This article is a transcribed edited summary of a video Bob and Brad recorded in April of 2024. For the original video go to https://youtu.be/Wh6R48fvz30
Mike: Are you struggling with back pain related to lumbar stenosis?
Brad: So stenosis is something that a number of people have. It can be treated with exercises. You need to find the right ones. We have eight options here and you need to go through all of them, find out which ones relieve your pain, and work with them.
Mike: So tip number one is to check if you have an anterior pelvic tilt. Now that sounds like a big word, but essentially all that means is if your pelvis is tilted like me forward like this and oftentimes when you try to stand upright, I'm doing a very extreme version of it. You can have tight hip muscles and this can cause your back to get worse.
Brad: So we will look at this more clearly with a skeleton here. So here's the pelvis, the anterior motion, if you have tight hip flexors, the muscles in front will actually pull the pelvis forward like this.
Brad: Now the stenosis is happening right where the nerves exit the spine. When this gets going, actually the foramen or the holes that the nerves come out at get even tighter and squeeze and impinge causing pain. So we need to relax those hip flexors, allowing them to open up, making sure that there's plenty of room for the nerves and less pain as a result. All right, Mike is going to demonstrate a really nice hip flexor stretch. You're going to do this on the edge of your bed like Mike is doing. If your bed is really soft or you have a footrest there that gets in the way, you could do this on a sturdy table or if you have a plinth at home, which most people don't, but you'll have to work with what you have. Mike actually does his off the edge of his bed regularly.
Mike: Yeah, it's a little soft but it works for me. So what you're going to do is start in a lying down position with both knees to your chest. You're going to let one leg drop down to the floor like this. If you're tight, you may be way up here and can't go down any further.
Mike: Try to go down as far as you comfortably can, bend that knee back, and you'll feel more of a stretch. Pull the opposite leg towards your chest. Hold this for 30 seconds. This leg should be in a nice, straight line. Don't let it venture off to the side. You're not going to get as good of a stretch. Once you do one side, switch and do it on the other side. Again, the same rules. Hold for 30 seconds. If this is making your back pain worse, then this isn't going to help you. If it feels good, then keep doing the stretch.
Brad: I want to emphasize the importance of the leg or the hip that's not being stretched, the knee that's up, make sure you pull that knee up so that actually stabilizes the back and allows the hip flexor to stretch versus irritating the spine. Again, Mike mentioned if the knee is way up away from the table, and it only drops down part of the way and the other knee drops down farther, it's a very strong indication that the knee that's up has tight hip flexor problems. You really need to do this stretch. Take your time with it. It may feel a little awkward at first, but you'll get a good feel for it and learn to relax. Good key to stretching it. So now this next stretch is to specifically open up one side of the spine to open the foramen and decompress the nerve. Mike's going to point to where it is. Now when we do the stretch, watch what happens where that nerve exits, it's going to pull and open that up right there and that's where the whole goal and that's going to relieve that stenosis. Let's show them how it's done, Mike.
Mike: So these stretches are from Rick Olderman, who's a physical therapist. So we're going to show it in a doorway first. You can certainly use a pull-up bar if you have access to it. Brad will show it with a stick because we realize some people can't reach up that high. So you're going to take the side that is bothering you if it's one-sided pain. If it's both-sided pain, just kind of pick a side. So I'm going to take my left hand here. I'm going to face my palm away from me. Reach the top of the doorframe and then I'm going to lean into the doorframe. This is going to open up those foramen and can help take away some of your pain. I'm just going to sit here for 30 seconds. Some people may not need to lean into it too much to feel a stretch. Some people can lean in more. Just make sure your pelvis isn't hiking up because it's not going to help, let it relax. Breathe through it and you can perform it on the other side if you want. Just see if it helps. You can try both sides and see if this helps your pain.
Brad: Now, if the doorway is too tall or you don't have one, you can certainly use a stick that's reasonably solid, or you can use a piece of PVC pipe. We use the Booyah Stik. We had people use a broomstick, as long as it's solid enough, you could put it on a table and if the table is smooth and your stick is smooth, you simply put a shoe there so it does not slip around. We're just going to bring the hand up, palm facing away from you, grab the stick. We're not going to let the hand slide down. Just going to grip it there and step away a little bit. If you see right here, loose clothing. If that clothing tightens up and stretches, that's good. That means we're stretching the right area. Not only does it open up the foramen, but there are probably tight muscles in that area closing the foramen, so we need to relax and stretch them as well.
Brad: Now if you do the painful side and it does well and you do the other side and it creates pain, only do one side, do the side that feels good. Both sides may feel good. Everyone's back is a little bit different so listen to your body. Now this next stretch is very simple. It's one of my favorites. I do it on a regular basis because it consistently relieves my lower back pain. It manages it well. I do have stenosis at L4-L5, L5-S1. Go ahead Mike, show how simple it is.
