Help—It Hurts to Walk!
Question: I have spinal stenosis. Sometimes the pain is worse when I walk uphill or climb stairs. I can't even walk far due to the pain, which makes me feel out of shape. Granted, I'm not as fit and trim as when I played college football 20 years ago, but shouldn't I be able to walk without pain? Why does the pain increase when I walk uphill, and what can I do to help relieve my back and leg pain?
—Fountain Valley, CA
Answer: Spinal stenosis is a condition commonly associated with growing older. However, in your case, it may be those years of college football that put extra wear and tear on your spine and perhaps caused your back to age faster than the rest of you.
Stenosis is a Greek word meaning "narrowing," so spinal stenosis is when the areas around your spinal cord and nerves become constricted for various reasons. Your spinal cord and nerve roots can then be pinched or squeezed as they pass through the narrowed spinal channels, resulting in pain.
Your spinal channels can be narrowed because of:
- osteoarthritis: The cartilage cushioning your joints can start to wear thin or even wear away completely as you get older. Then the bones rub against each other-not a nice image, I know—and bone spurs (osteophytes) may develop. Those small bone growths can stick out into the spinal channels.
- intervertebral disc problems: The discs between your vertebrae can bulge or even herniate, pushing on your spinal cord or spinal nerve roots.
- injury: For example, lifting something heavy without using the right technique can cause a disc to bulge or herniate.
So how does being tackled in football fit into spinal stenosis? Football and other high impact sports increase your risk of developing spinal stenosis. The increased stress on your back can cause your intervertebral discs to degenerate more quickly, making them more prone to herniation. High impact sports may also cause your cartilage to wear out faster. (Other risk factors for spinal stenosis include poor posture, being overweight, and generally just growing older.)
As you've discovered, spinal stenosis does sometimes make it extra painful to walk uphill or climb stairs. Both of those activities cause you to lift your leg higher than normal, and depending on where your nerves are being pinched, this movement can put more pressure on the nerves. In essence, walking uphill and doing stairs decreases the space in your already-narrowed spinal channels.
With spinal stenosis, you may also have pain when you're walking normally—but generally, that's when you're walking a longer distance (as in longer than from your car to the house). Again, that's because the walking movement may increase the pressure on your spinal cord or nerve roots.
In those instances, you can try to relieve your pain for the moment by bending forward or even sitting down. Both of those positions help to take pressure off your nerves by creating more space in your spinal channels.
Other possible options to relieve your pain include:
- losing weight: Extra weight puts more strain on your spine. Since your back has already been through a lot of stress, you might consider slimming down now (if you're over the ideal weight for your body type and age—check with your doctor).
- physical therapy: A physical therapy program could help in many ways, including getting you started on a lumbar strengthening program. Your core muscles and your low back muscles are the supporting structures of your spine, and stronger muscles support the spine better.
- medications: Your doctor will prescribe the best medication for your pain, but typically anti-inflammatories are prescribed for pain resulting from spinal stenosis.
- injections: For severe cases of spinal stenosis, your doctor may inject corticosteroid medication into the area where you have pain.
In my experience, I've found that a multi-disciplinary approach—using several treatment options in combination—helps reduce patients' pain from spinal stenosis.