Case Study: Spinal Stenosis

The body is a beautiful and complex piece of engineering. The musculoskeletal system is designed to work optimally with a delicate balance of flexibility and strength during posturing and motion; the muscles supporting the skeleton through graceful arcs of movement whether the application is for a dance sequence or simply swinging a bag of groceries out of a shopping cart. Our young bodies certainly start out that way, taking these complicated feats of engineering in stride and for granted, but then life happens. 

It is true to say that when someone walks into the room for evaluation for physiotherapy services, that they are the sum of their life’s work and play so far. By the time a human being reaches their forties (and sometimes earlier when there are more complicated histories), there are many layers of restrictions and compensation which may be contributing to a problem. Some may be the real scars left from a traumatic accident and some may simply be the result of habit. For many patients there is also a dominant emotion that is accompanying their pain or decrease in function. A common expression is the sense of outrage that their body has failed in some way, or is producing persistent pain, effectively stopping them from enjoying activities that contribute to the person’s sense of self and quality of life. Often there is fear there, too. These feelings can be exacerbated with a trip to the physician’s office as patients often undergo diagnostic testing which may well reveal some level of arthritis or degeneration in their joints. These findings can really frighten patients and can make them feel hopeless; they may remember how elderly relatives were incapacitated with pain and could not function well. This is when the sense of their “well self” becomes challenged and their sense of vitality starts to fade. An individual may start to live “To spite the pain” or they may stop many of the activities that give quality to their lives; this is unnecessary in most cases.

So, let me tell you a common story...

A patient in his early fifties presented for evaluation. He had had some numbness in both thighs which had come and gone over the past few years. However, the numbness had become more constant over the past few months, and more worrying, and had started to wake him in his normal sleeping position on his side. He had consulted a physician who did some testing which was significant for “spinal stenosis” or narrowing of the spinal canal. The patient had discussed his options with the physician who suggested epidurals; the patient had researched this idea and wished to pursue more conservative options. At this point, the patient suggested PT and the physician agreed; it is important to note that patients are often their own advocates in this process. The patient’s symptoms were much more persistent on the right side and this bias was reflected in the patient's posture during evaluation which was influenced by a muscle that had shortened out of habit from his sitting position. I shared this observation with the patient and also encouraged him to think about how long it takes stenosis to develop to the point that it is visible on an x-ray. It did not suddenly develop 3 months prior, when his symptoms became much increased! 

These observations were logical to the patient and he started to feel a little hope. This is a pivotal point in any treatment plan; it needs to make sense to the patient in order that they will engage. Normalizing the postural alignment and releasing the tight muscle were the first steps in the process; as we did so, the numbness became less frequent. There were other problems we addressed such as bio-mechanics which were less than optimal in the surrounding joints, ergonomic challenges for the sleeping position as well as at the computer, and developing a home program that was enjoyable for the patient as well as sympathetic to the work we were doing and his underlying condition.

During sessions, we developed a concise set of exercises to support the extensive amount of manual work performed in the treatment sessions. Throughout, the patient was being thoroughly educated about the nature and behavior of their condition as we worked. The bottom line is that the patient’s x-rays remain unchanged, yet he is now free of symptoms. 

Should his symptoms start to resurface:

1. He usually knows what caused it, and, therefore, there is minimal fear.

2. He knows exactly what to do about it.

The feedback that I receive most consistently from my clients is that they are empowered by the knowledge that they gain from our sessions and feel that they can make good decisions regarding their problem because of it. The problem need not dictate their life.

In the example above, it took 8 visits to get the symptoms down to 75 % on a consistent basis, and we weaned out over a further 4 visits. However, most clients have at least that recovery in approximately 4-6 visits for more localized joint and postural issues.

In conclusion, Physiotherapy evaluation and treatment is a “hands-on” approach to musculoskeletal health (the equivalent degree in the USA is Physical Therapy). All joints and soft tissue can be addressed with these methods: the spine, fingers, toes and everything in between! There is a significant emphasis on manual techniques during the sessions and patients comment that the evaluations feel very thorough for this reason. The patient’s symptoms are usually reproduced in the evaluation in order to isolate specific structures or movements that are causing problems. The more closely these can be pinpointed, the quicker results will be. The exercises associated with physical therapy are prescribed in order to support changes made during the sessions. 

Lorraine and the crew at BritPT Wellness Solutions