Mike: So it's simply hanging. You are going to need some type of pull-up bar or something to hang from in order to do these. Notice right now my feet are on the floor, but my hips and pelvis are relaxed. This is essentially a distraction technique or traction, basically just separating your vertebrae, taking away any pain you may be having from stenosis. You can hold it here for as long as you comfortably can, and come back up. As you advance and if you're say younger or stronger, no matter your age you can do this and actually let your feet dangle or it's a tall enough system, that is perfectly acceptable too. But for beginners, you can start with this method.
Brad: And I really want to emphasize when you start doing this that you start out slow. If you go down like he did with his feet off the floor on the first day, you're probably going to have pain. It's not going to be comfortable. Simply go down, allow only 50% of the weight, and not lifting the feet up. It should feel comfortable. Do not get too aggressive right away. I can't stress that enough.
Mike: Typically when you're hanging, most people like to do it for two to three minutes roughly, but just let pain be your guide and obviously your grip strength.
Brad: I usually go about 30 seconds regularly and it works well for me. Everyone's a little different. Now walking with stenosis is something you'll want to do if you tolerate it. So in other words, most people with stenosis will walk so far, that they start having back pain. When you sit down, the pain dissipates relatively rapidly. So you're going to walk as far as you can comfortably. For example, if you can walk and at about 10 minutes, it starts to be irritated, you walked too far. Your next walk, the next day go eight minutes so there's no irritation there. Make sure you're on a flat surface, you're not hiking in the hills, and then always walk eight minutes. You can progress it a little bit, maybe up to nine minutes and then 10 as it's tolerated.
Mike: Now another good suggestion is if you can comfortably walk eight minutes and you want to do more, maybe walk eight minutes in the morning, eight minutes in the afternoon, and eight minutes in the evening. Just break up your walking so your back can tolerate it.
Brad: That's right.
Mike: So the next tip is if you're walking and you have back pain constantly but say you go to the grocery store and you notice, hey when I lean on a shopping cart, we call this shopping cart syndrome, my back pain feels a lot better. What you're actually doing is taking pressure off the spine by leaning on a shopping cart so it may be time to experiment with the walker as needed. Now I have a standard front-wheel walker here, Brad can show on a four-wheeler. But essentially you can press through your hands, taking pressure off your spine, and most often people will slightly flex forward like this with stenosis because it feels better and they will walk like this. If this is how you have to walk to begin walking again, it's perfectly acceptable and you should try it.
Brad: Now if you're at the level where you can walk fairly well with that grocery cart and it feels good, you may want to use a four-wheeled walker like this, which allows more freedom and it has a chair to sit down and when your back does get sore. Walking is a great form of exercise. You want to continue to do it as well as long as it doesn't irritate your back. That's the big advantage of a four-wheel walker, allows that freedom. I'm slightly forward, but I'm working on getting straight, but I don't want to irritate it.
Brad: So we're in that mid-range where it's tolerated, allowing you to walk longer distances, and then you can sit down, take a break. Oftentimes a little break when you're walking with stenosis, a few minutes can be enough so you can get up and walk again pain-free. Don't overdo it, be careful with it and use good judgment. Okay, now we're going to address problems that can occur in the upper back and in the lower neck, particularly with a flexed forward posture. The head will come forward and we get this bump, we call that the neck hump and that can cause problems and pain.
Brad: If you look at it on the spine, we have good posture, but this happens. Can you point that out, Mike?
Brad: So what we need to do is straighten that out, opening the gaps in that area so we have good posture and relieve the stress and pain there. So, Mike, he's just going to straighten up, bring the shoulders back as far as you can, and try to straighten this area as much as possible.
Brad: It's one of those things that takes time. Work with it and monitor your posture throughout as you're walking, as well as doing the stretch. Alright, so Mike's going to demonstrate using the wall and actually stretching that lower neck. Go ahead Mike, this is a nice stretch to do.
Mike: So first of all, you want to get close to the wall, place your buttocks on the wall, and then initially just try to touch your shoulders to the wall. Some people may be tight and they're rounded forward. Work on eventually trying to touch your shoulder blades to the wall. If you can successfully do this and it is not painful, the next step is to work on that forward head posture I have. So simply try to touch the base of your skull here to the back of the wall. Notice I'm not looking up, I'm just going straight back, performing a chin tuck. This would be optimal positioning. Obviously, if you've been stuck forward for a while, it's hard to get into this motion. So just take your time slowly each day, try to get more of your back touching, and eventually try to work your neck muscles.
