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As we age degenerative changes can occur in our lower back. Terms used to describe the changes include degenerative disc disease, osteophytes, sclerotic changes, spinal stenosis, and arthritis. These can all cause stiffness, soreness, lower back muscle spasms and lumbar radiculopathy (pain into the buttocks, hips and down the legs). Let’s see what we can do to help ourselves improve our function and mobility and decrease our pain. One can have many of these diagnosis on X-Ray but have very little or no symptoms at all. This gives us hope when doing these exercises!
Spinal Stenosis describes the decreasing size of the spaces of the spine. Central stenosis describes the narrowing of the central spinal canal. Usually this is due to arthritis of the lumbar spine causing degenerative changes, osteophytes, and/or bone spurs.
In central stenosis, symptoms may will occur in both limbs. Foraminal stenosis is often used to describe the narrowing of the spine’s lateral spaces, where nerve roots exit. Foraminal stenosis will usually involve symptoms down one limb.
Degenerative Disc Disease (DDD) often accompanies arthritis of the spine and spinal stenosis. DDD is when the discs between the vertebrae start to thin and bulge in certain areas. There is not as much moisture. This is one reason we tend to get shorter as we age. This in turn causes the vertebrae to become closer together putting stress on the joints between the vertebrae.
Often patients with spinal stenosis, arthritis and/or DDD will find symptoms increase bending backwards (extension of the spine), walking, and standing and improve with sitting, lying down or bending forward. Diagnosis of spinal stenosis often involves medical imaging such as an x-ray.
Physiotherapy focuses on flexion-based exercises, general spinal mobility, core stability, lumbar traction, hip mobility and hip strengthening. Here is an example of some physiotherapy exercises for lower back arthritis. Talk to your health care professional to see if these exercises are right for you!
Pain management solutions for lower back arthritis includes: modifying your activity that aggravates you, performing your exercises daily, Cold / Heat therapy wraps,
Lumbar Traction and electrotherapy modalities such as TENS just to name a few.
Usually heat is put on your back when you have arthritis, for about 20 minutes at a time. Make sure the pad is not too hot and that you have some insulation and feeling. You do not want to burn your back. Having said that, some prefer ice and find this helps with there pain. There really is no general right answer, jus what is right for you!
Lumbar Traction is often used to help take the pressure of the lumbar joints. We often like use dynamic traction (on and off) as apposed to static traction (sustained), but every person finds a different amount of force and duration works better for them.
TENS helps decrease the pain and we often use together with heat, again for about 20 minutes at a time. TENS can however be used for longer durations and in fact can be used while doing activities such as walking.
Robin McKenzie has developed a system for Treating Your Own Back and his exercises and lumbar roll have become the gold standard for treating back pain conservatively. The book discusses various causes of back pain, including discogenic sciatica in more detail and the various exercises and strategies that can be done to help reduce your pain and recover from sciatica.
Lumbar rolls are often helpful with patients who have sciatica. Core stability exercises are often prescribed for patients with sciatica and lower back pain. These are designed to help stabilize your back when moving around. Often we use elastic bands and exercise balls to perform these core stability exercises.
Brian Mulligan also has a book on self treating your back called Self Treatments for Back, Neck and Limbs – A New Approach, along with a great product to help self mobilize your back, called the Self SNAG Lumbar Strap.
Finally, a few words about differential diagnosis. A number of different conditions can cause back pain, including muscular low back pain, trochanteric bursitis, hip OA, and IT band pathology. Many X-rays will show a bulging disc, spinal stenosis, degenerative disc disease (DDD), osteophytes and v but have no pain or symptoms because they do not irritate the nerve roots or sciatic nerve.
The Physio Store website does not provide specific medical or physiotherapy advice of any kind. All content on The PhysiotherapyRoom website including text, images, video, graphics, documents and other information, provided by The Physio Store Inc. does not constitute medical advice of any kind, and is not intended to be, and should not be, used to diagnose or identify treatment for a medical condition and may not be relied upon by you as medical or health care advice. You are advised to always seek the advice of a physician and/or qualified physiotherapist or other health practitioner in your area BEFORE taking any action, ordering or starting to use any product or exercises from our website.
The Physio Store Inc. is not responsible or liable for any failure to follow the foregoing advice.
Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Pim A. J. Luijsterburg, Arianne P. Verhagen, Raymond W. J. G. Ostelo, Ton A. G. van Os, Wilco C. Peul, Bart W. Koes. European Spine Journal July 2007, Volume 16, Issue 7, pp 881-899 (1A)
Dionne CE. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. 2008
Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, Hwang SW, Mendel RC, Reitman CA. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). The Spine Journal. 2013 Jul 1;13(7):734-43.
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