What's wrong

Hundreds of thousands of people suffer from undiagnosed or misdiagnosed pain.
Even with so many it is only a small percentage of the population and often overlooked by doctors.

The best diagnosis is a full MRI and physical examination by a specialist. CAT scans are inconclusive and expose the patient to unnecessary radiation. X-rays, even worse.

Generally speaking, there is no cure. Surgery is never a sure thing and sometimes leaves patients worse.

But, what is the cause of it? This isn't a helpful question as it can be so many things, either on their own or working together, and it can be as simple as getting older. There is no cure for that.

The right treatment can be better than any pill or cutting.

Common Signs of hip problem

• Standing discomfort (94%)
• Numbness (63%)
• Weakness (43%)
• Bilateral symptoms (68%)
• Discomfort above and below knee (78%)
• Buttock / Thigh only (15%)
• Below the knee (7%)^[4]
• "Shopping cart sign"- need to grab a shopping cart when going into a store in order to hold onto the cart and bend over relieving the pain in the legs.

other

• Gait disturbance (i.e. walking to the side or feeling like one leg is shorter)

These are five simple questions to help you help your doctor determine what's wrong.
Most of below will be more relevant for hip pain and leg pain.

1. Does it hurt to sit down or lie down and it gets better when you stand.
Yes probably means disc problems. Slipped disc. Prolapse of disc. Herniated disc.
This generally gets better with medication, rest, correct exercise.
See your doctor and thank you for reading, the rest of this material is for those that said No.

2. Standing or walking causes numbness, weakness, or pain in the legs or hips. Sitting down or leaning forward or lying down bring relief.
Yes probably means stenosis of the spine or disease of the hip or both.
Stenosis is where the bones, muscles, tendons of the back squeeze the nerves.
This compression of the nerves is felt as pain. Those that suffer from it know how inaqequate those words are and those that don't will never understand the toll it takes.

Disease of the hip can be arthritic or infection or both.

3. Is the pain more or most noticeable in the thighs or hamstrings, the knees, the shin or calf, the ankles.
Yes indicates hip issues. If it is mainly a hip issue spinal surgery will not relieve the pain but can be very effective for those with only stenosis issues. However, inversion table therapy and strengthening and conditioning exercise should be considered as a first option. See your doctor and thank you for reading.

4. This will check for hip issues.
When sitting on a bench with your legs bent at the knees and the knees apart and your lower leg hanging down like the hand of a clock. Rotate your left leg to slowly bring your left foot up to your right knee, and do the same with the right foot to the left knee. Now try to slowly rotate your left foot to your left hand and then do the same with the right side. (see also below link: lateral external rotation.) Pain, stiffness, spasms, cramps are probably from hip issues. See your doctor and thank you for reading.

The below documentation is information I gathered from the internet while researching this to get a better handle on my own issues. Over time as I learn how to blog better I will clean this up with better source material.



lateral external rotation of leg

exercises

I use an inversion table. The story goes that in ancient times they would strap people to ladders to invert them, so if you have a ladder and some friends and a lot of faith.
I prefer the table. For the more athletic there are the batman boots aka gravity boots (insert trade mark product of your choice  http://www.youtube.com/watch?v=2Q5-eNPO44w) you can hook up to a bar.
Full inversion only needs a few minutes.
For those unable to fully invert, the angle needs to at least 60 degree to allow for decompression.

Below pictures show some useful stretches to remove stiffness and improve flexibility. Always start slow and gentle, let the muscles and joints stretch on their own, never force, never bounce a stretch.

Stretch one is also useful if you raise the knees upright with heels as close to the buttocks as possible (and with a gentle pelvic tilt to avoid over-arching the lower back) and then slowly let the knees come apart and do a gentle split. Gentle wiggling allows for a deeper stretch. Later, you might prefer to repeat a few times for better stretch.
This stretch can then be altered so that keeping knees upright and together you move your heels 30cm (a foot) or so apart and then rotate your right knee to the space between your left heel and left buttock. This gives a useful relaxing stretch of the hip in the other direction. I find this relieves pain at night while sleeping better than simply raising the knees up.  Remember to pelvic tilt to avoid over-arching.


