If your spinal stenosis is giving you a backache or some leg pain, you may be wondering what you can do—outside the doctor’s office—to help yourself feel better. If your spinal stenosis is giving you a backache or some leg pain, you may be wondering what you can do—outside the doctor’s office—to help yourself feel better. Because stenosis (as well as other types of pain related to spinal arthritis) leads to changes in your bones such as overgrowth or facet joint hypertrophy, it can result in compression and subsequent irritation of the spinal nerve root. Specifically, this occurs when a bone spur or "lipping”—which is a lip-shaped piece of bone that forms at the edge of a joint (again, as a result of arthritis-related conditions) comes into contact with the sensitive nerve root area.
The resulting symptoms of this compression and irritation are called radiculopathy; they can cause pain that travels down one leg (or one arm if your arthritis-related disc problem is in your neck). Other symptoms of radiculopathy include weakness, numbness and/or electrical sensations such as shock, burning, tingling or a “pins and needles” feeling also going down one leg or arm.
Irritation to the spinal nerve root often leads to a body posture response known as "flexion bias.” In this context, a bias is the tendency to assume, move into and/or stay in the position that gives you the least amount of pain and fewest symptoms. A flexion bias is basically a bent forward position, with your spine flexed. It can be seen as a rounding of the back, and may also be accompanied by chronically flexed knees and ankles, as well as shoulders that are also rounded forward.
For someone with stenosis related disc pain, flexion bias is likely the easiest position to be in. Except that...
What's Wrong With a Flexion Bias?
While your flexion bias might calm down the pain and tension temporarily, in the larger context of things, it can work against you. This type of forward flexing is considered to be a "compensation" or temporary workaround to keep you as comfortable as possible given your condition. But most of the time, it’s left at that; people with stenosis related disc conditions tend to do what they have to do to reduce their pain as best as possible, and then chalk the rest of it up to their injury and/or getting older.
Finding Pain Relief With Movement and Exercise
When you have a disc problem that's due to stenosis (and a resultant flexion bias), and you’re convinced that re-establishing good body mechanics is the way to a better quality of life, what kind of exercise should you do?
For the most part, a combination of core strength work with a specific type of flexibility motion discussed below is a good strategy. The idea here is to put your flexion bias to good use in reducing compression on the spinal nerve roots, and then reversing out excess flexion in your spine by incrementally developing your abdominal strength.
Pain Relief Exercise Program for Stenosis Related Disc Problems
An exercise program for spinal nerve root compression that arises from spinal stenosis should include “strengthening and scaffolding the area,” as well as the use of mobilizing moves to “gap” the joints, according to NHS physiotherapist Sammy Margo.
What is gapping, and how can it help you relieve pain?
Gapping consists of simple back flexion movements that make more space in the area where the spinal nerve roots are located. This area is called the intervertebral foramen. By opening up the intervertebral foramen, you may be able to relieve the compression and irritation on the nerve root that is responsible for the radiculopathy symptoms.
Gapping exercises move your back into a flexed position. Even though they are meant to relieve the pain, they still spell “flexion bias” for your spine. So by following gapping and mobilizing moves with core support work, you can begin to introduce—incrementally—small amounts of spinal extension to bring you back towards good body mechanics.
To sum, the exercise strategy for relieving symptoms of stenosis or arthritis-related nerve root compression is to first increase flexion in your lumbar spine, and then develop the opposite action—extension—to help with posture, alignment, and good body support.
Let’s start with a few gapping movements to help increase flexion in your lumbar spine, and then learn a simple but effective way to start stabilizing your core.
Low Back Muscle Stretch Using Hip Flexion While Lying on Back
Lie on your back in the “hook-lying position.” This is where your knees are bent and your feet are flat on the floor. Begin by lifting one knee towards your chest, and then the other. Clasp your hands around the top of your shins, or if you can’t comfortably reach that area, around the back of your thighs. Pull your thighs towards your chest, and as you do this allow your sacrum bone to “go along for the ride,” so to speak. This means the sacrum will elevate from the floor slightly as a response to pulling your thighs towards your chest.
