Stenosis is the narrowing of the space around the spinal nerves. It doesn’t take much imagination to envision how this much this condition hurts! A sinister companion to arthritis, stenosis can affect either the low back (lumbar stenosis), the upper back and neck (cervical stenosis), or both areas at the same time. Here I’ll give an overview on lumbar stenosis, using one of my clients as an example.
Lumbar stenosis: a case study
John and I have been working together for over a year. An avid cyclist, he contacted me after finding my Globe & Mail column on the two essential tenets of strength training. Since that time John has made excellent progress, adding an impressive mix of strength and strength-endurance to his already well-developed cardiovascular fitness.
That is, until, the spring when things began to fall apart. It started, as these things often do, with a back injury. While doing some home renovations, John felt a tiny pop in his lower back, near the right hip. Nothing major, just a slight nagging pain. This forced us to shift gears with our training; rather than risk turning this minor strain into a full-blown ISSUE, we opted to set aside the weights for the time being and focus on building core strength while incorporating mobility drills for the hips, shoulders and spine.
And wouldn’t you know it, this approach worked!
That is, until it didn’t. And once it stopped working, that nagging pain had grown into something worse. John was now having trouble even moving without experiencing sharp pains in his back, hip and leg. It was at this point we agreed to put a pause on our training until John spoke to a doctor.
Prognosis: lumbar stenosis!
John’s doctor referred him to a physiotherapist, who diagnosed a pinched nerve due to lumbar stenosis. His physio recommended we continue our core strengthening exercises, but suggested we remove rotational and lateral bending movements from the program until further notice.
This makes sense, as lateral bending and rotation — as well as spinal extension (arching the spine backwards) — can create pressure in those narrow vertebral spaces where the pain originates from. But of course, there are two sides of the body to consider here — the left side and the right side.
The pain-relieving plan
With lumbar stenosis, lateral bending into the direction of the pain aggravates the condition, as does rotating away from the direction of the pain. But what happens when we do the opposite? What happens when we laterally bend away from the pain and/or rotate into the direction of the pain? What happens when we flex forward at the hips rather than arch backwards?
We open the narrowing spaces that are constricting the nerve in question, providing almost-instant relief!
My plan with John is now set. We will continue to focus on building core strength with neutral-posture exercises like the Pallof Press and the plank, while adding some light lateral flexion work in the form of windmills. One-Arm Suitcase Carries will help strengthen John’s rotational muscles without subjecting him to any risky movements.
The role of the personal trainer
It may strike some as odd that I would write about a client whose health I had a hand in making worse, but it’s important to own up to one’s mistakes and limitations. It’s ridiculous for personal trainers to position themselves as infallible sources of scarce information.
My role is to help people get as healthy as possible. When that’s not working, it’s time to find someone who knows more about the subject than me. Then we work together as health professionals, serving our mutual clients needs to the best of our abilities, always sharing information, never competing for attention or acclaim.
If this sounds like the sort of service that’s missing from your fitness program, hit me up today for a free consultation.