Spinal Stenosis and Running

author : AMSSM
comments : 2

Member Question from bcball

“I have a long history of spinal stenosis that runs on my dads side of the family. I was treated for it eight years ago with a steroid injection by the nerves. I was 250lbs then and decided I did not want to go through life like my dad and his brothers and sisters. So I lost weight, currently at 190 pounds, my lowest was 175. I started training for triathlons four years ago. I did a half Ironman in 2007. Last year I decided to only run since I am horrible at swimming.

I did two half marathons last year and one half marathon in May of this year. I noticed my butt would hurt on the left side after long runs, but stretching would make it feel better so I thought it was a muscle thing. I started training for a full marathon in June, and five weeks in the pain was too much so I went to the doctor. After x-rays, MRI and going to a neurologist, my spinal stenosis has progressed to moderate/severe. The neurologist said he would recommend surgery but we can try the steroid shot again and see what happens. Either way, he said no more running or anything high impact. I'm crushed. Running was the one thing I could do year round outside, it's practically free, and I can get lost in my own thoughts deep enough to not mind training.

So does anyone have experience with spinal stenosis? From what I have researched it sounds like there isn't much I can do to stop the degeneration of the vertebrate. Any advice would be greatly appreciated.

Answer from Deanne Eccles Rotar, MD

Member AMSSM

Spinal stenosis is narrowing of the spinal canal or where the nerves exit from the canal with resultant impingement of the nerves.  There are two main areas of narrowing.  The first location is the central canal, which is the central opening that begins at the neck and runs to the tailbone.  The spinal cord travels in the central canal and is surrounded by spinal fluid.  The cord tapers and ends at the L1/2 level, typically, and then the nerve roots continue down the canal and exit on the sides.  The second area of impingement occurs at the side openings called the neural foramina.  The nerves split off from the cord and exit the foramen along their path to innervate specific muscle groups.  When the nerves are pinched, pain can be felt in the area of the affected nerves innervated but the pain can be more diffuse.

The three main structures that contribute to narrowing of the canal or foramina are the intervertebral discs anteriorly, the facet joints posteriorly, and the lamina laterally.  The discs are cushions between the vertebrae that can degenerate and bulge with age resulting in a decreased space in the front of the spinal cord or nerves in the lower canal.  The facet joints connect one vertebra to the next (above and below).  They can become hypertrophied (enlarged) due to arthritis from wear and tear changes.  This hypertrophy acts to decrease the space for the nerve and cords posteriorly and at the foramen laterally.   The pedicles are V shaped portions of bone that makes up the lateral portion of the canal. The pedicles can be shortened congenitally causing narrowing, which seems to be a contributing factor for you based on your family history.

Once degenerative changes have occurred there is nothing that can be done to reverse the pathology, non-surgically.  I would advise limiting irritating activity, which may slow progression of the degenerative changes.  Typically activities that cause irritation are impact activity and extension activity (activity that involves arching backwards) since they load the posterior elements of the spine with resulting narrowing of the canal and foramina further.  Since running involves impact and some extension it is not typically recommended for individuals with spinal stenosis.  Flexion exercise opens the canal and foramina and usually relieves symptoms.  Biking is an excellent flexion and non-impact activity and is recommended in stenosis.  Swimming is also non-impact and is usually involves neutral or flexion positions of the lumbar spine.  

My recommendation is to use the stenosis as an opportunity to work on your biking and swimming and make those strengths.  You would also benefit from core strengthening and flexion biased stretching.  You can maintain excellent fitness with these activities.  I would limit running to once a week on average and try to keep the distance under 6 miles.  This distance may seem like too little but I think you can still participate in sprint and Olympic distance races but realize that you are not going to be as strong on your run.  It would also not be unreasonable to consider increasing the distance more if you are extremely gradual with rate of change.  You should also pay attention to any onset of pain into the gluteal, hip or leg area -that would mean you are irritating the nerves with the activity and would need to further cut back.  I understand your frustration with not being able to run regularly but try to move forward in gaining skills with biking and swimming, which will make you a better triathlete in the long run.  Good luck!

Deanne Eccles Rotar, MD

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date: January 17, 2011

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AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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