Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with bending forwards. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.Causes may include osteoarthritis, rheumatoid arthritis, spinal tumors, trauma, Paget's disease of the bone, scoliosis, ...

spinal stenosis

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Author: Sylvia Marinova, PhD student in the Genomic Stability Laboratory at BAS

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Back pain, and in particular lower back pain, are attributed to the most common complaints of modern man. Largely due to the nature of work and daily life, leading to "sedentaryness", irregular posture and insufficient movement.

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This in turn causes the appearance of functional changes of the musculoskeletal system, and hence complaints described as pain, discomfort, stiffness or heaviness.

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In this article, we will focus on the lower back area, its anatomy and the most common causes of pain, as well as treatment options.

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What you might not know about the lower back

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Here is a brief anatomical reference to the spine device and in particular its cruciate area. Do not miss this part, even if it seems boring, because it will help you better understand the origin of back pain.

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Together, <a href="https://www.bioseek.eu/en/eng/research/pubmed/Treatment_of_chronic_low_back_pain_new_approaches_on_the_horizon_28546769" target="_blank" rel="noopener"></a> the vertebrae form the spine [ref.1], forming a protective duct in which the spinal cord is located. Thespine absorbs much of the weight of the human body and provides us with a standing, which is also supported by the musculature around.

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They form the lower back, starting from the last thoracic vertebrae and reaching the last part of the spine- sacrum. They increase their size progressively, allowing them to absorb most of the weight of the body.

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Between the vertebrae are the so-called " intervertebrae discs. They act as shock absorbers in the spine and take away the vibration and tension that is created when moving, protecting the vertebrae in this way.

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Each disc is made up of a rigid outer fibrous ringthat surrounds a soft gelatin-like core consisting of85% water, type 2 collagen and small connective tissue cells.

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The vertebrae are connected by joints and ligaments that allow the movement of the spine in different planes. There are also small and large muscles that support the entire structure. Their even development is extremely important for proper posture, as well as for reducing tension onthe spine itself. If the muscles do not function sufficiently, then the risks of trauma and pain increase.

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It remains to mention the nerve fibers that come out of the spine through small openings in the lumbar vertebrae. Where they are fed out ofthem, we call them nerve roots . Lumbarnerves are 5 pairs and inert the lower part of the human body, responsible for the sensory and movements of its parts. If the nerve roots are affected for one reason or another, it is possible that the pain will spread along their entire length and even lose sensitivity.

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What causes lower back pain

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The identification of <a href="https://www.bioseek.eu/en/eng/research/pubmed/Assessment_of_spinal_pain_26096091" target="_blank" rel="noopener"></a> the origin of back pain and precise diagnosis are of utmost importance for the appointment of the correct therapy. In general, pain is considered nonspecific [ref.2] in the majority of cases as the root cause remains unclear.

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Some common causes of back pain can be:

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<ul>
<li style="font-weight: 400;">Disc hernia - in this condition, the nucleus of the intervertebrae disc shifts, tearing the fibrous ring. Due to the structural changes that occur in the intervertebrae discs described above. The pain in this case comes both from mechanical irritation of the nerve roots and from inflammation that is caused. In some patients, acute pain passes within a week or two, but in others it remains for a long time. Other risk factors for a herniated disc are heavy physicallabor, overweight, weight lifting.</li>
<li style="font-weight: 400;">Muscle spasms and stretching - muscle spasms can be caused by trauma due to physical activity, injury or concomitant disease (e.g. fibromyalgia).</li>
<li style="font-weight: 400;">Spinal distortions - congenital distortions or those due to improper posture are very often the cause of backache.</li>
<li style="font-weight: 400;">Some diseases - for example, osteoarthritis, spinal stenosis, etc. Some of them can be particularly serious. Therefore, it is important to consult a doctor if we suffer from back pain for a long time and do not know what they are due to.</li>
</ul>

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Pain is defined as acute ,when its duration is not more than 6 weeks, and chronic , whenit does not pass at least 3 months.

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You will learn more from <a href="https://www.spine-health.com/video/video-understanding-different-types-back-pain" target="_blank" rel="noopener">this video</a>.

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Role of the muscles

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There are large and complex muscle groups, the role of which is to keep the spine in an upright position, take away from the tension on it and allow it different movements such as twisting and bending in different directions.

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Some of them are involved in our daily movements such as pelvic muscles, but others remain unevenlyloaded . This leads to their weakening over time, and the consequencescan be muscle spasms, greater predisposition to trauma, as well as changes in the spine itself.

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Physiotherapy, as well as some specific exercises, can be aimed at strengthening the three main muscle groups supporting the spine:

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<ul>
<li style="font-weight: 400;">Spoilers (extensors) - these are the dorsal and pelvic muscles</li>
<li style="font-weight: 400;">Folding (flexors) - abdominal (abdominal) muscles and ilopsoasa</li>
<li style="font-weight: 400;">Rotators - hang on the side of the spine and are connected to the rotation and maintenance of the stand</li>
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This is usually also part of the first steps in the treatment of back pain.

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See more in <a href="https://www.spine-health.com/video/lower-back-strain-video" target="_blank" rel="noopener">this video</a>.

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What is the treatment of lower back pain

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Treatment depends on the root cause of the onset ofpain. In general, it can be divided into two groups - conservative and invasive treatment.

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The conservative treatment consists in taking medications that aim to reduce inflammation, relieve pain and relax muscles. Some of this type of treatment is also physiotherapy and special exercises that strengthen the muscles around the waist.

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In the absence of improvement and conversion of pain into chronic, then it is possible to switch to more invasiveprocedures.

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There are different <a href="https://www.ninds.nih.gov/DISORDERS/PATIENT-CAREGIVER-EDUCATION/FACT-SHEETS/LOW-BACK-PAIN-FACT-SHEET" target="_blank" rel="noopener">types of operational</a> procedures [ref.3]that are chosen according to the specific need.

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In conclusion, we will say that prevention is extremely important. We can protect ourselves from the onset of back and waist pain and their recurrence by improving our general physical condition and making sure to create proper moving habits, consciously monitor our posture and develop our musculature informedly.