When Walking Stoops You Over: The Tell-Tale Signs of Lumbar Spinal StenosisLumbar spinal stenosis (LSS) is a common condition for people over 60. It comes from compression of the nerve roots that exit the spinal column or of the cauda equina, a bundle of nerves in the base of the spinal canal. The condition can result in low back pain, pain in the legs and feet, numbness or tingling, and difficulty walking.
LSS tends to get worse over time and may even get in the way of patients' ability to do daily activities. Doctors make certain assumptions about symptoms that go along with LSS, but few studies have given a full medical profile of patients who have it. These authors wanted to do just that. Their study was designed to identify symptoms that go with LSS and find out which of them relate to difficulty walking.
Patients were recruited from three specialty clinics: a center for spine disorders, a pain treatment unit, and an orthopedic spine practice. There were 43 patients in all, about half of them from the orthopedic practice. Sixty-five percent of the patients were women. Almost all of them were Caucasian. Patients' ages ranged from 46 to 90; 74 was the average age. Patients had experienced low back pain for about two years. A few of them (16 percent) had even had back surgery.
After patients were diagnosed with LSS, they filled out questionnaires about their pain and difficulty walking. They then underwent a full physical examination. The exam included assessments of posture, balance, range of spinal movement, muscle strength, and reflexes.
One-third of the patients said they had problems with balance. The same percentage had trouble standing with their feet close together and eyes closed without swaying. Nearly half of the patients walked with their legs in a wide stance--a common way of making up for balance problems.
Patients with LSS generally find it comfortable to stoop forward to relieve the pressure in their low backs. This held true for patients in this study. Eighty-one percent either had a stooped posture or were missing the slight inward curve normally found in the low back.
As expected, patients' range of spinal movement was limited. Two-thirds of the patients had trouble bending backward from the waist and reported pain in this position. This supports the belief that this position shrinks the size of the openings where the nerve roots come out of the spinal column. It also narrows the spinal canal, potentially putting more pressure on the cauda equina. Yet thirty-seven percent of the patients also had a hard time bending forward.
The majority of the patients (63 percent) had some numbness or tingling in their thighs, calves, or feet. These symptoms were sometimes severe and often happened a few times a day.
Most of the patients either did not respond or had poor responses to sensation tests (for example, vibration or pinpricks) of their legs and feet. They also showed weakness in some of the muscles of their lower limbs, which matched reports of muscle weakness in the questionnaires. One-third of them said they had severe lower-body weakness; another third said they had mild to moderate lower-body weakness. This could be attributed to the fact that patients in pain are less active, leading to even greater muscle weakness.
Most patients (65 percent) said they had low back pain at the time of the exam. They also felt pain in the buttocks (81 percent), thighs (84 percent), calves (51 percent), and feet (35 percent). About one-third of the subjects said they had back pain all of the time. Roughly three-quarters said the pain got worse with walking. During the exam, patients' pain often flared up when they bent forward or backward.
Sixty-three percent of the patients said they had severe or very severe problems walking. About the same number of patients were unable to walk two or more blocks. Surprisingly, women were more likely to have difficulty walking than men. So were patients with balance problems and those whose pain worsened as they walked. Age didn't seem to affect patients' balance or walking. The authors conclude that pain and balance problems are the tell-tale features that limit walking in patients with LSS.
Maura D. Iverson, PT, SD, and Jeffrey N. Katz, MD. Examination Findings and Self-Reported Walking Capacity in Patients with Lumbar Spinal Stenosis. In Physical Therapy. July 2001. Vol. 81. No. 7. Pp. 1296-1306.
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