Brad: So after it feels more comfortable using the wall, you can simply do this stretch without the wall. You'll get a good feel for it and do it without that as you stand throughout the day or even in a seated position in a firm chair, you can work that posture, getting things where they need to be. Okay, so as you progress, the neck is feeling more loose, and the lower back is loose. We're going to address the thoracic spine.
Brad: These next two stretches we'll show you work quite well. One of them is fairly aggressive, and we'll show you that and how to work with it. Now the first way to stretch it is probably a little easier and less aggressive. What works well is if you have a chair that has rollers on it, and then at a tabletop, you can put a cushion, or a pillow for a little cushion on the table. Elbows will go on the cushion, your hands are going to go behind the head. You're not really grabbing aggressively, just a place to put them to rest. And now I'm going to go outwards with the stool and stretch and I can feel that upper back really starting to stretch. Come forward, you can hold it. The key to this is going a comfortable distance, a comfortable stretch, and just relaxing for about 15 to 30 seconds. If you haven't done this before, it may be only five to 10 seconds until you get used to that because it is a little aggressive.
Brad: Now after you've done this and it feels pretty comfortable, you want to get more aggressive. Mike, you can show them the next one. On this one, you do need to get down on the floor comfortably.
Mike: So we are going to be doing the same thing Brad just demonstrated. My hands are going to go behind my head and my elbows will stay on a chair. This is a good height for me. Again, you're going to be on your knees. Just walk your knees back and you can see if I'm flexed and stuck in this posture, what I'm going to do is try to extend and relax this. You're almost doing a cat-camel motion if you've ever done that, but my forearms are supported, so it's really going to stretch into my thoracic spine and I feel a good stretch doing this.
Mike: So if this feels good for your stenosis, it's certainly a good option to try. You can, again, just hold this for a duration of time, five, 10 seconds, up to 30 seconds if it feels good, and repeat this throughout the day. Now we will show another option that may be better for some people.
Brad: Alright, so this next stretch again for that thoracic region we mentioned, you can take a towel or a couple of towels, and roll it up so it's about six inches in diameter. Get it firm, tape it up, and we're going to use that as a fulcrum point to actually mobilize that thoracic spine. We'll put it on the floor. I'm going to have a pillow for my head as you'll see how this works. I'm going to put that towel roll right between my shoulder blades. Oh, my back just cracked there, it worked very nicely, and it felt good. And you work forward or back, whatever feels like the comfortable and the most important spot, you'll get a feel for that after you do it. You have a pillow so you can relax the neck. I might actually tilt the pillow or use two pillows and then start here. You can bring the arms up overhead. Let gravity stretch. You're going to stretch out the front pec muscles as well and do this as tolerated.
Brad: Typically, you'll start out with five seconds or so. Again, the pillows are important so you can relax your neck. We don't want to irritate the neck and get sore muscles. If you happen to have a foam roller, the 36-inch foam roller works well. They make them different densities, the softer one is more comfortable and you'll put that down. This is a little more challenging as you will because it's a little unstable. So that can be a benefit for some core strengthening while you do this. And you need to make sure that the roller or the full roller is at a point where you can hit your head on it. If you end up with your head off the roller and your head goes back, it's no good, not what we want. Use a pillow underneath that feels much better. And now we're going to do the same thing. This works a little better than the towel roll. It gets in where it needs to go and you can hold it here and this is one of those things you can work on just in general. Even if you don't have stenosis, it's a great postural stretch.
Mike: So the last tip, number eight, is for if you're walking around either your house or you're out and about and you're having some back pain, it's going to be something you can do. It's a traction technique. So if you're at home, use a countertop. If you're out and about, try to find a park bench or picnic table that is very sturdy. What you're going to do is go up to the table. This is kind of short compared to those things, but we'll work with it. I'm going to face my palms away from me, and then I'm going to walk my feet away from me. I'm going to put my feet in the other direction and I'm just going to kind of let my body hang. This is going to get some distraction in my spine muscles there, which can help if you're having any stenosis issues.
Brad: It's important that you lock your elbows, it takes a lot of work off the arms. Again, this is too short. We need to be about four to six inches higher than this and it's much more comfortable. I'm sure Mike will agree.
Mike: Yeah, you probably won't have to kick your feet back quite as far as this if you're doing it on a taller surface, but it's the same concept.
Brad: Alright, so there are eight different options. Try all of them. Do the ones that offer relief and continue to do them. You can go on to other ones as you progress, as we instructed in the video.
Mike: If you want to check out more videos on stenosis, check out our video "Spinal Stenosis Best & Worst Exercises Must Know!" These are the best and worst exercises you must know.
Brad: That's right, enjoy.
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