A spinal canal stenosis is when a narrowing of the spinal canal occurs. This can be caused by the normal aging process of the spine, or by inflammatory diseases (e.g. osteoarthritis). In spinal canal stenosis, compression of the spinal cord occurs with corresponding symptoms. The therapy is performed conservatively, if possible. In the case of severe compression, however, a relieving operation is necessary to protect the sensitive nerve tissue.
Physiotherapy/treatment
The anatomical narrowing of the spinal canal is usually irreversible. However, conservative physiotherapeutic treatment can be used to counteract further narrowing. To this end, the physiological position of the cervical spine is attempted to be maintained or restored as far as possible.
Certain head postures, e.g. a protraction (when the chin is pushed forward), can lead to an additional narrowing of the spinal canal. By correcting posture, which involves strengthening and stretching the corresponding muscles, an attempt can be made to counteract the progression of spinal canal stenosis. Mobilizing exercises and techniques of manual therapy can also be used to support this process.
- Posture correction (strengthening, mobilization and stretching)
- Manual therapy
- Strengthening of surrounding structures
- Compensation strategies for malfunctions
- Analgesic techniques
- Trigger point massage, massages
- Create homework program
- Physical therapy
In the case of existing nerve damage, the affected muscles of the periphery should also be trained in order to counteract atrophy, i.e. the breakdown of the muscles. Compensatory strategies can be worked out with the patient in physiotherapy in case of irreversible functional disorders. In addition, relaxing and pain-relieving techniques are used.
Trigger point treatment, massage or application of heat can relax poorly supplied and tense muscles and lead to symptom relief. A homework program with strengthening and mobilizing exercises should be carried out regularly by the patient in addition to the therapy. If an operation is performed despite physiotherapy, the post-treatment includes stabilizing exercises and mobilization as far as possible.
Manual therapy for spinal canal stenosis in the cervical spine (cervical spine) is carried out with the aim of relieving pain, carefully releasing blockages in the vertebral joints and thereby widening the spinal canal as much as possible. In addition, the muscles of the cervical spine can be relaxed by trigger point treatment and selective massage. In manual therapy, traction of the cervical spine can be performed at the beginning.
The therapist places his hands under the occipital bone and exerts light traction on the entire cervical spine. In addition, the short neck muscles that start there can be massaged. Releasing blockages in the cervical spine is both controversial and risky, but the therapist can move the vertebral joints against each other and thus improve joint play.
Manual therapy of the cervical spine also includes treatment of the cervico-thoracic transition, i.e. the transition of the cervical spine into the thoracic spine and the surrounding joints. More detailed information on manual therapy can be found in the article Manual TherapyIn the physiotherapeutic or conservative treatment of spinal canal stenosis, the strengthening of the surrounding musculature plays a major role. In particular, the autochthonous back muscles, which run like two strands to the right and left of the spine up to the occipital bone, stabilize each individual movement segment with the vertebral joints.
The superficial neck muscles also contribute to the stabilization and mobility of the vertebral joints. The stabilization of the individual movement segments of the cervical spine is important in spinal canal stenosis so that the space of the spinal canal does not become even more constricted. In addition, even with rapid head movements, the development of joint blockage and the entrapment of emerging nerve fibers from the spinal canal is prevented.
In addition to the local neck muscles, it may be useful to strengthen the surrounding shoulder and neck muscles, such as the M. trapezius, which pulls from the cervical spine to the shoulder, in order to achieve better stability. Since movements such as protraction (pushing the chin forward) or extension (placing the head in the neck) lead to a further narrowing of the spinal canal, a counter movement, the retraction, is recommended.Retraction: The patient sits upright on a chair or performs the exercise in a standing position. In the beginning it may be useful to practice the exercise in front of a mirror to be able to control it better.
From the upright posture, the patient now pushes the chin back as if he wanted to do a double chin. The cervical spine stretches upwards and becomes long, the back of the head rises towards the ceiling. The position can be held for a few seconds and then slowly released.
When releasing, only the tension should be released, but not the counter-movement actively. The exercise can be performed in 3-4 sets with about 10-12 repetitions. For reinforcement, a slight overpressure can be applied at the end of the movement.
