No trauma to my Back? But now I have pain with walking!

It's very common to see asymptomatic, bulging disc after the age of 30 and unlikely to cause spinal nerve root compression.  It's important to understand the difference between disc bulging versus disc herniation.  Bulging disc appears round and symmetrical compared to herniated disc, which appears angular and asymmetrical.  Both can cause spinal complication but, most often, herniated disc is the culprit.  Although bulging/herniation is just one of the causes of spinal canal narrowing, there are a few more causes.

Spinal stenosis refers to one or combination of the following:

  • Narrowing of central canal (no wiggle room for your spinal cord)
  • Narrowing of lateral recess (formation of bone spurs)
  • Narrowing of neural foramen (no wiggle room for your nerve root to exit from your spinal cord to your limbs)

What are the symptoms of spinal stenosis?

  • Generally over 50 yo
  • Dull, aching pain, numbness, tingly in lower extremity (neurogenic) vs tight/cramping (vascular cause)
  • Occurs bilaterally but can be unilateral
  • Pain is provoked when walking or standing
  • Leaning forward or sitting relieves the pain
  • Neurogenic intermittent claudication (episodic pain)

What tests may be needed?

Physical history and exam with your physician generally can divulge the pathophyisiological causes (particularly neural vs vascular).  Imaging studies (MRI, CT) are very helpful in showing central canal narrowing and bone spurs.  Nerve conduction studies (EMG) will confirm how well the nerve signal travel to the muscle starting from the spine. 

What are treatment options?

It's imperative that you seek medical advices quickly if you are experiencing new bowel incontinence, pain in most positions, or foot drop!

  • Take pain relieving medication (start with OTC include acetaminophen (sample brand name: Tylenol) or ibuprofen(sample brand names: Advil, Motrin)
  • Stronger pain med may be necessary
  • Muscle relaxants if truly spasm in nature
  • Stretch and strengthen the muscles around your abdominal core
  • Weight reduction
  • Physical Therapy to correct body's biomechanic
  • OMT (Osteopathic Manipulation Therapy)

Surgery (decompressive procedures) has high initial success rate but 25% become symptomatic again within 5 years.  Successful reoperation on these patients have shown 75% positive outcome. 

What can I do right now?

Stay moderately active but avoid exacerbating movements (bending and lifting heavy objects).  Do not stay inactive!!!  Although it's intuitive to rest when you have discomfort, it is counterproductive in this scenario.  Prolonged inactivity will result in back weakness and stiffness.  Light to moderate daily movement is highly encouraged. 

It's important to consult with your physician to rule out other organic causes and differentiate minor differences (e.g. neurogenic vs vascular or both) for your current symptoms.

 

Dr. David Carfagno is a Board Certified Internist and Sports Physician, who trained at the Cleveland Clinic Foundation.

Tri-Quoc Pham M.A. is ACSM Certified Personal Trainer and a 4th year medical student at Arizona College of Osteopathic Medicine.

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  4. Saifuddin A. The imaging of lumbar spinal stenosis. Clin Radiol 2000; 55:581.