Warning. Stretch 2, the lunge should not be done as seen - it must only be done with the foot always in front of the knee: this prevents straining of the knee ligaments.
Also, Stretch 3, some people recommend using the alternate hand so that the knee bends in the correct way. Compare this to when you squat with your feet 30cm (or so) apart, the position is similar to using the alternate hand. See Stretching exercises chart 20 and 21.

The above exercise 2 (Deep lunge)  I do using a  stable 30cm support on the bent knee side, so that I can rest my weight.

The 3rd stretch below I also find useful with a modification. With shoulders straight on, in parallel to the hips, rest your right forearm above the right knee and gently press down so that the leg is parallel to the bench. This is called a "hip opener.'' Then, slowly lean forward at the hip and try to bring your head as close to the knee as you can. This is called a "forward bend hip opener." Avoid strain or force and ensure you support your upper body weight and don't put pressure on the backbone or discs.
Similar to the One Legged King Pigeon Pose, but we can leave that for the experts.


A variation of this is Stretching exercises (see below) 18 - gluteal stretch. I find doing both provides better relief than doing just one.








Graphic from http://www.sportsscience.co/wp-content/uploads/2013/03/whole-body-stretching-routine.png

It is blogger shrunk to fit here. Click on it and select original size from the below options or on the above hyperlink, right click, open in new tab and toggle between tabs.

Source material used

arthritiseducation.com/site/Learning_Article.html?NewsID_Learning=28

Arthritis and the Hip

   Of the more than 100 forms of arthritis, two are most common in the hip: osteoarthritis (OA) and rheumatoid arthritis (RA).

  OA is the most common arthritic condition affecting the hip. It is characterized by loss of cartilage space and pain in the groin or buttocks, sometimes radiating down the front of the thigh to the knee. There is limited motion and increased pain when walking. Later in the disease process, motion is even more limited and there is pain at rest. Osteoarthritis of the hip can usually be handled with exercise, less-strenuous activity, anti-inflammatory medication and support from a cane or walker. Adult arthritic hips that do not respond to treatment require total hip replacement.

 The second most common non-arthritis hip condition is actually a spine disorder. In adult patients, this may be a ruptured disk in the spine or degenerative arthritis of the spine. Older adults will often have spinal stenosis. In these patients the cartilage disks, or spacers between the vertebrae, will lose a large portion of their water content and begin to degenerate and flatten. The bone will form spurs, causing pressure on the nerves that exit at each disk level and then exit out of the pelvis into the buttock. Patients will experience chronic back pain, muscle spasms in the lower back and pain in the buttocks. In more advanced stages, the pain will travel down the back of the leg to the knee, ankle or foot, either in front or in back of the calf (sciatica). Because the sciatic and femoral nerves may be affected, pain from spinal stenosis may sometimes feel like hip pain.

  A comprehensive treatment plan includes strengthening and flexibility exercises, use of heat and cold, joint protection including weight control, anti-inflammatory medication, analgesics and muscle relaxants. If symptoms persist, a series of epidural blocks can decrease the amount of swelling in the nerves and relieve pain. Occasionally, surgery will be necessary. Spinal surgery has improved markedly over the past decade and gives significant relief of nerve compression.

SPINAL STENOSIS + oa

Although an increasing number of patients are undergoing hip joint replacement surgery to treat painful and diseased hip joints, the cause of the associated pain that arises in other areas of the body, or referred pain, remains elusive. Patients who have hip joint diseases sometimes complain of pain around the knee joint. Pain arising from a degenerate hip joint is also localized to the groin (in 84% of cases), buttock (76%), anterior thigh (59%), posterior thigh (43%), anterior knee (69%), shin (47%), and calf (29%).^[1] The distribution of pain is not restricted to above the knee.

