Manual therapy ‘boot camp’ reduces pain

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lumbar spinal stenosis

The ageing population is shrinking.

It is a fact of life that as we age our spine changes and we shrink.  Some people can start shrinking as early as their 30's, but for most people the shrinkage starts after the age of 50.  By the age of 70 men can have lost an inch off their height, and women as much as two inches. By 80 years old, both may have lost another inch. Loss of height can be attributed to many different factors, including loss of lean body mass and degenerative spinal problems. The most common spinal problems associated with age are osteoarthritis, degenerative spondylolisthesis, adult scoliosis, degenerative disc disease, and spinal stenosis.

Lumbar Spinal Stenosis

Spinal stenosis is the medical term for a condition where the spinal nerves in the back are ‘choked’.  In Lumbar Spinal Stenosis those nerves are in the lumbar region and the choking leads to severe leg pain when walking, numbness and tingling in the legs, back ache and sciatica. Symptoms tend to start gradually over a period of time.  The pain come and goes, and is worsened by activities such as walking and standing upright.

Neurogenic Claudication

In Lumbar Spinal Stenosis, compression of the nerves that come from the spinal cord causes them to be inflamed and this is known medically as neurogenic claudication.  The painful cramping and weakness can be on both sides (bilateral), or on one side (unilateral), and it can affect the calves, buttocks, and thighs.  In the most severe cases the pain is constant.

No walk in the park

The evidence that keeping active leads to a healthier old age is irrefutable, but for people with lumbar spinal stenosis it is no walk in the park.  The pain of walking is so severe that patients become less and less active. Most patients only find true relief from pain by sitting down.

 Conventional Treatments

Pain management with non-steroid anti-inflammatory drugs such as aspirin and ibuprofen is usually the first line of treatment for Lumbar Spinal Stenosis. Advice on changing posture when walking and rest is also advised. If the problem does not improve the next line of treatment is usually surgery to remove the pressure on the ‘choked’ nerves. However there is now evidence that some manual therapies can reduce the pain and improve the general symptoms of the nerve inflammation.

New evidence – manual therapy 'boot camp' roots out the pain

A new study published in the Journal of Manipulative Physiological Therapies, reviewed the effectiveness of a special manual therapy program in reducing neurogenic claudication in patients with Lumbar Spinal Stenosis.  The special program, termed a ‘boot camp’ involved twice weekly sessions of soft tissue and neural mobilization, chiropractic spinal manipulation, lumbar flexion-distraction, and muscle stretching. Patients were also given home-based exercises and advice on how to self-manage their problem. A questionnaire was used to self-report symptoms such as pain, disability, and ease of walking at the start of the study and then again after 6 weeks of Boot Camp. Patients were also asked about their satisfaction with the treatment. Results showed better scores for less pain in both the leg and back as well as all other clinical symptoms. The team concludes that the preliminary study shows that a non-surgical 'boot camp of manual' therapies is a valid treatment for improving symptoms in patients with neurogenic claudication.

 

Ammendolia c et al. Clinical Outcomes for Neurogenic Claudication Using a Multimodal Program for Lumbar Spinal Stenosis. A Retrospective Study. J Manipulative Physiol Ther. Jan 2015.

 

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