Lumbar Spinal Stenosis Treatment Toronto
Lumbar spinal stenosis (LSS) is a narrowing of the central spinal canal in the lower back that can place pressure on the spinal nerve roots. It may cause a condition called neurogenic claudication, which can cause pain, numbness, tingling or weakness in the buttocks and legs.
People with lumbar spinal stenosis may have difficulty standing upright and walking. It usually develops from degenerative changes, although people who are born with a relatively narrow spinal canal can develop symptoms at a younger age.
Lumbar spinal stenosis is a common cause of chronic pain and disability in seniors. When symptoms make standing or walking difficult, they can interfere with exercise, work, social activities and independence as you may feel compelled to live a more sedentary lifestyle.
As the population ages, the number of people affected by lumbar spinal stenosis is expected to increase.
Lumbar spinal stenosis does not progress the same way in everyone. Some people improve or have periods of remission, while others remain stable or experience worsening pain and walking limitations. It is not fully understood why lumbar spinal stenosis progresses in some people but not others.
The good news is that you can learn safe exercises and self-management strategies to help manage your symptoms. Research supports a nonsurgical treatment approach for people with lumbar spinal stenosis and neurogenic claudication.¹
Spinal Stenosis Treatment: Boot Camp Program for Spinal Stenosis©
A randomized clinical trial by Dr. Carlo Ammendolia and colleagues found that a 6-week comprehensive nonsurgical program produced greater improvements in walking ability than self-directed care.¹
At My Toronto Chiropractor Clinic, Dr. Horowitz offers the Boot Camp Program for Spinal Stenosis©, a focused 6-week program designed to help you improve your ability to walk and maintain physical function and activity levels.
The program was developed by Dr. Carlo Ammendolia and incorporates manual therapy, exercises and self-management strategies. Exercises are aimed at improving flexibility, core strength, and the strength and endurance of the back and leg muscles.
Goals of the Boot Camp Program
- Improve standing and walking ability — Help you stand and walk for longer periods.
- Improve function, strength, activity and quality of life — Help you remain active and maintain as much independence as possible.
- Improve self-management — Teach you strategies and body-positioning techniques that may reduce symptoms and help you manage daily activities.
Lumbar Spinal Stenosis Treatment with Dr. Horowitz
Depending on your examination findings, symptoms and physical abilities, Dr. Horowitz may incorporate several approaches into your lumbar spinal stenosis treatment program:
- Boot Camp Program for Spinal Stenosis© — A structured 6-week program incorporating exercise, manual therapy and self-management strategies.
- Chiropractic manual therapy — May be used to improve movement and address joint and soft-tissue restrictions.
- Specific exercises — Instruction in focused exercises designed to improve flexibility, core strength, leg strength, balance and physical function.
- PulStar® Computerized Spinal Analysis & Therapy— A low-force approach to spinal mobilization that does not require twisting your body.
- Stationary bike instruction — To build leg strength, endurance and cardiovascular fitness. People with lumbar spinal stenosis and neurogenic claudication often experience reduced leg symptoms when bending or leaning forward, such as when leaning on bicycle handlebars.² ³
- Body repositioning techniques — Instruction in changes to posture and body position that may help reduce neurogenic claudication symptoms during standing and walking. Research has shown that people with lumbar spinal stenosis may tolerate walking longer in a forward-leaning position, and imaging studies demonstrate that lumbar spinal canal dimensions change with body position.⁴ ⁵
- Self-management and cognitive awareness strategies — Techniques to help you understand symptom triggers and manage your activities more effectively.
If your symptoms do not improve with conservative treatment, or if they continue to progress, surgery may be considered.
Surgery can provide significant improvements in pain and function for appropriately selected patients. However, long-term research has found that the advantage of surgery over nonsurgical care may diminish over time.⁶
Call (647) 349-4909 to learn more about the Boot Camp Program for Spinal Stenosis© and whether it may be appropriate for you.
What Causes Lumbar Spinal Stenosis?
Lumbar spinal stenosis occurs when the space within the spinal canal in your back becomes narrowed. Degenerative changes associated with aging can contribute to this narrowing, including thickening of spinal ligaments, enlargement of the facet joints and vertebral bone, and changes in the intervertebral discs.
As the spinal canal becomes narrower, there is less space available for the
nerve roots of the cauda equina. Compression of these nerves can contribute to the pain, numbness, tingling, weakness and walking limitations associated with neurogenic claudication.
Changes in blood flow around the compressed nerve roots, including venous congestion, have also been proposed as contributing mechanisms in the development of neurogenic claudication.
Symptoms of Lumbar Spinal Stenosis
Lumbar spinal stenosis may cause symptoms in your buttocks, thighs or legs, particularly when you are standing or walking. Symptoms can vary from day to day and may affect one or both legs.
A characteristic feature of neurogenic claudication is that symptoms often improve when you bend or lean forward. Some people find they can walk farther when leaning forward over a shopping cart.⁴
Neurogenic vs. Vascular Claudication
Neurogenic claudication caused by lumbar spinal stenosis should not be confused with vascular claudication. Although both conditions can cause leg pain and difficulty walking, they have different causes.
Neurogenic claudication results from narrowing of the lumbar spinal canal and compression of the spinal nerve roots. Walking symptoms may improve when you sit or bend forward. This is why some people with lumbar spinal stenosis can walk farther when leaning forward over a shopping cart.
Vascular claudication is caused by insufficient blood flow to the leg muscles, usually because of narrowing of the arteries. Symptoms are typically brought on by walking or exercise and improve with rest. Unlike neurogenic claudication, leaning forward does not typically provide additional relief or allow you to walk farther.
It is important to speak with your family physician about your symptoms about your symptoms so that appropriate vascular tests can be ordered as needed.
Book a Lumbar Spinal Stenosis Examination in Toronto
If lumbar spinal stenosis is interfering with standing, walking, exercising, working or your everyday activities, a chiropractic examination can help assess your symptoms and determine which treatment options may be appropriate for you.
Have questions before booking? Visit our Frequently Asked Questions or Fees & Appointments pages for more information.
Reviews
Have a Question?
Contact Us
1. Ammendolia C, Côté P, Southerst D, et al. Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial. Archives of Physical Medicine and Rehabilitation. 2018;99(12):2408–2419.e2.
PubMed — Ammendolia et al. randomized trial
2. Tomkins-Lane CC, Melloh M, Lurie J, et al. ISSLS Prize Winner: Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis: Results of an International Delphi Study. Spine. 2016. The international expert consensus specifically identified “flex forward to relieve symptoms” and relief when using a shopping cart or bicycle among the key clinical features of LSS.
PubMed — Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis
3. Genevay S, Courvoisier DS, Konstantinou K, et al. Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis: The N-CLASS criteria. The Spine Journal. 2018. In this study, leg pain that decreased by leaning forward or flexing the spine independently predicted neurogenic claudication.
PubMed — N-CLASS criteria for neurogenic claudication
4. Gendreau M, et al. Comparison of walking variations during treadmill walking test between neurogenic and vascular claudication: a crossover study. Chiropractic & Manual Therapies. 2021.
Read the full peer-reviewed article — PubMed Central
5. Madsen R, Jensen TS, Pope M, Sørensen JS, Bendix T. The effect of body position and axial load on spinal canal morphology: an MRI study of central spinal stenosis. Spine. 2008;33(1):61–67. doi:10.1097/BRS.0b013e31815e395f.
PubMed — Madsen et al. MRI study
6. Lurie JD, Tosteson TD, Tosteson A, et al. Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine. 2015;40(2):63–76.