Sometimes the nerve roots in your lumbar spine can get hung up or restricted at an area called the vertebral foramina. These foramina are the passages in the bones of the vertebra through which nerve roots pass. Each foramina varies in size depending on location.
In conventional medicine, when this foraminal compression occurs a medical operation called foraminotmy is performed to remove the pressure on the nerve roots. This nerve root compression can be caused by bone compression (from arthritic changes), disc herniation, scar tissue, or excessive ligament development.
In many cases where the restriction is caused by a soft-tissue obstruction, Active Release procedures can release the restriction. Some of these procedures are taught in the “Long Tract Nerve Courses”. These nerve gliding procedures use patient body motion to help free up the restriction at the foramina. If the sciatica and related symptoms are due to a soft-tissue restriction the patient will often see some immediate improvement.
Sciatica and Spinal Stenosis
Spinal stenosis is a condition in which the spinal canal narrows (MRI photo), compressing the spinal cord or the nerves that branch out from the spinal cord. Serious cases of stenosis do require surgery. Milder cases of spinal stenosis can be treated nonsurgically. Spinal stenosis can be caused by numerous factors such as disc herniations, thickening of ligaments, trauma (motor vehicle accidents), and spinal tumors.
Symptoms of spinal stenosis are:
- Leg pain that gets worse with walking and improves with bending forward or sitting. Generally the pain will only be on one side of the body. The degree of pain will depend on the amount of impingement.
- Muscle cramping in the legs. This cramping is usually worse going down hill and much better when the patient leans forward.
- RED FLAG – Loss of bowel or bladder function is an indication of cauda equina syndrome. This is a medical emergency, seek medical attention immediately.
To determine if you have spinal stenosis an MRI (Magnetic Resonance Imaging) test may be needed. Normal X-rays will not rule out spinal stenosis.
Treatment of Spinal Stenosis
Mild to moderate cases of spinal stenosis usually respond very well to a combination of manual therapy, exercise, and activity management.
Exercise and daily activities in cases of spinal stenosis should be performed within a completely pain free range-of-motion. Be consciously aware of each action you perform throughout the day whether it is sitting, standing, or lifting. Brace your core before you lift, move more through your hips, and avoid staying in one position for too long. This will help to reduce inflammation, decrease spinal stress, and improve overall stability.
If you have not exercised for a while start out in stages. Work up to at least 30 – 60 minutes of exercise on most days. It is very important that you are consistent with your exercises to maintain your strength and flexibility. Just remember to warm up before exercising with some aerobic activity to reduce chance of injury and to speed the healing process.
Active Release Techniques cannot remove the cause of spinal stenosis, but it can remove a considerable amount of mechanical stress from the spine and improve spinal stability. This is often enough to help the patient reduce pain and improve over all function.
In cases where the pain is disabling, or where the patient’s ability to walk is severely impaired, surgery may be the best alternative. I have treated numerous patients with spinal stenosis who were waiting for surgery. Many of them just wanted to see if they could get some pain reduction. In most cases we were able to reduce the amount of pain significantly, some even avoided the surgery. In other cases the stenosis was so severe that the surgery was the only thing that gave these patients any degree of relief. After their surgeries many of these patients had post surgical ART treatments to remove some of the compensatory effects of long-term spinal stenosis. These treatments are of great benefit in helping these patients make a full recovery after the surgery.
In part three of "Resolving Sciatica with Active Release" we will cover Sciatic Nerve Peripheral Compression Syndromes.
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