Plain radiographs showed ipsilateral or bilateral hip joint arthritis in 4 patients. Magnetic resonance imaging, myelography, or computed tomography after myelography revealed central spinal canal stenosis at least at the L4–L5 level. One patient showed slight stenosis at the L3–L4 level and moderate stenosis at the L4–L5 level. To confirm the location of the origin of pain, we performed a transforaminal epidural infiltration of lidocaine onto the L5 spinal nerve. Infiltration of lidocaine onto the L5 spinal nerve was effective in 4 patients. On the contrary, infiltration of lidocaine into the hip joint was not effective in 4 patients (Table 2). We therefore diagnosed L5 spinal nerve compression at the lumbar spinal canal.

Because conservative treatment was not effective, surgery was planned. We performed posterolateral fusion surgery with instrumentation in the 4 patients. Decompression and fusion level was at L4–L5 in 3 patients and at L3–L4 and L4–L5 in another patient because of 2-level stenosis.

Unfortunately, leg pain did not resolve after lumbar surgery in any patient. Conservative treatment was not effective from 6 to 12 months after lumbar surgery and so hip surgery was planned. We performed ipsilateral total hip replacement for all patents. The patients became symptom-free after surgery, and to date the postoperative course has been uneventful (Figures 1 and 2).

http://www.spine-health.com/forum/conditions/spinal-stenosis/severe-hip-pain-related-stenosis-and-herniation-disc

I just had a laminectomy this morning to help relieve severe, debilitating hip pain with same pain in shin/ankle.
  It started several years ago, in the same fashion as many who have posted here.  I could walk maybe a block and thats it before that severe pain would sit you down in your tracks.  On a curb, in the middle of the fairway, or even just squatting like a little kid down low to the ground. I tried managing the pain with ibuprofen, intermittent injections of steroids and booze (on the golf course anyway) until 12 days ago when I had a steroidal injection that triggered severe, intolerable pain in those areas a day later.  The pain I experienced over the last 11 days changed me permanently as a person emotionally and mentally. No, not scarred, just changed, hard to explain in words right now.  I have dealt with back pain for 20 years due to a herniated disk like millions of people have, but this pain that occurs in the hip/leg went to a level I didn't know could exist, especially since there was no "safe" position I could find.  You know that special way to lie or sit to alleviate the pain we all find. Typically, it had been the sitting position like many have mentioned and as I talked about above.  I did find something close to that getting down on the floor in a fetal position, but you just can't stay in that position for that long.  I would sometimes get myself to sleep for 15 or 20 mins in that position before my body would reject it and straighten out a little waking me to severe pain.  I would guess I slept for up to 5 hours total over this period.  Luckily my employer is very understanding and figured out a way to allow me to deal with the problem and I am using all my vacation days, which I am fine with of course.
  I tried multiple pain killers that didnt touch the pain (percocet, hydrocodone, dilaudid injections, even flexaril).  There wasn't really time to try to get Gabapentin in my system to work. Additionally, on the second day, when my doc realized how severe my pain was after the injection he put me on a 5 day cycle of duramed to try to calm the nerve/inflamation.  Yes, all this over the 11 days.  
Getting back to my surgery this morning.  I woke up to no pain down in my shin/ankle, but incredible pain still in my hip, yes without standing or walking, I was on my back.  I quickly turned on my side trying for that fetal position, but obviously was still in terrifying pain.  They loaded me up with fentanyl, which I had not had before, but it messed me up pretty good.  Problem is, no pain relief from it.  After several painful hours, the pain has started to subside, and I am now back to pre-injection form, where walking is what brings the onset of pain.  I am somehow very happy about this however.  In my conversations with my surgeon, he said because the nerve and area are so swollen and irritated, that until we can bring that under control, I will probably not receive much relief beyond what is current.  I am taking ibuprofen for now, (I got so messed up on the fentanyl, and subsequent percocet they gave me later, that I cannot take anything else, my stomach feels like garbage and pretty nauseous)  And I suppose the tube down my throat during surgery probably has something to do with the nausea.
I am hopeful this surgery will eventually help me further in this hip pain we are talking about, but I wanted to share my story with people who know exactly what I am talking about.  I will follow up with my personal progress if anybody is still paying attention to this thread.  I am a newbie here, but I hope that doesn't deter you from reaching out and talking about similar experiences. I am 42 years old and healthy aside from this life-consuming issue.  Peace

Welcome to Spine-Health. You've found a great place for information, and the members of this forum are very friendly, knowledgeable and supportive.

