Narrow lumbar canal: The complete guide

Your doctor has diagnosed you with a narrow spinal canal (also called spinal canal narrowing or stenosis). Apparently, this diagnosis is responsible for your back pain.

What is narrow lumbar canal, and how does it manifest? Should we be worried? Are there natural remedies or treatments that are less invasive than surgery?

In this article written by a physical therapist, we discuss narrow lumbar canal in detail with a focus on natural solutions to reduce your symptoms. As a bonus, we will share exercises to relieve you.

Definition and Diagnosis of Narrow Spinal Canal

A mini lesson in anatomy will help you better understand the diagnosis of narrow lumbar canal.

The spine (or spine) is composed of superimposed vertebrae. In the lumbar region (lower back), there are 5 vertebrae which we call L1, L2, L3, L4, and L5. There is a hole between each vertebra called the vertebral foramen.

The juxtaposition of the vertebrae (via the intervertebral discs and zygapophyseal joints) forms a canal called the spinal canal. This is where the spinal cord passes and from where the nerve roots originate (which give, for example, the sciatic nerve or crural nerve).

In the narrow lumbar canal, the size of this Spinal canal decreases at the level of the lumbar vertebrae (L1 to L5). Normally this canal is around 15mm in diameter, but it is considered "narrow" when it is less than 13mm.

But why is the canal narrowing, you ask me? The causes are multiple and depend on each individual.

Here are the most common:

Lumbar osteoarthritis

Because it is often associated with osteophytes (bony prominences), lumbar osteoarthritis often results in a decrease in the size of the spinal canal. This degenerative cause is the most common of narrow lumbar canals.

This is also the reason why the population concerned is often over 50 years old.

To know everything about lumbar osteoarthritis, see the following article.

Spondylolisthesis

Le spondylolisthesis refers to a slipped vertebra. Inevitably, this will reduce the size of the spinal canal, and could lead to a narrow spinal canal.

Herniated disc

If the disc migrates backwards due to a herniated disc, it will reduce the size of the spinal canal and thus lead to a narrow lumbar canal.

Congenital

As mentioned, the normal diameter of the vertebral foramen is approximately 15 mm. Some people are born with a smaller spinal foramen.

They will therefore be at greater risk of developing a narrow lumbar canal in the future in the event of osteoarthritis or other conditions reducing the circumference of the spinal canal.

Other experience

Any pathology or condition that causes a reduction in the size of the spinal canal can lead to a narrow lumbar canal.

We think, among other things, of the following conditions:

abscess
infections (such as spondylodiscitis)
you die
hematomas
yellow ligament hypertrophy
etc.

Diagnosing a narrow lumbar canal

Concretely, how can we differentiate between the various causes of narrow lumbar canal?

It is often the clinical examination and medical imaging that will determine the potential cause of the narrow lumbar canal.

A doctor (or other back specialist) will perform a complete medical examination taking into consideration your medical history, and your associated conditions. Then he will do certain movements and other tests to identify the cause of your back problem.

Certain imaging tests will help clarify the diagnosis. There radiography will confirm the existence of the narrow lumbar canal, and will determine whether there is osteoarthritis or spondylolisthesis.

A magnetic resonance imaging (MRI), for its part, will provide information on the integrity of nervous structures, discs, etc.

What's more, un electromyogram (EMG) could also be prescribed to better appreciate nerve conduction in the legs.

Anyway, the narrowing of the lumbar canal sometimes comes with its share of consequences, especially when we know the importance of the anatomical structures that pass through the spinal canal (such as the spinal cord, nerves, blood vessels, etc. .).

Concretely, how does the narrow lumbar canal manifest in an individual? This is what we will discover in the next section dealing with the symptoms of this condition.

What are the symptoms of narrow lumbar canal?

What if I told you that the narrow lumbar canal was sometimes asymptomatic? In fact, according to some studies, up to 28% people with a narrowed lumbar canal on medical imaging did not present with lumbar pain.

On the other hand, it often happens that a narrow lumbar canal causes symptoms. This will depend on certain factors such as the narrowing itself, and also the irritated structures.

The most common symptom is low back pain (pain in the lower back).

As the narrow lumbar canal causes narrowing of the spinal canal, this can cause irritation to the surrounding nerve structures. If the nerves are irritated, neurogenic symptoms such as sciatica ou cruralgia (such as pain irradiations behind the thigh or Calf, tingling, numbness, etc.).

