Is a lumbar corset or support useful?

There is some evidence, although limited, that increased lumbar support may reduce some of the factors responsible for low back pain in lumbar stenosis, especially when there is a component of “acute” disc bulging. In addition, strategies which encourage the patient to ambulate in slight “flexion” can increase the patient’s walking stance and reduce symptoms.

What other treatments can be useful in lumbar stenosis?

• TENS (transcutaneous electrical nerve stimulation) can reduce symptoms.
  
• Trigger point injections and facet joint injections can reduce secondary muscle and joint pain, respectively.
  
• Epidural steroid blockade may play a role in reducing inflammation of the nerve roots, when the stenosis pain is more “acute.”
  
• Surgical techniques have a substantial role in patients who are resistant to the above treatments.

Is exercise helpful in lumbar stenosis?

Exercise plays an important role in reducing the degree of deconditioning and disability in patients with lumbar spinal stenosis. A postural evaluation to learn the most comfortable positions for activities is vital. Exercises which involve flexion are often helpful in patients with chronic stenosis; at times, when the stenosis is “acute,” exercises stressing extension (such as those used for disc pain) are beneficial. In addition, flexibility exercises can be helpful in reducing the stress to the back in daily activities, by allowing other portions of the body, such as the hips and pelvis, to assume greater mechanical stress.

How is the facet syndrome treated?

There has been relatively little research on management of the facet syndrome until the last decade. Physical therapy modalities can again be useful in reducing symptoms. In addition, lumbar mobilization, a more gentle form of manipulation, can be helpful in regaining normal joint motion and freeing up scar tissue and adhesions about the joint capsules. In addition, Williams’ flexion exercises involving pelvic tilts, partial curl-ups, and knee-to-chest exercises, can reduce symptoms. See exercises following text.

Is manipulation helpful?

Although no foolproof studies have been done, many patients with a facet syndrome do feel better after manipulation. It is vital that other conditions affecting nerve roots and discs be ruled out before manipulation can be considered, It is also important that manipulation be placed into the context of a full rehabilitation program which includes the consideration of other exercises, modalities, as well as corsets or medication. In addition, no treatment can substitute for adequate education and postural advice.

Are medications helpful?

As in lumbar stenosis, medications can be helpful in reducing inflammation, muscle spasm, and pain.

What is the role for alternative treatments?

• Facet joint injections can be helpful. Studies have been controversial as to the exact per cent of patients who will respond favorably to these injections; however, there is no question that some patients do benefit from injection into the facet joint.
• TENS (transcutaneous electrical nerve stimulation) can be useful in reducing symptoms.
• Injections into muscles and ligaments can reduce secondary soft tissue pain related to the facet syndrome.
• There are surgical procedures which are evolving to manage more resistant cases. These are of less clear-cut benefit in patients with facet syndrome.