I recently treated a patient who is emblematic of a slew of patients, especially baby boomers. She came to me with an MRI showing severe spinal stenosis - and several other spinal irregularities. She had been referred to a surgeon, but, luckily, as the idea of surgery at age 83 did not appeal to her, ended up coming to me instead. As we talked during the evaluation, it was clear that she already had two strong impressions. One, the stenosis was the cause of her symptoms. And, two, her stenosis was an irreversible disorder that would possibly get worse without surgical intervention. She had met a former patient of mine and had called me on the off chance physical therapy could help.
Stenosis refers to the narrowing of an opening. In the spine, stenosis commonly refers to narrowing of the opening through which nerves pass secondary to either bony overgrowth (eg osteophytes) or disc height loss. These changes in the spine are quite prevalent. Can stenosis be symptomatic? Yes. Irreversible without surgery? Yes.
But ... can stenosis (true, bony stenosis) be apparent on imaging and not be the cause of the patient's symptoms? An even louder yes. Very commonly.
In this patient's case, other spinal irregularities were observed on imaging as well. However, she had left her doctor's office believing that the stenosis was producing her symptoms. How was that determined? Diagnosing stenosis on imaging alone is not enough. A patient deserves a thorough physical examination to determine the cause of her symptoms, and then deserves a treatment plan specifically targeting that cause. Upon moving my patient's spine in different directions during her physical evaluation - I use the McKenzie method of mechanical diagnosis and therapy - I noted a favorable response to spine extension. In her case, over the course of four visits, she responded very well to sustained extension in prone. -- Laura
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