People who’ve been diagnosed with spinal stenosis often wonder about their options for slowing its progression and relieving the pain; often, surgery is one of those options. But in the early stages of stenosis, there are ways to manage pain that don’t include surgery. In fact, most people turn to conservative care methods first in an effort to quell the symptoms for as long as possible before surgery becomes a necessity. But while these care methods may help ease some discomfort, there isn’t a way to prevent the progression of spinal stenosis—even with the help of physical therapy.
For Spinal Stenosis, Physical Therapy Doesn’t Work
Physical therapy is a great conservative care option for medical conditions that could be impacted by the reconditioning or strengthening of muscles, or by improving joint and muscle function. But spinal stenosis is an anatomical problem—a narrowing of the spinal canal that encloses the bundle of nerves known as the spinal cord. Strengthening your core muscles won’t hold off this deterioration, which is why physical therapy is largely ineffective for spinal stenosis.
From a pain relief point of view, most people with stenosis have already discovered one of the simplest ways to ease the pain: sitting down. The sitting position opens up the nerve passageways, which might also happen with mild stretching. But because the benefits are marginal for most patients with spinal stenosis, physical therapy in the classic sense isn’t very helpful.
What are better conservative care options for spinal stenosis?
Anti-inflammatories and epidural steroid injections have both proven to be helpful for this condition. Both help to calm whatever is inflamed (often ligaments), thereby relieving some pain.
- Anti-inflammatories—such as Advil, Motrin, Naproxen, or Aleve—are absorbed into the bloodstream and travel throughout the body, providing pain relief where needed. These types of drugs usually work for mild cases of spinal stenosis.
- Epidural steroid injections are used to deliver steroids to the epidural space between the spinal cord and the spinal canal. Because the anti-inflammatory steroid is injected very near the source of pain, much of it stays local (as opposed to spreading around the body as it would with a non-steroidal anti-inflammatory), making it more effective than taking an Advil. There are different types of shots to apply the medication to different areas of the epidural space.
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The number and timing of shots varies by case and by doctor. It used to be that shots were routinely given in a series of three. Today, some doctors use a general guideline of three shots in a six-month period, and others say three in a year. Regardless, most doctors base their decision on the outcome of the first shot. For my own patients, I usually recommend a second shot if the patient has improved more than 20% but less than 80%. If improvement is more than 80%, there’s no need for any further action at that time; if it’s less than 20%, a second shot is not likely to be effective.
In some cases it may be appropriate to use the epidural injection as both a therapeutic and diagnostic tool. For instance, if three foramen (nerve passage openings) are narrowing and your doctor is considering future decompression surgery, he or she may ask you to describe the level of relief you feel within the first eight hours after injection. Your answer could help determine which area of your low back is the primary contributor to your symptoms.
How long will these conservative treatments help?
If you’re still in the early stages of spinal stenosis, the usual course of treatment is to start with anti-inflammatories and, as the symptoms increase, start a discussion with your doctor about epidural injections. These treatments could buy you months or even years of pain relief as your stenosis continues to progress.
When the pain increases to a point where you feel it’s interfering with your life, you and your doctor should talk about next steps. Taking into consideration your lifestyle, family, and work, weigh how much the treatments are helping, and how long the effects last. Do you need shots more frequently than you once did? Do you need larger doses than you used to? When the treatments are no longer helpful, it may be time to talk to your doctor about surgery.