Spinal Stenosis and Cycling
Mrs. Road Fan has had some back pain lately, similar but different from when she needed surgery on L5/6, 15 years back. This time it's spinal stenosis.
Her doctor has said no cycling, but I'm a little surprised at this. Other resources, like the Mayo Clinic site, say cycling may be a good part of treatment.
Anyone here with spinal stenosis or a therapy background that can help shed light on this contradiction?
too old for bike shorts?
I'm a physical therapist. Spinal stenosis is usually associated with pain with extension. Cycling generally flexes the spine, so many patients can tolerate it much better than other types of exercise. The American Academy of Orthopedic Surgeons supports this:
Ask the doctor again why cycling would be a problem, and seek another opinion if the answer isn't based on a rationale that makes sense. Research evidence shows that staying active is the best treatment for low back pain.
Hi Road Fan,
Another physical therapist here and I'll second cyclehen's response with this caveat: if Mrs. Road Fan has a *severe* central stenosis (narrowing of the central canal) as opposed to foraminal stenosis (narrowing of the hole where the nerve leaves the spine), the flexion may be just as aggravating as extension. As well as asking for an explanation and a second opinion, I'd recommend asking for a referral to a physical therapist, if your insurance requires one (a referral, that is). Then see an orthopedic manual therapist for treatment.
The reason for this recommendation is that, just because a stenosis is seen in imaging (CT scan, MRI, or sometimes x-ray), that doesn't mean the problem is being caused by the stenosis. The stenosis may be completely benign in other words (just like a bulging disc).
Last edited by lbogart; 09-17-08 at 08:06 PM.
Reason: omissions due to multi-tasking :0)
Thanks both of you for the generous advice!
Originally Posted by lbogart
She's had an MRI and is referred to PT. We're thinking of finding one if possible that tends to specialize more in cyclist treatment. I had PT for rotator cuff inflammation and the Hospital's rehab service seemed to not be aware of the difference in cycling with a bike tha fit right and one that does not - "most people just scrunch up with those drop bars, we don't like them" was the response I got from a few DPTs.
She has some consequences of nerve pressure - it's not really benign right now.
Mrs. Road Fan rides a hybrid, and has a little excess hand pressure while riding it. It's been suggested she would benefit from a 'bent, but don't really see why.
Hi Road Fan,
You're very welcome! Good idea looking for a PT with a sports (and cycling if possible) background or specialist certification.
I certainly wouldn't recommend the 'bent option at this point--in many cases, sitting more upright is a very uncomfortable thing for a person with bad back (increased pressure on the discs and facet joints--the primary points of articulation between two vertebrae). I would also not recommend a 'bent until a dysfunction of the SI joint or piriformis syndrome has been ruled out. Both can produce pain in the low-back and both can produce radicular symptoms (pain in the legs, sciatica, weakness, etc.). Such dysfunctions as these are also why I'd recommend finding a PT who responds something along the lines of "well, we'll see if that's what the problem really is" after learning of the MD's diagnosis (they've been known to be wrong ;0) )
Keep us posted & again, good luck!
I'm not with you on the detailed anatomy (but that's what Wiki is for!!), but being an engineer, I see an upright back, say on a 3-speed or modern "comfort", and think, all those compressive forces! Straight through the spine. Then a well-fit rider with drop bars, and think how many dynamic ways that person's body will deal with shock. I keep thinking the drop bar (or well-placed hybrid bar) must be healthier.
Originally Posted by lbogart
You're exactly right... laying flat on our backs produces the lowest load possible on the spine (outside of a zero gravity environment), standing erect places the greatest linear (vertical) load on the spine, bending forward at the waist with upper body unsupported places very large shear forces on the spine which are greatest in the lower lumbar spine (long lever arm of the rest of the trunk hanging out there in space), BUT if you support the upper body (e.g., drop bars) this can be as unloaded a position for the spine as laying down.
Research also shows--and any long-haul truck driver who's been at it for a while can attest--that not only are the compressive forces themselves potentially damaging, but when you add-in exposure to high frequency vibration, the connective tissues bearing the load break down very quickly. We're exposed to the same high frequency vibrations on our bikes, so rides which place us in upright positions are less than ideal on several different levels.
