Narrow lumbar canal: What to do? (Complete Guide)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine  

Your doctor has diagnosed you with a narrow spinal canal (also called spinal canal narrowing or stenosis). Apparently this is the cause of your back pain.

What is narrow lumbar canal, and how does it manifest? Should we be worried (especially when all the forums seem to only talk about surgery!)? Are there any natural remedies or less invasive treatments (like exercises) before considering surgery?

In the following article, we will discuss narrow spinal canal in detail with an emphasis on a more “natural” approach to symptom relief (including specific exercises). 

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 vertebrae superimposed. In the lumbar region (lower back), there are 5 vertebrae called L1, L2, L3, L4, and L5. There is a gap between each vertebrate called vertebral foramen.

The juxtaposition of the vertebrae (via the intervertebral discs and zygapophyseal joints) forms a channel called the spinal canal. This is where the spinal cord and from there that originate the nerve roots (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 channel is about 15mm in diameter, but it is considered 'narrow' when it is less than 13mm.

But why does the channel narrow, you will ask me? The causes are multiple and depend on each individual. Here are the most common:

Vertebral 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 narrow lumbar canal. 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 about 15 mm. Some people are born with a smaller spinal foramen. They will therefore be more at risk of developing a narrow lumbar canal in the future in the event of osteoarthritis or another condition that reduces the circumference of the spinal canal.

Other

Any pathology or condition that causes the spinal canal to shrink in size can lead to a narrow spinal canal. These include abscesses, infections (such as spondylodiscitis), tumours, hematomas, yellow ligament hypertrophy, etc.

The diagnosis

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

This is often the clinical examination and themedical imaging which will help determine the potential cause of the narrow spinal 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.

Some imaging tests will help clarify the diagnosis. The X-ray will confirm the existence of the narrow lumbar canal, and will determine if there is osteoarthritis or spondylolisthesis.

An MRI examination, on the other hand, will provide information on the integrity of nerve structures, discs, etc. An EMG might also be prescribed to better assess 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 itself 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 lumbar pain (ache in the lower back). If the nerves are irritated, neurogenic symptoms such as sciatica ou cruralgia (such as pain irradiations behind the thigh or Calf, tingling, numbness, etc.).As the narrow lumbar canal causes narrowing of the spinal canal, this can cause irritation to the surrounding nerve structures. 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. Ponytail, what is it? These are nerve roots in the lower back that emerge from the spinal cord and provide control over the lower limbs and organs in the pelvic region.

At this time, there is anesthesia around the genital area, sphincter disorders (urinary and fecal incontinence), erectile dysfunction, and/or flaccid paralysis of the lower limbs. This is a medical emergency.

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”. 

Natural treatment of narrow lumbar canal?

Treatment usually begins with so-called "conservative" methods to relieve the condition in a natural way. Unfortunately, some situations require more invasive interventions (we will come back to this). But in general, the treatment includes among others:

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-epileptics such as Lyrica.

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

Note: For more information on the choice of medication for his back pain, consult next article. On the other hand, know that it is imperative to follow the recommendations of your doctor. He will know how to choose the right drugs, and adjust the doses according to the medical history and the patient's condition.

Relative rest and lumbar corset

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 it 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.

Manual treatments and analgesic modalities

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 or chiropractor can 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 (kinesitherapy/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.

Of course, you have to be active in a safe and progressive way when you suffer from lower back pain, and the physiotherapist (physiotherapist) is the therapist of choice to guide you.

Exercises against the narrow lumbar canal will be presented below.

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:

• acupressure mat
• myotherapy
• Quinton plasma
• percutaneous hydrotomy
• therapeutic yoga
• craniosacral therapy

Here is a non-exhaustive list of herbs and essential oils that are effective in controlling pain and inflammation associated with narrow spinal canal. The products are available on the site Country. Use promo code LOMBAFIT15 if you wish to obtain one of the following products, or any remedy aimed at relieving your symptoms and improving your quality of life:

• 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.
• Ginger. In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. the gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).
• Omega-3s. Omega-3s are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Sciatica, being most often linked to an inflammation secondary to a herniated disc, it can also respond to omega-3 provided it is consumed regularly. 
• Lemon eucalyptus. Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.
• wintergreen. Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.

Remember that these products do not replace medical treatment. Do not hesitate to consult for support adapted to your condition.

