, and cervical spine along with shoulders. These imbalances create unequal loading on the lumbar discs which can create disc herniations, degeneration, and bone spurs over time which can all lead to stenosis and pain. The only way to decrease the pain, is to rebalance the hips, pelvis, spine and torso.
Another major cause of lumbar spinal stenosis is an imbalance in how the muscles are supporting the spine. In a healthy person, the multifidus, iliocostalis, longissimus, spinalis, psoas, and all abdominal muscles work in coordinated fashion to stabilize and move the spine. Spinal stenosis is caused by an imbalance in how these muscles are working - in particular weakness in certain muscles and overwork in other muscles. This muscular imbalance creates compression and friction in the spinal structures and leads to bone spurs and degeneration over time.
We must also remember that the spine is a unit from the base of your skull to our pelvis and it is designed to work together. When part of our spine loses the ability to move (flex, extend, rotate, laterally flex) another part of the spine has to move excessively which over time will lead to arthritis developing in response to the increased friction in that area. Arthritis is in response to friction which is from excessive motion or increased compression and will cause excess bone growth into the joints in an attempt to stabilize the vertebrae and stop the motion/friction.
If we think about cervical stenosis, the same imbalances of the hips, pelvis, lumbar spine, thoracic spine, and shoulders cause an uneven platform and foundation for the cervical spine to sit on top of. That uneven alignment and movement of the cervical spine can again lead to disc herniations, disc degernation, ligament thickening, bone spurs, and cervical stenosis. The only way to eliminate neck pain and nerve impingement is to balance the hips, pelvis, shoulders and spine.
How do you know what imbalances are causing your spinal stenosis and pain?
Getting your posture, function, and movement evaluated by an expert in postural analysis is the only way to understand what is causing your pain. Sign up for a free 30-minute online posture evaluation here.
After you have had your posture and movement evaluated by a posture alignment therapist, they will be able to direct you in personalized posture exercises that will correct your imbalances and eliminate your pain. While you will feel relief immediately, it's important to remember that spinal stenosis does not appear overnight and will take time to feel significant and long lasting relief.
RSS Feed