Lumbar spine stenosis is the most common reason for spine surgery in older adults in Canada, and with our aging population, alternatives to surgery are needed.
If stenosis, or arthritis in your spine, is making it hard to walk, there’s an effective alternative to surgery. Over the past eight years, I’ve used a program of exercise and manual therapy on hundreds of patients, and many have said it gave them their lives back.
I call it a “boot camp” for spinal stenosis, because it’s hard work at first — and you must do the exercises for the rest of your life.
Many of my patients experience so much pain when they walk that they’re confined to their bedroom, house or street. They need to sit down after just a few minutes of walking due to numbness, tingling or shooting pain down their legs.
Yet after just two months of faithfully exercising, these same people can walk for half an hour or more. They’re able to visit grandchildren and take vacations. Their worlds open back up. And as long as they keep doing the exercises, the results can last. The idea is to train your lower back so that it mimics the sitting position when you stand or walk.
In our spine we have openings, or canals, that the nerves travel through to reach our legs. With age, our bones get thicker, our spinal discs become thinner, and arthritis causes inflammation. All of these changes narrow the canals, compressing the nerves and making it tough for blood and oxygen to get to the nerves travelling to the legs. This is what causes those terrible symptoms of pain, numbness and heaviness in your legs when standing or walking.
In contrast, sitting opens up those canals, allowing needed blood flow to reach the nerves going to your legs. My program trains you to hold yourself differently when standing and walking so that you’re keeping the canals open — essentially replicating the seated position. People with stenosis instinctively mimic sitting by bending over when they walk. But this is uncomfortable, unbalanced and could lead to a fall. So instead, I teach them to bend their pelvis up.
Start by pedalling for five minutes twice a day on a stationary bike, but leaning forward, so that you don’t aggravate your stenosis. The forward bending part is crucial, so make sure you’re doing it. Every week, add another five minutes to your daily pedalling until you can do it for half an hour. This builds your cardiovascular health and leg strength back up — very important if you’ve been inactive due to arthritis.
Next, you will strengthen your core muscles and learn the ‘pelvic tilt’ at the same time. Lay down and gently push your lower back into the floor. Ideally, you’ll be able to get it all the way down so that it’s touching the floor, but that will come with time and effort. Once you can do this laying down, you’ll do it standing, and then walking. When you’ve graduated to standing, put one hand on your belly and the other on your lower back, and practice repositioning your back. The movement should be like zipping up your pants.
I recently studied this program on 104 patients with an average age of 71, all of whom could walk at least 20 metres but for less than half an hour at a time. Half of the patients completed the six-week program with the help of a chiropractor who provided exercise instruction, manual therapy and counselling to keep them positive and work through any problems they encountered. The other half worked on their own using written instructions. The people on their own walked on average an extra 200 metres, but those who were supervised by a trained chiropractor walked at least 500 extra metres — and some could go much farther.
So for now, I would suggest you complete this program with a trained therapist’s help. It should cost about $1,000 to have a chiropractor, physiotherapist, occupational therapist or massage therapist supervise the six-week program, but supplemental health insurance covers at least some of these services. But remember: to keep up the improvements, you must keep doing the exercises every day for the rest of your life. I’ve set up a not-for-profit website, spinemobility.com, which has instructions for therapists and information for patients. (DVDs and some books are for sale, with proceeds funding my research, but you can find free instructions, information and videos too.)
Many people in Canada and around the world don’t have access to a therapist, so I’m also developing instructions and videos for patients so you can follow the program on your own. Although the extra 200 metres of walking my study subjects achieved on their own is significant, I think with better tools, we can improve on that.
Lumbar spine stenosis is the most common reason for spine surgery in older adults in Canada, and with our aging population, alternatives to surgery are badly needed. The biggest impairment from stenosis is walking — and when people don’t move enough, they raise their risk for diabetes, heart disease, depression and so many other problems.
To be sure, my program is not a cure for spinal stenosis. It’s a tool for managing this degenerative condition without surgery. But with consistent effort, anybody can benefit.
Dr. Carlo Ammendolia is an assistant professor in the Department of Surgery at U of T, and Director of the Spinal Stenosis Program at the Rebecca MacDonald Centre, Mount Sinai Hospital.