Adaptation of the workstation

Certain professional activities inevitably involve risks for the back. We are thinking, among others, of delivery people, cleaning ladies, truck drivers, etc.

In other words, tasks involving repetitive motions, heavy lifting, and/or prolonged static postures can increase back pain.

If your symptoms seem to get worse after a day's work, your doctor may grant you a variable length of time off work. Similarly, a job adaptation could help you.

Un Occupational therapist is the professional of choice to adjust your screens, show you optimal load handling techniques, propose a gradual return plan after a shutdown, etc.

In extreme cases, the retraining or professional redeployment can be considered.

Weight loss

In theory, the weight loss may have a positive effect on narrow spinal canal symptoms through the following mechanisms:

• Reduced stress on intervertebral discs lumbar, therefore prevention of the development or worsening of a herniated disc.
• Reduced stress on the posterior vertebral (facet) joints, thus preventing the aggravation of lumbar vertebral osteoarthritis.
• Facilitation of movements of the spine.

Even if the results differ from one person to another (depending on the severity of the narrowing, the cause, the terrain…) and are not guaranteed, it would be a shame not to try to lose a few pounds and then reassess their symptoms.

It is not always easy to lose weight when you suffer from a narrow spinal canal. The pain and other symptoms it generates sometimes discourage any physical activity.

However, it is important to ensure that you maintain a certain degree of daily activity to lose weight, or at least stabilize your weight and avoid joint stiffness.

In addition to physical activity, it is recommended to adopt a balanced and varied diet. the anti-inflammatory diet is particularly valuable in this context, as it helps provide the body with all the nutrients it needs while reducing inflammation throughout the body. It therefore allows weight loss and a reduction in pain of inflammatory origin.

Infiltrations

The doctor may suggest infiltrations to relieve the pain, especially when the medication does not seem to have an effect.

In general, the doctor goes there from one lumbar cortisone infiltration (depending on levels and irritated structures) Ideally, ultrasound-guided infiltration should be used to maximize results.

To learn all about infiltration (including the risks and benefits of each type of infiltration to relieve your symptoms), see the following article.

What are the exercises for the narrow lumbar canal?

As mentioned previously, a physiotherapist (physiotherapist) could help you prescribe physical exercises aimed at treating your lumbar spinal canal, and preventing your condition from getting worse.

If you have a narrow spinal canal, it's possible that lumbar extension movements make your symptoms worse, and flexion movements (such as bending forward) provide relief.

This is because lumbar flexion momentarily increases the diameter of the lumbar canal, while lumbar extension narrows it.

En Mckenzie method, we will then say that your preferred direction is lumbar flexion.

If so, your therapist might give you postural tips to actively reduce lumbar lordosis (especially if arching your back increases your symptoms).

He might also prescribe bending exercises such as those mentioned below. To this will be added a lumbar stabilization program aimed at toning the muscles of the trunk to protect the lumbar region.

Obviously, these exercises against the narrow lumbar canal will be adapted to your condition, and integrated within a global approach.

Exercise 1: Posterior pelvic tilt 

1. Lie on your back with your knees bent
2. Tilt the pelvis backwards so as to flatten your lumbar region against the floor.
3. Hold the position for 3 seconds and return to the initial position
4. Repeat 15 times, taking breaks as needed.

Exercise 2: Repeated Mckenzie Bend Squats 

1. Lie on your back and bend your knees
2. Bring the knees towards your shoulders at the same time, and add a 3 second overpressure with your hands (as if you were giving yourself a hug!). Then return to the initial position.
3. Repeat 15 times, taking breaks as needed.

Exercise 3: Repeated McKenzie Squats 

1. Sit in a chair with your legs apart
2. Lean your trunk so that your arms are as far back as possible (between your legs). Hold for 3 seconds in the fully flexed position and then return to the starting position.
3. Repeat 15 times, taking breaks as needed.

Exercise 4: Sit-ups 

1. Lie on your back and bend your knees. Place hands against you as shown.
2. In the same movement, take your shoulder blades off the ground and bring your elbows towards your knees. You will feel a contraction of the abdominals that you will have to hold for 3 seconds without blocking your breathing.
3. Do 2 sets of 10 reps.

Exercise 5: Abs Swiss ball 

1. Lie on your back and place a Swiss ball between your knees and arms as shown.
2. In the same movement, squeeze the Swiss ball by bringing your arms and legs against each other. Hold the contraction for 5 seconds.
3. Repeat 15 times, taking breaks as needed.

