What is Lumbar Foraminal Stenosis?
Lumbar Foraminal Stenosis refers to the narrowing of the gap (Foramina) between the bones of the lower back.
(It is also related to Facet Joint Dysfunction/Facet Arthropathy.)
Symptoms
- Pain in the lower back
- Sharp pinching pain when spine is extended and/or side bent to the same side of the Foraminal Stenosis
- Sciatic pain from pinched nerve
- Neurological symptoms (Tingling, Numbness and/or Weakness) referred to the leg
- Crepitus (Clicking in the joint)
- Facet joint referral pattern (Pain down the leg)
Causes
In my opinion – the main cause of Lumbar Foraminal Stenosis is due to an excessive amount of compression occurring in the lower back and how the spine adapts to it.
If there is a significant amount of compression in the lower back, the bones that make up the lumbar spine are essentially squashed together.
Over time – This can eventually lead to a reduction in the space between the bones and narrowing of the foramina.
Here is a list of factors that can contribute to the compression:
- Hyperextended Lower Back (Hyperlordosis)
- Laterally Flexed Lumbar Spine (Lumbar Scoliosis)
- Having one hip higher than the other (Lateral Pelvic Tilt)
- Repetitive movements into extension, lateral flexion and/or rotation
- Weak core muscles
- Carrying heavy weight
- Trauma
- Obesity
Other structures that are involved with Lumbar Foraminal Stenosis are disc bulges, inflamed nerves and bony growths (Osteophytes).
Diagnosis
Here are 2 methods that can be used to determine if you have Lumbar Foraminal Stenosis.
a) Investigative Scan of Lumbar Spine
A Magnetic Resonance Image (MRI), Computerized Tomography CT) or X-ray (XR) scan can be used to determine if you have Lumbar Foraminal Stenosis.
(Note: You will need to obtain a referral from your Primary Care Provider to get a scan.)
In the scan report: The following findings tend to be associated with Foraminal Stenosis:
- Disc Dehydration
- Degeneration/Arthritis
- Disc Narrowing
- Osteophytes
- Disc Bulges
- Spondylolisthesis
- Nerve root compression
(KEEP IN MIND: It is possible to have multiple findings on your scans and have no symptoms.)
b) Perform Combined Movements
Instructions:
- Stand upright.
- Arch your lower back backwards.
- Tilt your spine TOWARDS the side of pain.
- Hold this position for 30 seconds.
Results: If this position reproduces any of your symptoms, this may suggest that you have Lumbar Foraminal Stenosis.
Exercises for Lumbar Foraminal Stenosis
Step 1: Reduce Inflammation
Step 2: Releases
Step 3: Stretches
Step 4: Joint Decompression
Step 5: Gentle Movements
Step 6: Core Exercises
Step 7: Posture Correction
Step 8: Tips
Step 9: Surgical Intervention
Common Questions
Step 1: Reduce Inflammation
If there is a significant amount of pain in the lower back, it is important to address the inflammation first.
This will allow you to perform the suggested exercises more effectively.
a) Anti-Inflammatory Gel
Apply an anti-inflammatory gel to the area of pain for 3 times per day.
These gels usually contain the active ingredient Diclofenac Sodium.
b) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
It is recommended that you take an anti-inflammatory medication consistently for at least 7-10 days.
Keep in mind – there are different types/strengths of NSAIDs and is best used if the prescribed medication is appropriate to the severity of inflammation.
(Note: Please consult your Primary Care Provider before taking any medication.)
c) Cold Therapy
Apply an ice pack to your lower back for at least 10-15 minutes.
Do this 3-5 times per day.
Note: Do not apply the ice pack directly onto skin as this may cause an ice burn. (Place a towel between the ice pack and skin.)
d) Natural Products
Some of my patients have reported that taking natural products such as turmeric, ginger, chia seeds and fish oil capsules have helped to reduce their inflammation.
(I am not 100% sure how effective this is but it is something that you might want to consider.)
e) Cortisone Injection
This injection consists of a steroid (cortisone) and an analgesic substance.
The aim of this injection is to reduce inflammation and numb the painful area.
(In my opinion – try to avoid this option if possible! More often than not, the right exercises will help reduce your symptoms!)
Step 2: Releases
Tight muscles in the lower back can contribute to the compression of the joints.