I also had surgery for stenosis and like you, beforehand only found relief by bending forward, sitting or squatting (yes, sometimes on the golf course myself).

A laminectomy is a surgical procedure that removes a portion of the vertebral bone called the lamina. At its most minimally invasive, the procedure requires only small skin incisions. The back muscles are pushed aside rather than cut and the parts of the vertebra adjacent to the lamina are left intact. Recovery occurs within a few days.^[1]

A laminectomy is also the name of a spinal operation that conventionally includes the removal of one or both lamina, as well as other posterior supporting structures of the vertebral column, including ligaments and additional bone. The actual bone removal may be carried out with a variety of surgical tools, including drills, rongeurs and lasers.

http://en.wikipedia.org/wiki/Spinal_stenosis

Signs and symptoms[edit source | editbeta]

Common[edit source | editbeta]

• Standing discomfort (94%)
• Numbness (63%)
• Weakness (43%)
• Bilateral symptoms (68%)
• Discomfort above and below knee (78%)
• Buttock / Thigh only (15%)
• Below the knee (7%)^[4]
• "Shopping cart sign"- need to grab a shopping cart when going into a store in order to hold onto the cart and bend over relieving the pain in the legs.

other

• Gait disturbance

Causes[edit source | editbeta]

Aging: All the factors below may cause the spaces in the spine to narrow,

• Body’s ligaments can thicken (ligamentum flavum)
• Bone spurs develop on the bone and into the spinal canal
• Intervertebral discs may bulge or herniate into the canal
• Facet joints break down
• Compression fractures of the spine, which are common in osteoporosis
• Cysts form on the facet joints causing compression of the spinal sack of nerves (thecal sac)

Arthritis: Two types,

• Osteoarthritis
• Rheumatoid arthritis—much less common cause of spinal problems

Heredity:

• Spinal canal is too small at birth
• Structural deformities of the vertebrae may cause narrowing of the spinal canal

Instability of the spine, or spondylolisthesis:

• A vertebra slips forward on another

Trauma:

• Accidents and injuries may dislocate the spine and the spinal canal or cause burst fractures that yield fragments of bone that go through the canal ^[10]

Tumors of the spine:

• Irregular growths of soft tissue will cause inflammation
• Growth of tissue into the canal pressing on nerves, the sac of nerves, or the spinal cord.

MRI[edit source | editbeta]

The MRI has become the most frequently used study to diagnose spinal stenosis. The MRI uses magnetic signals (instead of x-rays) to produce images of the spine. MRIs are helpful because they show more structures, including nerves, muscles, and ligaments, than seen on x-rays or CT scans. MRIs are helpful at showing exactly what is causing spinal nerve compression.^[11]

Treatments[edit source | editbeta]

Non-surgical treatment includes:

• Education about the course of the condition and how to relieve symptoms

• Medicines to relieve pain and inflammation, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)

• Exercise, to maintain or achieve overall good health, aerobic exercise, especially riding a stationary bicycle, which allows for a forward lean, can relieve symptoms

• Weight loss, to relieve symptoms and slow progression of the stenosis

• Physical therapy, to provide education, instruction, and support for self-care; physical therapy instructs on stretching and strength exercises that may lead to a decrease in pain and other symptoms ^[12]

• Lumbar Epidural Steroid Injections- these may provide some temporary relief and sometimes work for a few years. If the stenosis is severe, these are not very beneficial.

