BCP Lumbar Stenosis

Question 1

What are the three types of Stenosis ?

Answer 1

Central - ligamentum Flavalum, Narrowing of canal, bulging disc

Lateral - facet joint thickening, Osteophytes

Foraminal - facet joint thickening, Osteophytes

Question 2

What are the three classifications of Lumbar stenosis?

Answer 2

• Congenital: Paget disease (bigger bones), Achondroplasia (Dwarfism)
• inflammatory: AxSPA
• Degenerative: Facet Arthroplasty, DISH, Spondlyiothesis

Question 3

Of the three classifications, which is the most common?

Answer 3

Degenerative

Question 4

What are the three Spondy’s and what’s their difference?

Answer 4

• Spondylolisthesis: Stress fracture and forward slippage of Vertebrae
• Spondylosis: Stress fracture in Pars intraticulars
• Spondylitis: Inflammation of vertebrae that could fuse

Question 5

What is the average age of someone who might develop Stenosis?

Answer 5

50-65

Question 6

What are the typical signs and symptoms of Lumbar Stenosis

Answer 6

• bi-lateral leg pain
• Lumbar extension brings it on (hold for 30s)
• Flexion seems to ease it
• potentially a negative SLR test
• Age between 50-65
• has worsened over time

Question 7

What symptoms would hint that it’s more likely Stenosis than a Herniated disc?

Answer 7

• Discs pathology tends to cause uni-lateral leg pain where Stenosis causes Bi-lateral leg pain typically.

Question 8

What would we do for early rehab?

Answer 8

• knee to chest rocking (Bent knees to decrease extension)
• Knees side to side lying to limit extension

Question 9

What types of exercises would you do for later staged rehab?

Answer 9

• Quadruped leg extension (start with Lumbar flexed and progress to Extended as eases)
• prone leg lifts

-Reverse Hyperextensions (start uni-lateral and progress to Bi-lateral)

• deadlift’s progression through ROM then load up.