Focus on releasing the same side that the Lumbar Foraminal Stenosis is on.
a) Quadratus Lumborum/Erector Spinae
Instructions:
- Locate where the Quadratus Lumborum and Erector Spinae muscles are.
- (Use Google if you are not sure.)
- Lie down on your back.
- Position your body so that these muscles are directly top of a massage ball.
- Apply a comfortable amount of body weight on top of the ball.
- Keep your body completely relaxed!
- Slowly circle around the target area and pause at any areas that cause more tenderness.
- Continue for 2 minutes.
- Repeat on each side. (If Required)
b) Latissimus Dorsi
Instructions:
- Make sure that you know the exact location of the Latissimus Dorsi muscle.
- Lie down on your side.
- Place the Latissimus Dorsi muscle directly on top of a foam roller.
- Position your arm in an outstretched position.
- Apply as much body weight onto the foam roller as tolerated.
- Keep your body relaxed.
- Make sure to cover the entire length of the muscle.
- Continue for 2 minutes.
- Repeat on each side. (If Required)
c) Obliques
Instructions:
- Sit down in a relaxed position.
- Use your finger tips to apply gentle pressure to the area between the side of the rib cage and waist.
- Continue for 1 minute.
- Repeat on each side. (If Required)
d) Psoas
(Do NOT attempt to release your Psoas muscle unless you know what you are doing! You will need to push through abdominal tissue to get to the psoas which can potentially be dangerous! Seek guidance from a healthcare professional.)
Step 3: Stretches
Focus on stretching the side of the spine that has the Foraminal Stenosis.
If you have Lumbar Foraminal Stenosis on BOTH sides:
Perform the stretches towards each side, however, you will need to make sure that you do not stretch too far into range as this may aggravate your symptoms.
(Keep in mind – if you stretch towards one side of the spine, you will also compress the other side.)
a) Quadratus Lumborum/Erector Spinae
(The following instructions are explained to stretch the left side of the lower back.)
Instructions:
- Stand up right.
- Place most of your weight onto your right leg.
- Lean and rotate your torso towards your right side.
- Hold onto your right knee for balance.
- Allow your left leg to lift and dangle.
- Make sure to keep this leg completely relaxed throughout the stretch.
- Allow gravity to pull your left leg down.
- Keep your pelvis facing forwards.
- Aim to feel a stretch on the left side of your lower back.
- Hold for 30 seconds.
- If required – repeat on other side.
For more stretches like this:
See post: Quadratus Lumborum Stretches
b) Latissimus Dorsi
Instructions:
- Hold onto the corner of the wall with your hand.
- Assume the position as shown above.
- Aim to bend your mid section as much as possible.
- Lean away from the wall.
- (Your hand should be supporting a good amount of your body weight in this position.)
- Twist your pelvis away.
- Aim to feel a stretch on the back/side of your torso.
- Hold for 30 seconds.
- If required – repeat on other side.
For more stretches: Latissimus Dorsi Stretches
c) Obliques
Instructions:
- Start from a standing position.
- Have your feet shoulder-width apart.
- Place your hand on the side of your hip.
- Use your other hand to reach to the opposite side.
- Push your hip towards the opposite side.
- Aim to feel a stretch on the side of your torso.
- Hold for 30 seconds.
- If required – Repeat on other side.
d) Psoas
Instructions:
- Assume a lunge position with your hands on your hips.
- (The hip at the back will be the side that will be stretched.)
- Pivot the foot that is at the back towards the midline.
- Keep your pelvis facing forwards at all times.
- Lunge forwards.
- Tilt your pelvis backwards.
- Push your hips forwards.
- Push your hips out towards the same side as the back leg.
- Aim to feel a stretch in the front of your hip.
- Hold for 30 seconds.
- If required – repeat on other side.
Step 4: Joint Decompression
These exercises can help loosen up the tight joints in the lower back.
a) Transverse Process Mobilizations
Instructions:
- Sit down on a chair.
- Reach around your lower back and place your thumb around the target area. (see above)
- Feel for bony protrusions. (These are the Transverse Process!)
- Apply a firm (but comfortable) pressure onto the Transverse Process.
- Perform 60 repetitions on each level.
Note: If you have not confident with this exercise, I’d suggest that you get a health professional to perform it on you.
b) Decompression with Ball
Instructions:
- Lie facing downwards on top of a large exercise ball.
- Support your body by placing your hands onto the floor.
- Position your body so that your lower back is in line with the top of the ball.
- Allow your legs to completely relax.