Surgical Treatment:

• Lumbar Decompressive Laminectomy- Removing the roof of bone overlying the spinal canal and thickened ligaments in order to decompress the nerves and sac of nerves. This procedure is well tolerated in the hands of a skilled neurosurgeon or orthopedic spine trained surgeon. 96% of patients undergoing this procedure report "good results".^[13]

Epidemiology[edit source | editbeta]

• Swedish study defined spinal stenosis as a canal of 11mm or less found an incidence of 5 per 100,000 inhabitants.^[14]
• National Low Back Pain Study recorded that out of 2,374 patients with low back pain, 35% had bone related spinal nerve compression.
• Data from National Ambulatory Medical Care survey suggests 13-14% of patients with low back pain may have spinal stenosis.
• The NAMCS data shows the incidence in the U.S. population to be 3.9% of 29,964,894 visits for mechanical back problems.^[15]
• The Longitudinal Framingham Heart Study found 1% of men and 1.5% of women had vertebral slippage at mean age of 54. Over the next 25 years, 11% of men and 25% of women developed degenerative vertebral slippage.^[16]
• 250,000-500,000 U.S. residents have symptoms of spinal stenosis.

http://www.webmd.com/back-pain/tc/lumbar-spinal-stenosis-treatment-overview

Lumbar spinal stenosis is narrowing of the spinal canal that usually starts gradually and develops over a long period of time. As the spinal canal narrows, it can squeeze (compress) and irritate the nerve rootsthat branch out from the spinal cord , or it can squeeze and irritate the spinal cord itself. The goals of treatment for spinal stenosis are to relieve pain, numbness, andweakness in the legs, to make it easier for you to move around (improve function), and to improve your quality of life. Treatment includes pain-relieving medicine, exercises, and other nonsurgical measures, and in some cases, surgical treatment.

Initial treatment

Unless your lumbar spinal stenosis is severe, initial treatment usually is aimed at relieving your symptoms without surgery. Most cases do not require surgery. Nonsurgical treatment often works to allow most normal activity and relieve mild to moderate symptoms of pain, numbness, and weakness in the legs.

Nonsurgical treatment includes:

• Education about the course of your condition and how to relieve symptoms.
• Medicines to relieve pain and inflammation, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).
• Exercise, to maintain or achieve overall good health. Aerobic exercise-especially riding a stationary bicycle (which allows you to lean forward)-can relieve symptoms.
• Weight loss, to relieve symptoms and slow progression of the stenosis.
• Physical therapy, to provide education, instruction, and support for your self-care. Physical therapy helps you learn stretching and strength exercises that may lead to a decrease in pain and other symptoms.

If you have symptoms of cervical spinal stenosis, testing and treatment may be done earlier than in treatment for lumbar spinal stenosis.

Ongoing treatment

Lumbar spinal stenosis often requires nonsurgical treatment on an ongoing basis. Treatment may include:

• Medicines to relieve pain and inflammation, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).
• Exercise, which is important for overall good health. Aerobic exercise-especially riding a stationary bicycle (which allows you to lean forward)-can relieve symptoms.
• Staying at a healthy body weight, which may relieve symptoms and slow the progression of the stenosis.
• Physical therapy, to provide education, instruction, and support for your self-care. Physical therapy helps you learn stretching and strengthening exercises that may lead to a decrease in pain and other symptoms.

If medicines, exercise, and physical therapy do not relieve your symptoms, your doctor may recommend an epidural steroid injection (ESI). This injection includes a combination of a corticosteroid and a local anesthetic pain relief medicine. These injections are used for pain that occurs mostly in the legs.

Treatment if the condition gets worse

The course of lumbar spinal stenosis varies. Symptoms may be severe at times and less severe at other times. If you feel numbness, weakness, or have trouble standing or walking, it may mean that your condition is getting worse. Problems with bladder and bowel control also may mean your spinal stenosis is getting worse.

If you are experiencing a flare-up of severe low back pain that is not relieved by other forms of treatment and you are unable to engage in daily activities, your doctor may prescribe hydrocodone or other opioid medicines. But these medicines do not work well for symptoms that occur in the legs. Also, the side effects ofopioids-such as mental confusion, drowsiness, and constipation-can be more of a problem than the pain of lumbar spinal stenosis.