Note: These exercises are not worth a medical consultation. Be sure to exhale on exertion, and stop as soon as you feel persistent pain. If in doubt, consult a healthcare professional.

How to sleep?

It is not uncommon for people diagnosed with a narrow spinal canal to complain of poor quality sleep.

With this in mind, here are some sleeping postures that are sometimes effective in relieving symptoms and sleep better at night.

Lying on your back with a pillow under your knees

This position reduces the anteversion of the pelvis (lumbar hyperlordosis), which reduces stress on the facet joints. Basically, keeping your knees slightly bent will prevent your back from arching excessively, reducing the stress on your vertebrae.

For people who see their symptoms worsen in extension (often the case in the presence of a narrow lumbar canal), this position can be comfortable and thus improve the quality of sleep. 

Lying on your side with a pillow between your legs

Keeping a pillow between the legs reduces lumbar torsion. By bending the knees, this also decreases the lumbar lordosis (sometimes painful in the presence of a narrow lumbar canal).

For added comfort, many of my patients opt for a knee pillow such as this one. 

When to consider surgery?

Unfortunately, some people diagnosed with a narrow spinal canal will need to resort to the operation to relieve their symptoms.

Remember that this treatment option should not be considered out of hand. On the other hand, surgery will be considered in the following situations:

Red flags

Some conditions require urgent medical (and often surgical) intervention. This is particularly the case of cauda equina syndrome previously discussed.

Symptoms are often severe and disabling.

Persistence of pain

Sometimes the lumbar canal causes a persistent functional disability. In other words, it greatly affects the quality of life of the sufferer.

In the event of persistent disability (between 3 and 6 months) despite well-conducted conservative treatment, a medical specialist may consider the surgical option.

What are the types of operation for narrow lumbar canal?

Once the doctor has decided that surgery is the preferred option to treat the narrow spinal canal, the goal will be to increase the size of the spinal canal.

This involves correcting (or removing) the structures that narrow the spinal canal. The decompression laminectomy, where the surgical removal of the spinous process and the spinal blades, is often used.

When the stability of the vertebrae is compromised (for example, a spondylolisthesis in advanced stage), arthrodesis can be performed. This consists of a surgical fusion of 2 vertebrae to increase stability.

Obviously, an orthopedic surgeon will discuss with his patient the types of surgery possible, the associated risks, the prognosis for recovery, etc. More and more orthopedists are using endoscopic surgery to minimize complications and speed healing.

Other types of decompressive surgery

Other types of decompressive surgeries include:

• Laminoplasty
• Discectomy
• Corpectomy
• Foraminotomy
• Flavectomy

It should be noted that the optimal surgical technique for treating the spinal compression or nerve roots remains controversial. One approach is not necessarily superior in all circumstances, and the best option will depend on patient-specific anatomical and symptomatic factors.

Convalescence following an operation for narrow lumbar canal

Recovery following a narrow spinal canal operation will depend on several factors.

On the one hand, the type of surgery will influence the prognosis for recovery. If the surgeon had to place rods and screws, the healing time will necessarily be longer. If he opts for a laminectomy, we can hope to walk again the next day after the operation. Of course, a physiotherapist or nurse will guide you through this process.

The duration of hospitalization lasts an average of 3 to 5 days. This will allow the medical team to provide you with post-operative care, to monitor and detect complications (rare), and to prepare for your discharge.

In general, the patient is driven home after the hospital stay. In some cases, a convalescent home can be considered before returning home (you will need to discuss your situation with the surgeon).

The work stoppage will generally last between 6 to 12 weeks depending on your situation (job, medical condition, rehabilitation, etc.). A physiotherapist and/or an occupational therapist will support you in your return to normal life (home chores, work, sports activities, etc.)

Conclusion

So much for the narrow lumbar canal! Hopefully you are now more familiar with this condition if your doctor ever gave you this diagnosis.

More precisely, you have an idea of ​​the different possible causes of narrow lumbar canal, and also know the symptoms according to the anatomical structures affected.

As for the treatment, remember that it should start with so-called conservative methods with the aim of avoiding surgery as much as possible. Passive treatments can relieve you, but don't forget to complement them with an active approach.

In extreme cases, surgery remains a viable option. An orthopedist will know how to weigh the pros and cons of surgery based on the symptoms and their implication in the patient's life.

Good recovery!