- Your toes should either be gently resting on the floor or dangling down.
- Aim to feel a stretch sensation in the lower back region.
- Hold this position for 30 seconds.
c) Manual Traction
Instructions:
- Lie down on the floor.
- Keep your legs completely relaxed.
- Instruct someone to hold onto both of your ankles and gently pull on both of your legs.
- Aim to feel a stretch sensation in the lower back.
- Hold for 30 seconds.
Note: If your body slides along the floor as your legs are being pulled, perform the exercise whilst lying on top of a tiled floor. Make sure that the skin on the lower back is in direct contact with the floor. (This will help stick you to the floor!)
d) Traction
Instructions:
- Stand in front of a stable bench.
- Place both of your hands on top of a bench.
- Lock your elbows straight.
- Lean most of your body weight onto your hands to take pressure off your feet.
- Keep your legs and lower torso completely relaxed.
- Keep your toes lightly rested on the floor.
- Aim to feel a stretch sensation in the lower back.
- Hold for 30 seconds.
Note: If you have issues in your arm, this exercise may not be suitable for you as it requires your arms to support a majority of your bodyweight.
Looking for other ways to decompress your lower back?
See post: Spinal Decompression Exercises
Step 5: Gentle Lower Back Movements
These exercises will help reclaim the normal movements of the lower back.
The following exercises are designed to be gentle. DO NOT move into any pain!
a) Knees Side-To-Side
Instructions:
- Lie down on your back.
- Keep your knees bent and feet on the floor.
- Gently rock your knees from side to side.
- Only allow the knees to drop as far as it is comfortable.
- Perform 30 repetitions.
b) Pelvic Tilts
Instructions:
- Lie down on your back.
- Keep your knees bent and feet on the floor.
- Gently tilt your pelvis forwards.
- Arch your lower back.
- Aim to feel a gentle contraction in the lower back muscles.
- Relax to starting position.
- Perform 30 repetitions.
c) Knee to Chest
Instructions:
- Lie down on your back.
- Hold onto your knees.
- Keep your legs completely relaxed throughout the exercise.
- Bring your knees towards the chest.
- Perform 30 repetitions.
d) Standing Side Stretch
Instructions:
- Stand upright.
- Tilt your torso towards one side.
- Repeat on the other side.
- Perform 30 repetitions.
Step 6: Core activation
Strengthening the core muscles will help support and stabilize the joints of the lower back.
This can shift some pressure onto the core muscles and away from the lower back.
How to activate the Core
Starting position:
- Lie down on your back with knees bent and feet on the floor.
- Keep your neck and chest completely relaxed throughout the whole exercise
- (If required – You can use a pillow underneath your head.)
Instructions:
Take a deep breathe in through your nose. Breathe out.
As you breathe out through your mouth:
- Slowly push out ALL of the air out of your lungs.
- Engage your core muscles (“draw belly button in AND gently tense your abdominal muscles”)
- Your lower rib cage should drop down as you exhale completely.
- Flatten your lower back completely on the floor.
- Aim to feel a strong contraction in the abdominal region.
- Whilst keeping your lower rib cage in the dropped position, take a breath in through your nose.
- Repeat 3-5 cycles.
For a complete list of Core Exercises:
See post: Core Activation Exercises
a) Dead Bug Exercise
Instructions:
- Lie down on your back.
- Keep your arms and bent legs raised in the air.
- Activate your core muscles. (see above)
- Keep your lower back flat on the floor.
- Slowly lower the opposite arm/leg as far as possible without allowing the lower back to lift off the floor.
- Repeat 10 times.
b) Maintain core activation throughout the day
It is important to engage your core muscles throughout the day.
This does not mean that you have to tense your stomach muscles at 100% intensity all of the time.
The aim is to generate an appropriate amount of core contraction relative to the movement/activity that you are performing.
For example – If you are sitting on a chair, you will still want a 1-5% contraction of the core. Whereas – if you need to lift a heavy object off the floor, you would want a 80-100% core contraction.
Step 7: Posture Correction
You may also need to address the following postures as they can predispose you to developing Lumbar Foraminal Stenosis.
a) Hyperlordosis
Hyperlordosis refers to the excessive arch in the lower back.
This hyper extended position of the spine can lead to the narrowing of the gap between the bones of the lower back on BOTH sides. (Bilateral Foraminal Stenosis)
Would you like exercises for this?