If you have tried nonsurgical treatment for a period of time as determined by your doctor but your symptoms have not improved, you may want to consider surgery. Imaging tests (such as MRI) will be done to find out the amount and location of spinal canal narrowing. You and your doctor will want to discuss the severity of symptoms, along with imaging test results, before making a decision about surgery.

Back surgery (decompressive laminectomy with or without spinal fusion) may be considered when you:

• Have severe symptoms of pain, numbness, or weakness in the legs that restrict normal daily activities and have a negative impact on your quality of life.
• Are in otherwise good health and do not have other medical conditions that might make it harder for you to have and recover from surgery.

The goal of surgery for spinal stenosis is to relieve pain, numbness, or weakness in the legs-not to relieve back pain. People who have surgery solely for back pain are less satisfied with outcomes than are those who have surgery for nerve root symptoms and pain in both the back and legs. Back pain associated with spinal stenosis is often not relieved by surgery. Also, numbness, weakness, and pain may return after surgery.

 Spinal stenosis: Should I have surgery?

What To Think About

Epidural steroid injections (ESIs) are usually only used to treat symptoms of lumbar spinal stenosis that occur in the legs. This treatment does not always work. And when it does work, it may only relieve symptoms for a short time. Experts are not sure about the long-term effects. Talk to your doctor about the risks related to the number of injections he or she expects you will need.

Surgery is usually not recommended for an older adult who is able to manage symptoms with nonsurgical treatment and is able to do normal daily activities. Surgery may be considered if the severity of symptoms and the decrease in quality of life outweigh the risks of the procedure. Surgery may not be an option for some older adults whose other serious health problems increase the risks from surgery.

+++++++++++++++

There are differences in symptoms between spinal stenosis pain and herniated or ruptured disc pain. A herniated disc often is more painful when sitting and relieved by standing or walking (opposite of stenosis). A herniated disc can cause sciatica (so can stenosis) and can be a result of degenerative changes in the disc. Sciatica will commonly radiate or travel down the backside of the thigh, into the calf and sometimes the foot itself. 

http://www.aafp.org/afp/1998/0415/p1825.html

Classically, the symptoms of lumbar canal stenosis begin or worsen with the onset of ambulation or by standing, and are promptly relieved by sitting or lying down. Thigh or leg pain typically precedes the onset of numbness and motor weakness. Along with numbness and weakness, these symptoms and signs constitute the syndrome of neurogenic intermittent claudication. Patients commonly complain of difficulty walking even short distances and do so with a characteristic stooped or anthropoid posture in more advanced cases. Although standing and walking exacerbate the extreme discomfort, bicycle riding can often be performed without much difficulty because of the theoretic widening of the lumbar canal that occurs with flexion of the back. Some patients actually obtain transient relief of pain by assuming a squatting position, which flexes the trunk. Conversely, lying prone or in any position that extends the lumbar spine exacerbates the symptoms, presumably because of ventral in-folding of the ligamentum flavum in a canal already significantly narrowed by degenerative osseus changes.

The straight leg raising test (Lasègue's sign), which is performed by raising the straight lower extremity and dorsiflexing the foot, is classically associated with reproduction of ipsilateral radicular pain secondary to nerve root compression by a herniated lumbar disc, presumably by stretching the compressed ipsilateral nerve root. Most patients with a true positive straight leg raising sign complain of excruciating sciatica-like pain in the elevated leg at 30 to 40 degrees of elevation. This sign is usually absent in patients with lumbar stenosis.

It should be noted that herniation of disc material and subsequent reparative processes may contribute to the overall picture of stenosis, but acute disc herniations generally produce a clinical picture that differs from the more chronic symptoms of canal stenosis. Patrick's sign, which reproduces leg pain with lateral rotation of the flexed knee, implies ipsilateral degenerative hip joint disease. This is an important piece of the differential diagnosis in patients with stenosis, some of whom may have both conditions.

