Lumbar Spinal Stenosis

• Low back pain is the second most common reason for primary care visits, following the common cold.
• 14-22% of patients with low back pain have lumbar spinal stenosis
• 90% of patients with lumbar spinal stenosis will also have associated hip or leg pain.

Pathophysiology
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Spinal Stenosis is a narrowing of the spinal canal, causing clinical symptoms of spinal cord and/or radicular compromise.  It can occur in the central spinal canal or neuroforamina as a result of thickening of the ligamentum flavum, formation of osteophytes (arthritis), facet hypertrophy and bulging of intervertebral discs.  A study of 191 patients with Lumbar Spinal Stenosis symptoms determined that ligamentum flavum hypertrophy was a key contributor.  
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Lumbar spinal stenosis can cause nerve root compression, which leads to radiating leg pain or numbness/tingling and burning.  Commonly, lateral and foraminal stenosis is related to decreased disc height, lateral disc bulging and (rarely) cyst development.  Radiating symptoms into the hip or leg are most commonly observed in patients with lateral or foraminal stenosis.
 
Physical therapy for spinal stenosis consists of determining what physical impairments are present and addressing the movement dysfunctions of the individual.  Common findings include limited lumbar extension, muscle weakness in the hips, lower extremities and abdominals and / or soft tissue restrictions in musculature such as hip flexors, hip rotators and calf musculature.
 
Conservative treatment is recommended for 3-6 months before opting for surgical intervention.