This condition can also cause weakness and muscle fatigability of the limbs, leading to pain. general fatigue and the need to stop walking after short distances.

In severe cases, there may be a cauda equina syndrome.

What is a ponytail? These are nerve roots located in the lower back that emerge from the spinal cord and provide control to the lower extremities and organs located in the pelvic region.

At this time, anesthesia around the genital area, sphincter disorders (urinary and fecal incontinence), erectile dysfunction, and/or flaccid paralysis of the lower limbs will be observed. This is a medical emergency which sometimes requires surgical intervention!

Another potential symptom of narrow spinal canal is intermittent claudication. In addition to low back pain and pain in the lower limbs, the patient's complaints may be a feeling of heaviness in the legs, muscle fatigue and night cramps.

Typically, symptoms are worse on walking, and relieved on sitting. This comes from the fact that the lumbar flexion (as in a sitting position) momentarily increases the size of the lumbar canal, while extension and maintained lumbar lordosis (as in walking – especially when descending a slope) narrows it.

This is also the reason why people with narrow spinal canal find their symptoms ease when they lean on a grocery cart in the supermarket. This is the “Caddy sign”.

Narrow lumbar canal treatments

Treatment generally begins with so-called “conservative” methods to relieve the condition naturally. Unfortunately, some situations require more invasive interventions.

In general, treatment includes:

Medication

Although it won't correct the cause of the narrow spinal canal, medication can be helpful in controlling the symptoms.

The doctor often starts with a prescription for anti-inflammatory, painkiller and/or muscle relaxants to control the initial symptoms.

In the case of neuropathic pain (for example, radiation in the leg associated with numbness and tingling), the doctor may prescribe anti-epileptic drugs such as Lyrica.

In cases of severe pain, it is possible to resort to anti-depressants, oxycodone, codeine, morphine and its derivatives, etc.

Note: It is imperative to follow your doctor's recommendations regarding your medication. He will know how to choose the right medications and adjust the doses based on your medical history and general health.

Rest and lumbar support

Please note, do not confuse relative rest and complete bed rest. The mistake many people with low back pain make is to stay in bed until the low back pain subsides.

Although this can relieve symptoms, this strategy comes with its share of consequences, such as increased stiffness, muscle atrophy, social isolation, and so on.

The best solution will therefore be to minimize rest as much as possible, and instead limit movements that accentuate the pain.

For example, a therapist might ask you to temporarily avoid swimming and any other activity involving lumbar extension movements. Or, the walking periods could be limited to a certain time so as not to aggravate the symptoms.

In more extreme cases, a doctor might prescribe a lumbar corset that would limit lumbar hyperlordosis. Again, don't get used to wearing the brace long term, and wear it more like a crutch that you would use after a sprained ankle. The same is true for the lumbar belts.

Massages and manipulations

Since narrow spinal canal is most often accompanied by lower back pain, manual techniques from a therapist can help.

Massages or mobilizations from a osteopath, physiotherapist (physiotherapist) or chiropractor can thus reduce pain and reduce associated muscle tension.

On the other hand, these methods alone are not sufficient in the long term, and should ideally be accompanied by a active approach.

Active approach (physiotherapy)

It is sometimes difficult to conceive that exercise can help relieve back pain, especially when all movements are painful.

On the other hand, the scientific studies are unanimous: Physical exercise is the best way to combat low back pain in the long term.

Obviously, you need to be active in a safe and progressive setting when you suffer from lower back pain, and the physiotherapist (physiotherapist) is the therapist of choice to guide you.

Alternative treatments

Alternative treatments and natural products certainly have their place in the management of the narrow lumbar canal, but their limits must first be identified.

No, an acupuncture session will not correct the source of your narrow spinal canal. Nor even the cupping, Shiatsu-massage, medicinal plants, etc.

These modalities will rather act on the consequence of your lumbar canal (such as pain and/or lumbar stiffness), and offer you often temporary relief.

If the pain prevents you from going about your business, and you prefer to limit the intake of medication, these treatments can be effective in addition to a medical approach to improve your quality of life.

Other forms of alternative medicine sometimes used in the treatment of narrow spinal canal include:

Natural remedies that may relieve symptoms include (click on the product you are interested in for purchasing options):

Turmeric

Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.