+++++++

“To establish the diagnosis of lumbar spinal stenosis, two criteria have to be met,” says Dr. Kovacs, director of the Spanish Back Pain Research Network in Palma de Mallorca, Spain. The patient has to report pain down the leg “and a CT scan or MRI must show that the narrowing of the lumbar canal is compressing the nerve, which corresponds to the anatomical distribution of leg pain,” he says. 

Clinicians have tried myriad treatments to offer patients relief, but convincing evidence of a proven treatment has been elusive. A recent look at data from 21 clinical studies involving 1,851 patients found only “low quality” or “very low quality” evidence for pain control and improved walking from pharmacological interventions like calcitonin, prostaglandins, gabapentin, methylcobalamin or epidural steroid injections. Evidence is so sparse, the authors say, that specific clinical guidelines cannot yet be recommended. The report also concluded that large, well-designed clinical studies are “urgently needed.”  

The benefits of spinal or nerve root decompression surgery or the fusion of adjacent vertebrae are “probably marginal,” and the effectiveness of intra-discal electrotherapy (IDET), a popular treatment, “remains unproven,” according to a 2008 review of the scientific literature by the Cochrane Collaboration.

After consulting Dr. Labensky, Stanton agreed to undergo three months of physical therapy two to three times a week. “I was told this routine works for 90 percent of people with spinal stenosis,” Stanton says. “It gets them out of pain and on with their lives.”

The therapy, conducted in a hospital clinic, uses Nautilus-like exercise machines to strengthen back and leg muscles. Back exercises help with stenosis and leg pain by working on the soft tissue component of spinal stenosis. “Most patients also have some disc disease, either bulging or frank herniation," Dr. Labenski says. "When this occurs the disc almost always, due to anatomy, pushes posteriorly into the spinal canal, worsening the spinal stenosis.”
 
Strengthening spinal extensor muscles takes pressure off the disc because stronger muscles can handle more of the body weight that discs otherwise absorb, he says.

“Exercise is an evidence-based option for common back pain,” Dr. Kovacs agrees. But, he cautions, clinical trials have not been convincingly conclusive. “The available evidence is not enough to affirm its effectiveness on scientific grounds.”

How Exercise Worked in This Case
 
Stanton, however, says he doesn't need to see any scientific papers. “It worked,” he reports. “But it wasn’t easy therapy. It was really intense. For one exercise, I was strapped into this medieval-looking lower-back machine, like something from a torture dungeon. I had to use my legs and torso to push backwards for 30 reps. The therapists started me with 70 pounds and over three months worked me up to 185 pounds.”
 
By then, “the burning and cutting sensations were practically gone,” Stanton says. “My body felt strong and I had energy. I didn’t know how mentally and physically exhausted I’d been from the spinal stenosis until I completed the therapy.”
 
But as Stanton found out, therapy isn’t something you can just walk away from. “For a few weeks after I completed the therapy I didn’t do much. I wasn’t doing my at-home back exercises or stretching. And the pain started coming back.”
 
On the advice of Dr. Labenski, Stanton joined a health club — most have Roman horses and other back-strengthening equipment. “It’s a big commitment, but I try to go to the gym every day,” Stanton says. “The pain is 90 percent gone again. Working out beats being in constant pain — and it sure beats back surgery. Plus, it just feels good to be in shape again. It’s amazing how the body can heal itself. I feel years younger.”
 
When conservative approaches like exercise therapy do not work, however, surgery remains the most frequent treatment. Techniques vary and success rates have not been systematically studied, making it difficult to compare outcomes. If patients have sudden loss of strength in one or both legs or lose feeling in their upper, inner thighs or groin, surgery should be seriously considered, Dr. Kovacs says. For patients with vertebral slipping, spinal fusion should also be considered, he adds.
 
“If the pain ever becomes as intense as it once was, I would consider surgery,” Stanton says, “but for now I have my spinal stenosis on the run. I just wish I’d known 10 years ago what the cause of my pain was and where it was really coming from. All those years I was afraid to do intense exercise for fear of worsening my condition — but it's what I needed to do all along.”