Q: I love holiday gatherings, but have noticed that each year I have more difficulty standing for very long to chat with people because my back hurts. It feels better if I lean forward or sit down. My back hurts worse when I walk down stairs or down the driveway. I’m starting to get numbness in my leg. I don't remember injuring it. I am 65. Is there anything I can do?
A: Your symptoms sound like you are developing a common condition called lumbar spinal stenosis. There are bony canals in your spine that the spinal cord and nerves run through.
These canals become narrower as you age, causing spinal stenosis. This generally affects people over 50, or someone with a previous back injury.
Spinal stenosis is usually caused by osteoarthritic spurs that impinge into the spinal and nerve root canals and progressively get worse. The spurs may have no symptoms at all, or may pinch the spinal nerves causing pain, numbness, weakness, or cramping in your legs.
In more extreme cases, it may cause difficulty walking, paralysis, or effect sexual, bowel, or bladder function. Degeneration and extrusion of intervertebral discs and thickening of ligaments around the spine may also cause narrowing of the canals and compression of the nerves.
Your doctor can confirm the diagnosis with a medical history and physical examination, then order diagnostic studies like an MRI. Other tests may be necessary if there are red flags for more serious potential causes of your back pain, like tumors.
There is no cure for spinal stenosis but you can reduce symptoms with exercise and weight loss. Exercise for at least 30 minutes three times weekly to build strength and improve flexibility. Walk as tolerated and gradually increase the distance.
Ask your doctor for a referral to a physical therapist. A recent article in American Family Physician (October 2018) advised seeking a therapist trained in the MacKenzie method technique of mechanical back pain evaluation and exercises.
Over-the-counter medications such as ibuprofen or naproxen can be used for short term pain relief. Topiramate may be prescribed for short term management of chronic back pain.
The American College of Rheumatology advises that although there is “little objective data to support” the use of epidural steroids, they may provide “a great deal of temporary, and occasionally permanent, relief.” Apparently many of the studies testing the effectiveness of epidural steroids included people who also had co-existing other causes of back pain.
Consider trying acupuncture, massage, or yoga (as tolerated). Avoid back extension or heavy lifting.
In severe cases, surgery (like a decompression laminectomy, often followed by a vertebral fusion) may be advised, but the degenerative arthritis is likely to progress so it may not be a permanent solution.