Lower Back Pain from Spinal Stenosis
A common cause of lower back pain in older adults is spinal stenosis. Spinal stenosis is commonly caused by arthritis changes in the spine. Arthritis causes narrowing of the spinal canal. If the spinal canal becomes too narrow the nerves are compressed which results in pain. Then, a unique pain pattern called neurogenic claudication develops.
As a result of neurogenic claudication, the farther a person walks, the more the nerves are squeezed. The more the nerves are squeezed, the more pain is felt in the back and legs. To relieve the pain, the person must stop walking or sit down. The only other health issue that has a similar pattern is a circulation problem.
The treatment for spinal stenosis depends on how severe the symptoms are. For instance, with milder symptoms, the treatment includes exercise and anti-inflammatory medications. The exercise program includes a few key parts: one, strengthening the core muscles (abdomen and back muscles), two, stretching the back and leg muscles, three, correcting poor motor control patterns. For number three, a physical therapist or chiropractic provider can help.
In regards to anti-inflammatory medications, the most commonly used include ice, ibuprofen, and naproxen. They are available over-the-counter. Also, there are many anti-inflammatory medications available with a prescription that are stronger or longer acting. Although they all work in a similar way, some people have better results with some versus others.
On the other hand, more severe symptoms can limit a person’s ability to walk. In particular, with worsening neurogenic claudication, back and leg pain increase as the person walks farther. The person gets to the point where they truly can’t take another step. They must lean forward or sit down for relief. After a period of rest, they can walk again and the cycle repeats. In these cases, surgical consultation is often needed.
An exercise program is helpful for a couple of reasons. It won’t increase the size of the spinal canal, but it will train the body to support and protect the spine. Core strengthening helps improve the reflex function of the core muscles, so they automatically contract and protect the spine. One of the core muscles, called the transverse abdominis (TVA) is a key muscle that works reflexively to protect the back with movement.
In addition, stretching helps restore the range of motion to muscles. When hip and leg muscles are shorter than they should be they pull the spine into a less optimal position. This position can put more bad forces on the back and predispose to irritation and pain.
Lower Back Pain Relief
Treating the pain from spinal stenosis depends on the type of pain. With back problems, there is aching pain from arthritis changes and nerve pain from nerve compression. The aching pain responds best to ICE and anti-inflammatory medications (ibuprofen and naproxen). Meanwhile, burning and tingling respond better to a different group of medications called nerve pain agents. Common examples of nerve pain medications are gabapentin, amitriptyline, and duloxetine. Interestingly, this group of medications works by raising the level at which the nerve sends pain signals.
In conclusion, spinal stenosis is a common cause of lower back pain in those over 50 years. If symptoms are mild treatment is conservative with exercise therapy, ICE, and medications. On the other hand, severe symptoms with neurogenic claudication that limit walking often require more invasive treatment, including surgery.