See post: How to Fix Hyperlordosis
b) Anterior Pelvic Tilt
Anterior Pelvic Tilt refers to the forward rotated position of the pelvis.
This can lead to Hyperlordosis. (See above)
Would you like exercises for this?
See post: How to Fix Anterior Pelvic Tilt
c) Lateral Pelvic Tilt
Lateral Pelvic Tilt is where one side of the pelvis is higher than the other.
This can cause the spine to counter-tilt in the body’s attempt to maintain an up right posture.
Excessive side tilting of the spine can lead to foraminal stenosis.
Would you like exercises for this?
See post: How to Fix Lateral Pelvic Tilt
d) Lumbar Scoliosis
Lumbar Scoliosis involves the presence of a lateral curvature (side bending) in the Lumbar spine.
Would you like exercises for this?
See post: How to Fix Scoliosis
Step 8: Tips
Here are some helpful tips to consider when addressing Lumbar Foraminal Stenosis.
a) Sleeping position
If you sleep on your back:
Place a thick pillow underneath the knees to keep your lower back in a less extended position.
If you sleep on the side:
Place a small pillow underneath the waist crease.
This will minimize the amount of side bending on the Lumbar Spine.
b) Stretch whilst sleeping
This is a great way to provide a gentle traction force to your lower back as you are lying down on your back.
Instructions:
- Lie down on your back.
- Hug your knees towards your chest.
- The lower portion of your back should lift off the bed as you do this.
- Slowly lower your spine (one level at a time) and legs back down onto the bed.
(Keep in mind – you will probably roll out of this position. This is fine. Even 5-10 minutes can help.)
c) Sitting
When sitting: Try to imagine your ribcage is “floating” away from your pelvis.
This can help reduce the amount of compression in the lower back.
d) Aggravating Movements
Avoid exposure to movements, positions or activities that make your symptoms worse.
If you need to perform repetitive movements of the spine towards the side (such as side bending and/or twisting, consider modifying how you are moving your body.
Step 9: Surgical Intervention
Does Lumbar Foraminal Stenosis require surgery?
Generally speaking – Surgery should only be considered if you have:
- Persisted with the recommended exercises for at least 2-4 weeks,
- Progressive neurological symptoms (especially with severe weakness and/or atrophy of muscles) or
- Significant amount of pain
- Poor function
(Note: If you have any doubts whatsoever, please seek medical guidance.)
Main surgeries performed for Lumbar Foraminal Stenosis:
a) Osteophyte Removal: Removal of Bony spurs.
b) Foraminotomy: Removal of bony tissue to increase the size of the Foramina.
c) Laminectomy: Removal of a section of the bone (called the Lamina) that is in direct contact with a compressed nerve.
d) Discectomy: A section of the damaged disc is removed.
e) Spinal Fusion: 2 or more vertebra are joined together (via a bony graft and screws) to stabilize the joints.
Common Questions
Feel free to ask me a question in the comment section and I’ll get back to you.
a) Is Lumbar Foraminal Stenosis serious?
Yes – it has the potential to be very serious! (… But not all the time!)
It really depends on how severe the stenosis is as this will usually dictate the amount of compression on the nerve/joint (… and thus the severity of the symptoms).
b) Can it be reversed?
In my opinion – it is possible to improve the symptoms associated with the foraminal stenosis.
c) Is walking good for lumbar foraminal stenosis?
Yes.
Walking is a great exercise for the lower back as long as your symptoms are not being aggravated.
Walking has a plethora of health benefits and is encouraged as much as possible.
d) What movements should be avoided?
In terms of preventing the foraminal stenosis from worsening, it is best to avoid the following:
- End range side bending to the same side of foraminal stenosis
- Excessive arching of the lower back
Conclusion
If you are experiencing symptoms that are directly related to having Lumbar Foraminal Stenosis, it is important to address it as soon as possible.
Failure to do so may allow certain structures (such as the nerve, disc and joint) to be compressed leading to symptoms such as severe pain, poor movement in the lumbar spine, tingling, numbness and/or weakness in the leg.
Try out the recommended exercises on this blog post for at least 2-4 weeks.
If there has been nil significant improvements, you may need to consider getting a review with a Neurosurgeon.
What to do next
1. Any questions?… (Leave me a comment down below.)
2. Come join me:
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3. Start doing the exercises!
Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. Seek guidance from a healthcare professional before starting any exercise. For more information: Medical Disclaimer.