One Saturday afternoon, Erik Levitt was a normal dad who walked – even ran – with his daughter to her swim lesson. But that evening, he was immobile. "If I just put my foot down, it would be a stabbing pain and it would cause numbness and I couldn't walk," says Levitt, a 42-year-old telecommunications professional in New York City. But when the sun rose on Sunday, he was a normal dad again, able to play with his kids in the park. A similar cycle struck at a recent business conference, during which Levitt used a walking stick one day but didn't need it the next.
"It's difficult to live with because it's never consistent," says Levitt of spinal stenosis, which he was diagnosed with via MRI in 2013 after his big toe, then entire foot, went numb during a physical therapy session for a different condition. The diagnosis describes a narrowing of the spinal column that limits the amount of space for the spinal cord, spinal fluid and exiting nerves. As a result, people like Levitt can experience muscle weakness, numbness, tingling and pain. In severe cases, they may experience bowel and bladder dysfunction and can lose control over their hands, says Dr. Afshin E. Razi, a clinical assistant professor of orthopaedic surgery at NYU Langone's Spine Center.
"Buttoning [your] shirt becomes difficult because you don't feel the tips of the finger. People drop things out of their hand; they can't open a jar," he says. "And sometimes … you become unsteady because the message is not getting from the brain down to your legs."
Spinal stenosis is common among older adults, thanks to relatively normal age-related wear and tear on bones, says Dr. Matthew McCarthy, a neurologist at The Sports Neurology Clinic at The CORE Institute in Michigan. "Most people [over age 60] will have some sort of narrowing as a result of age-related changes, but may not have symptoms from it," he says.
But spinal stenosis, which typically affects either the lower back or neck, can also occur in younger folks like Levitt, who was born with a narrower-than-normal spinal column and also has psoriatic arthritis, a chronic condition that can inflame the spine's joints. Other young or middle-aged adults may develop the condition after suffering back injuries like herniated discs or even developing tumors. Some athletes are vulnerable too, particularly if they're involved in sports like football, weightlifting or gymnastics that put a lot pressure on their spine during play, training or both, McCarthy says.
"People are aware of the severe spinal cord injuries – career-ending injuries" where they're carted off the field or court, he says. But unlike all the attention paid to the dangers of concussions and repeated head injuries, "a lot of the more chronic injuries … might be underemphasized."
But being aware of spinal stenosis is important since appropriate, timely treatment can improve functioning. In fact, even professional athletes can return to play after a diagnosis, although there's no established protocol for evaluating if or when they should do so, says Eric Robertson, a physical therapist who directs Kaiser Permanente Northern California's graduate physical therapy education program.
"Just having a diagnosis is not a prognosis for immobility and the requirement to cease function or sports, even at a high level," he says. "It's a sign that everybody needs to recognize that this part of your body might need more attention."
Here's how he and other experts suggest showing your back some love if you have spinal stenosis or suspect you might:
1. Tune into neck and back pain.
Don't think you have to be an athlete – or even active – to be at risk for spinal stenosis or other related conditions. In fact, more people are visiting spine doctors today thanks to their modern sedentary lifestyles that involve hours of hunching daily. "Computers, laptops, handheld devices are causing a lot more neck pain and back pain," Razi says. To prevent or help alleviate it, aim to get out of your seat every 20 to 25 minutes and to involve core-strengthening exercises into your weekly – if not daily – routine.
2. See a professional (or several).
If your back or neck pain is accompanied by potentially neurological-related symptoms such as muscle numbness, weakness, tingling or all of the above, talk to your primary care physician or see a neurologist, orthopedic surgeon or other spine specialist, Razi recommends. "Make sure somebody checks on [you] to make sure there's no significant progressive neurological problem," he says. "That can be permanent." If your concern is sports-related, consider visiting a clinician like a sports medicine doctor or sports physical therapist with expertise working with athletes, McCarthy suggests. "This is something that's amenable to management from a team," says Robertson, a spokesman for the American Physical Therapy Association.
3. Know your options.
If you receive a spinal stenosis diagnosis – often done through physical evaluations and tests that can help clinicians trace impairments to a particular part of the spine – "don't rush into surgery," suggests Levitt, who manages his conditions with anti-inflammatory, anti-anxiety and muscle-relaxing medications, as well as regular physical therapy. "[Physical therapy] is the difference between a pain-free day and a painful day," he says.
Indeed, physical therapy that focuses on improving range of motion, balance and core strength, for instance, can be very effective, McCarthy says. "If you can improve the neck's stability and range of motion, you can actually improve the sort of functional capacity of the person's spinal canal to accommodate the cord and their nerves."
When conservative treatments don't provide enough relief, surgery that helps create space for nerves may be the only option, Razi says. Although such procedures come with risks like the chance of needing additional back surgeries in the future, "most patients do very well," he says. Even NFL players who've undergone them have successfully returned to play.
4. Keep moving.
While people with spinal stenosis may find themselves hunching or sitting still to manage pain, experts recommend doing just the opposite. "Move more to slow the progression of degenerative changes," says Robertson, who encourages patients to walk in order to promote an upright position and help stabilize their hips. Levitt, for one, makes sure he gets up to walk while on frequent plane rides for business trips and stays involved in activities with deliberate, controlled actions like martial arts and softball. "The more active you are," he says, "the longer you will be active."