If you wrap your hands around your shins, be careful not to stress your knees. (If you also have knee pain or issues, you may want to stick with wrapping your hands around the backs of your thighs.)
Another way to get the same effect is to rhythmically but gently pulse your folded lower extremities towards and away from the front of your trunk. The distance doesn't have to be great—it's the movement's effect on your low back area that counts.
Consider doing 10 repetitions twice per day, or hold the position for up to 30 seconds (remembering to breathe, of course).
Along with increasing the “gapping” in the intervertebral foramen, this basic move may give your low back muscles a nice stretch.
Yoga Child’s Pose
Another great way to stretch your back muscles and increase intervertebral foramen gapping is to do the yoga child’s pose. In fact, if you didn’t feel much of a low back muscle stretch in the first exercise (which can happen if your hip and/or back muscles are particularly tight), you may find flexibility to be more accessible with this one.
Start in the all-4s position where you’re supporting yourself on your hands and knees, and your trunk, from head to pelvis makes a tabletop, or a (relatively) straight line that is parallel to the floor.
Warm up with a pelvic tilt move by bringing your hip bones up toward the ceiling while simultaneously bringing the bottom of your pelvis down towards the backs of your thigh. (The two moves are related.) As you do this, try not to involve your upper back; instead, try to isolate the movement at the pelvis and low back.
Gently release back into the start position. Repeat this warm-up move up to 5 times.
Next, bring your hips back over your feet, allowing your trunk, head, and arms to come along for the ride. This means you’ll end up in the child’s pose position. Stay there for up to 15 seconds, unless you experience pain. (In that case, don’t go as far, or stop the exercise. If the pain doesn’t subside after you stop the exercise, call your doctor.)
Keep breathing, even though you’re in a static position. After you’ve reached the 15 second (or less) mark slowly and gently come back up into the all-4s position.
Sustaining the child’s pose, which puts your back muscles on a stretch and opens the intervertebral foramen, may also improve flexibility in your buttock muscles, your quadriceps muscles, and some of your shoulder muscles.
Breathing deeply while in the position will help amplify the benefits. For safety’s sake, though, take care not to overdo it. Using a “less is more” approach can be very effective, especially when your back is hurting. This may mean limiting yourself to between 1 and 5 deep breaths before coming back up.
Follow Gapping up With Core Abdominal Contractions
Now it’s time to increase your core strength. As discussed above, the purpose of following up flexibility and gapping exercises with abdominal strengthening is to help stabilize your spine and to start decreasing the degree of flexion bias—while remaining comfortable, of course.
There are a couple of ways to go about this, but one of the most popular and likely most effective is called the drawing-in maneuver. The drawing in maneuver is basically the same abdominal stabilizing approach that is used in Pilates. Note that if you choose to use the drawing in maneuver, this doesn’t mean you have to commit to a Pilates program in order to feel better.
Drawing in Maneuver Explained
As with the first gapping exercise above, begin by lying on your back, preferably in the hook lying position (knees bent, feet flat on the floor).
Once you’re in position, the first step is to establish a neutral pelvis. This is a place in between the two extremes of anterior tilt, where your hip bones are forward relative to the bottom of your pelvis, your back arch increases, and your low back muscles tighten up and posterior tilt where the bottom of your pelvis is forward relative to your hip bones, the curve in your low back decreases and elongates and your low back muscles are on a slack.
From there, inhale and exhale. As you exhale, pull your abdominal muscles in towards your spine and up.
Inhale and relax.
Repeat this about 10 times twice per day.
By the way, the drawing in maneuver can also be done in the all-4s position, while lying on your stomach and even when you’re sitting at the desk or watching TV. So no excuses—get strong in the core!