Let me know if you don't find the anatomical info you need ;0)
HI I have stenosis for jogging
I had advancing stenosis from years of jogging?weights and other activites, after a few months of bike ridding the pain is gone and the actual condition has improved. I can't take NASIDS so pain management is important.
Biking is pretty low impact compared to other forms of weight bearing exercise.
Some experts think that long term biking may actually cause decrease in bone mass, now that may be a plus for someone with a calcification problem like stenosis.
My two cents.
Spinal stenosis is a narrowing of one or more areas in your spine — most often in your upper or lower back. This narrowing can put pressure on your spinal cord or on the nerves that branch out from the compressed areas.
Spinal stenosis can cause cramping, pain or numbness in your legs, back, neck, shoulders or arms; a loss of sensation in your extremities; and sometimes problems with bladder or bowel function. Spinal stenosis is most commonly caused by osteoarthritis-related bone damage
Last edited by djnzlab1; 09-19-08 at 07:59 PM.
too old for bike shorts?
I would contend that loss of bone mass is never a good thing. Bony spurs (osteophytes) are often seen in persons with poor bone density. Keep up adequate calcium intake and cross train with some weight-bearing exercise. Cycling may not have enough impact to stimulate bone, and some are concerned that prolonged sweating, such as on lengthy bike rides, may cause excessive calcium loss.
UPDATE! Mrs. Road Fan has three bulging discs, one of which is touching a right-side nerve.
She went to PT last week, and the dear souls there tried traction. That night she had level 10 pain, so we went to the ER, where she was given effective meds. After meds and some rest, she returned to work and was managing decently. Something excited it again, 10's again, back to the ER. She got a referral to pain management. The PM doc showed her the MRI (jeez, three weeks later!!!) and she has central spinal stenosis, which this doctor called on the severe side. She's scheduled for a steroidal epidural at the pinching disk, next week. The PM doc says PT is entirely the wrong strategy at this point, and recommends meds such as this to reduce the inflammation, then an appropriate schedule of exercises to build strength to a managing level. He also says that she should try this before any surgery is planned, and that the PTs she saw should have never put her on traction.
We're at least getting a coherent treatment plan now.
Regarding surgery, I have trouble imagining how a surgeon could get into the central channel and remove intrusive bone without affecting the nerves that are present ....
Road and Mrs. Fan
too old for bike shorts?
Wow. So sorry to hear about Mrs. Fan. While traction certainly sounds like a failed approach, I would be careful not to let that prevent your wife from continuing to seek appropriate care from a skilled physical therapist. PT practice also includes education in body mechanics to avoid "stirring things up", and strategies for staying active within the limitations of pain. I would be wary of PTs who just "do PT on you" versus educating about ways to manage pain and disability, and begin gentle strengthening and mobilization as tolerated. Beware of the effects of pain meds and immobilization (most urgently constipation) and encourage activity within the limits of pain. Good to hear you have a surgeon who is conservative, as most of these situations, as painful as they are, do resolve without surgery. Keep us posted... we're pulling for you both!
PS-- Here's a link to an article about the most common type of surgery-- if you're like me, you like to understand all the contingencies, even if it doesn't come to that point.
Thanks, cyclehen. I forgot to mention, we anso got a referrel to a sports-specialized PT who works a lot with severe spinal issues like this, and according to the pain management doctor takes a far more sensitive approach.
Originally Posted by cyclehen
More later, gotta go now.
The causes of sciatica are many but it most commonly results from either a herniated disk or spinal stenosis. Depending on the cause, the pain of acute sciatica usually goes away on its own in four to eight weeks or so.A thorough diagnostic work-up will reveal the cause.Fortunately, sciatica typically resolves without the need for surgery in about 4-6 weeks. However, if any neurologic deficits develop, such as a foot drop or changes in normal bowel and/or bladder functions, then immediate surgery is usually performed.For acute sciatica without any neurologic deficit, the use of epidural steroid injections can be very beneficial in resolving the discomfort.