Volume I; Issue 11
epub Feb 13, 2008
by Denise Deig, MSPT, GCFP, BFLT/T
Stenosis indicates a narrowing of the space in which the spinal cord resides. This narrowing of the spine can compress the spinal cord (SC) or the nerves exiting the spinal canal1. Narrowing can occur throughout the spine but is most commonly found in the vulnerable joints of the neck or lower back. You may find it helpful to view the anatomy of the spine and this condition at Integrative Learning Center of Mid-America's Online Library as you read this article.
Depending on the location(s) of spinal cord or nerve compression the following symptoms may occur1:
The two types of spinal stenosis are primary or acquired. Primary spinal stenosis is a rare congenital condition present at birth; whereas, age is the primary risk factor with acquired spinal stenosis. Degenerative changes, such as osteoarthritis, often occur in the spine with advancing years. Bony spurs can form when the cartilage cushion disintegrates and a "bone on bone" configuration results in a narrowing of the spinal canal.
Other less common causes of acquired spinal stenosis include:2
Medical treatment for minor conditions includes pain relievers, physical therapy or use of a supportive brace. If pressure continues on the nerves muscle, wasting or atrophy may occur. More serious cases may require surgery, although this does not stop the degenerative changes and symptoms may reoccur or worsen through time.2
Regular exercise including both aerobic activities (walking, biking), flexibility, and strengthening is recommended. Walking is suggested to be the best exercise for spinal stenosis. Flexion activities such as biking are recommended as the forward flexed posture of the spine may help relieve symptoms.3
The primary precaution and contraindication with spinal stenosis is avoiding end range back extension or excessive incurving of the cervical2 and lumbar spine. Using good body mechanics (neutral cervical and lumbar curve) with sitting, standing and especially with lifting is important. Furthermore, providing support for the normal lumbar curve with sitting or driving by using a small pillow or rolled towel may be helpful.
Sleeping position is also important. Avoid stomach lying or prone position. Use of a pillow under knees in supine or between knees when side-lying can be helpful. Make sure the mattress is firm enough so posture is not distorted during sleep.
To understand the potential impact of Bones for Life® or the Feldenkrais Method® in individuals with Spinal Stenosis, see the addendum to this article.
The special emphasis Bones for Life (BFL) processes place on alignment and exploration of the interrelationship between the neck and the low back may be very helpful for students who have spinal stenosis. The sequential processes guide the student into a deep understanding of how changes and improvements in spinal alignment will impact their movements and hence their ability to function in daily life.
Walking is one of the standard medical recommendations for those who have spinal stenosis. BFL not only cultivates dynamic postural alignment with walking, but also explores and integrates the activity of walking into the majority of the processes taught. The result is a more upright relationship, using the ground as a springboard, to reestablish fluidity and power. Each step has the potential to become a cue for lengthening and decompressing the spine. If a student with spinal stenosis is able to maintain and improve the function of walking at multiple micro levels, as is taught in BFL, the result can only be an improvement in their quality of life and activity level.
The Feldenkrais Method offers tremendous benefit for those who are unable to lead an active lifestyle due to pain or limitations of motion. The individual challenged with Spinal Stenosis can gradually learn how to make what may seem like micro-level shifts in the spine and ribs that will alleviate pain and increase comfort. Breaking functional patterns into manageable parts and staying within the guidelines of pain free movement allows for positive changes to occur in these clients in the Feldenkrais: Awareness Through Movement® classes.
Functional Integration® (the Feldenkrais Method's private sessions) may lend even more benefit as the practitioner is able to identify problem areas and assist the student in fine-tuning movement specific to their unique presentation and concerns. If the overworked areas of the spine are supported, more normalized muscle tone and efficient action can result.
In either class or private sessions, it is important that the student both passively and directly learns to transmit pressure through the improved spinal organization. Without this skill, the carry over into the upright will not be as great as possible.
Denise Deig is the author of Positional Release: from a dynamics systems perspective. A Physical Therapist, Guild Certified Feldenkrais Practitionercm and Bones for Life® Teacher/Trainer. She has a private practice in Fishers, Indiana. You can find out more about her and her practice at www.denisedeig.com. Deig can be reached by email at firstname.lastname@example.org. She offers certification and continuing education programs through www.integrativelearningcenter.org.