This is best done by placing the gap between thumb and index finger on the chin, with the forearm at right angles to the cervical spine. Now, at the end of the movement, a slight pressure is applied just against the chin (to avoid lever forces) and the retraction is increased. A slight pulling in the transition to BWS can be felt.
Raise the head: The patient lies on a mat in supine position. The chin is pulled towards the chest and the back of the head is pushed upwards. From the double chin, the head with the stretched cervical spine is lifted approx.
1 cm and held for up to 10 seconds. A variation is when the head with the stretched cervical spine rotates to one side before it is lifted. This trains the fine lateral muscles.
More exercises can be found in the articles:
- Exercises for spinal canal stenosis
- Spinal canal stenosis – exercises for at home
The homework program for spinal canal stenosis should include particularly active exercises to strengthen the neck muscles, for example lifting the head in the prone position with a downward view. In addition, light stretching exercises for the shoulder and neck muscles or self-massage with a tennis ball can be shown during therapy and repeated at home. The treatment with a heat cushion can also be done very well at home for pain relief and muscle relaxation.
If functional disorders occur in the area of the cervical spine, this can lead to considerable restrictions in everyday life and at work. Since functional disorders of the cervical spine impede the rotation of the head and thus limit the field of vision, it is necessary to reconsider one’s own driving ability during persistent complaints. Manual therapy and physical therapy in the context of physiotherapy can already achieve an immediately effective effect, which can already significantly expand the range of movement.
Compensatory strategies for non executable movements of the cervical spine during the acute phase of the complaints are already natural as a protective posture. The upper body can be turned in the desired direction to relieve the cervical spine. It is important to keep the shoulders as relaxed as possible in order to avoid secondary complications and pain in the shoulder and neck area, which often occur in cervical spine disease.
In spinal canal stenosis, the treatment of pain plays an important role in the therapy. Pain-related movement restrictions caused by relieving postures are attempted to be avoided. To relieve pain, relieving manual techniques such as traction, i.e. light traction on the cervical spine, can be used.
In addition, the surrounding musculature such as the shoulder and neck muscles can be brought into stretching positions to release tension. In addition, the neck muscles can be relaxed with massage grips or treated specifically with the trigger point technique to release their tension. Trigger point massage is a manual massage technique in which certain pressure points (trigger points) of the muscle are treated with medium pressure in order to reduce the tension of the muscle and decrease pain caused by muscle hard tension.
The specific point on the muscle belly or base is pressed for between 30 and 60 seconds, at least until a significant reduction in muscle tension is felt. This relaxation of the muscle is part of a reflex arc that serves to protect the tissue. In physical therapy for spinal stenosis, as in physiotherapy, the focus is on reducing pain and muscle tension.
In addition to the classic massage of the cervical spine, the shoulder-neck area and the upper thoracic spine, trigger point therapy can also be used to treat the muscles. In preparation for these massage techniques, heat therapy, such as a mud pack or a heat cushion, can loosen the muscles. The hot roll can also be used to stimulate the metabolism and regulate muscle tension.Warm baths are a possibility of the heat therapy, which is also at home very well feasible.
Also the damp warmth of a towel doused with hot water can alleviate the complaints. In the field of electrotherapy, gentle methods such as applying pain-relieving interference current or treatment with ultrasound can be used. A prerequisite for this is usually that no metal is present in the treatment area.
Acupuncture is one of the alternative healing methods and can be used on its own or in conjunction with physiotherapy, physical therapy, medication or surgery. It is mainly used for chronic complaints where other therapy methods have reached their limits. According to acupuncture doctrine, acupuncture needles are placed at certain points near the pain, but also at points far away from it.
The classic, long needles remain at the points for about 20 to 30 minutes and are then removed. It is also possible to use permanent needles, which are small and flat and can be worn for several days. Dangers or side effects are not to be expected with acupuncture.
It is even possible to achieve success with this treatment method where other therapy methods fail. The basic organic disorder of spinal canal stenosis, the narrowing of the spinal canal and the resulting compression on the exiting nerves caused by aging processes, osteoporosis or spondylolisthesis cannot be causally treated by physiotherapy. However, pain-reducing therapy and the expansion of mobility can significantly reduce the symptoms, so that surgical therapy is delayed for years or is no longer necessary.
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