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Paul Phillips PT, June 20 2023

Unraveling the Puzzle: Walking with Leg Pain? Could Your Back Be the Surprising Culprit?

You're strolling casually to your favorite coffee shop just a few blocks away, enjoying the sunny day. Suddenly, out of nowhere, you feel an odd, nagging ache in one of your legs. It's not like you injured yourself or anything, but this has been happening quite consistently over the past few weeks. You've noticed that whenever you take this walk, that dull ache starts creeping up. A short pitstop on a park bench seems to alleviate it, but if you don't take a break, that dull ache quickly transforms into a full-fledged pain. What in the world is going on?

Well, today's blog post is all about unraveling the mystery of spinal stenosis. We'll dive into how this common condition, typically occurring in the lower back, can surprisingly be the cause behind that persistent leg pain. Recent studies have revealed some eye-opening statistics: 2% of people between the ages of 40 and 49, and 11% of those aged 70 to 79, experience this type of leg pain as a result of their back. Let's dig in and discover what's really happening here!

Why Does Spinal Stenosis Cause Leg Pain?

Lumbar stenosis causing leg pain is a condition originating in the low back, in which the nerves that serve the legs are pinched. 

Let’s do a quick anatomy lesson: the nerves of the legs, which supply our muscles and skin of the legs, begin in our low back, branching from the spinal cord.  Those nerves are long, cord-like structures that then travel downward the full length of our legs. 

Where the nerves exit the spinal column, they travel through small holes in the sides of the vertebral column. These small holes are made of two half holes, from two vertebral bones that are stacked, one on top of another. These bones are spaced apart by the discs.  

Fact: These discs get thinner with age and this is a normal part of aging. We have all noticed that our grandparents get shorter with age. This thinning of the discs results in less space for the nerves. This is how the nerves can be pinched. 

Who's at Risk of Spinal Stenosis?

Most people who have this problem are over the age of 50. As we age, the spaces between the bones of the spine narrow, creating the potential for a pinched nerve. As shown above, in one study, 11% of those aged 70-79 had this condition. Younger people have not reached the age at which thinning of the discs could cause this problem.

Many patients ask if X-rays could be useful to confirm this diagnosis? X-rays may in fact show that the discs are thinning, however the catch is that all people will show thinning of the discs as they age, but most will not have this problem. If you have a group of people with stenosis symptoms and another group with no symptoms, their X-rays may actually look identical.

So why do some people with thinning discs experience leg pain, while others with the same disc situation don't?

It's like playing detective, trying to uncover the missing pieces of this mystery. What else could be contributing to this problem? Stay tuned as we are about to dig deeper into the fascinating world of spinal stenosis and its enigmatic ways.

How Does Stiffness in the Hip Joint Intensify the Agony of a Pinched Nerve?

A normal walking stride requires us to be able to extend our supporting leg behind us. But, what if one of our hips is stiff enough that it won’t extend beyond pointing straight down?

The common compensation we see patients arching their low back to achieve a full stride. This means the low back is really working hard to accommodate that stiff hip. This can cause the small space where the nerves of the low back pass to get pinched with each step. 

This video shows how restricted hip extension can cause excessive low back arching and how this can pinch nerves.  

How Does a Physiotherapy Assessment Unveil the Presence of Spinal Stenosis?

With a thorough assessment, a physiotherapist can assess if your leg pain is caused by a low back problem related to a stiff hip joint. Focus only on the location of pain will not be able to connect these particular dots! 

The pattern of symptoms is why physiotherapists are so interested in patients' description of their symptoms because it is the recognition of symptom patterning that leads us to do an excellent physical assessment. In this scenario, the fact that symptoms are worse standing and walking, and are relieved by sitting leads us to assess the low back. 

If a low back assessment can provoke and relieve symptoms, this confirms the low back as the cause of the leg symptoms. This will, in turn, prompt us to evaluate the hip using physical assessment to measure the hip's range of motion. If the hip range of motion in the backward direction is less than it should be, then we have discovered a reason for the pain and the potential solution!!

How can Physiotherapy Help with Spinal Stenosis?

If it’s determined that your leg pain is caused by the low back and a stiff hip, a physiotherapist will give you a specific and appropriate home exercise program, which will focus on hip stretches. By regaining the missing hip range of motion, we can often alleviate, or even get rid of this type of leg pain. We will teach you how to do these home exercises in the clinic, sending home resources in the form of paper, or video instructions to follow. In follow-up appointments, we ensure patients are performing their “homework” properly and listen to feedback on how symptoms are progressing. 

Manual therapy is often included during clinic sessions and may include low back hands-on techniques. We often teach patients positioning techniques for use at home to relieve pain. These positions are specific to this problem and help reduce pressure on the nerves of the low back. Specific positioning is useful because hip stretching techniques often take a few weeks to gain hip range of motion and, ultimately, help the leg pain.  

Understanding the “why” behind the pain is empowering and helping you know how to work towards a solution is always our goal!

Is Physiotherapy Effective in Treating Spinal Stenosis?

These days, academic journals are increasingly writing about a  concept called "regional interdependence."  It’s the idea that modern physiotherapy should consider the body as a moving system and that clinicians should assess how areas outside of the painful area may be affecting the movement system as a whole. 

This clinical concept of regional interdependence necessitates a complete assessment, and lumbar stenosis is one condition that illustrates well how one area of the body can affect another. 

A recent study by Schneider and Colleagues, published in 2019, found that in 259 patients diagnosed with lumbar stenosis, the patient group that received manual therapy and an individualized exercise program made bigger functional improvements and improved their walking distance more than the group receiving a more general exercise class, or the group receiving medical care including medications.

Key Takeaways 

If you are over the age of 50 and have developed a new leg pain that is worse when standing and walking but is alleviated by sitting, a physiotherapy assessment could hold the key to unraveling this mystery and finding that you have lumbar stenosis.

If the assessment reveals that this link between your back and hip is indeed causing your leg pain, your physiotherapist will craft a complete physiotherapy treatment plan that's tailor-made just for you. They'll be there by your side, expertly guiding you through each step of the solution.

So, if you're ready to take charge and say goodbye to that pesky leg pain, it's time to embrace the wonders of a physiotherapy assessment. Get ready to team up with your physiotherapist and embark on a journey towards a pain-free future and improved quality of life. The solution is within reach, and you've got a dedicated partner by your side every step of the way!

Thanks for reading!

Written by

Paul Phillips PT


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