In this video I'm going to answer the question does lumbar spinal stenosis lead to hip and
knee pain? People with lumbar spinal stenosis are often confused about how to read their symptoms,
because often they don't even have back pain at all or pain in the lumbar spine. Most of the time,
people with lumbar spinal stenosis only have pain into their legs, including their knees and hips.
But if you've got a history of old knee problems or old hip problems,
it can get really confusing and how to tell if the pain is coming from the old
hip and knee problems or if it's coming from your lumbar spinal stenosis problem.
Coming up next in this video, I'm going to tell you how your lumbar spinal stenosis diagnosis
has a deeper-rooted problem that could be setting you up for hip and knee problems.
My name is Dr. David Middaugh. And I'm a specialist physical therapist at El Paso manual
physical therapy. And this channel is dedicated to helping people stay healthy, active and mobile
while avoiding unnecessary surgery injections and pain medications. Please consider subscribing to
this channel so that you don't miss out on any of the helpful videos we post each and every
week. So let me get straight to the point. The root problem of lumbar spinal stenosis
is often a muscle imbalance where the muscles on the backside of the spine,
the ones that run up and down. The back of the bones here are overdeveloped overused,
they're too big, too stiff, too dense, and they're causing lots of compression through the spine.
That's why things are getting compressed. Now stenosis itself means narrowing of the openings.
But when there's a lot of compression from the muscles here, that closes the little
openings on the sides of the spine where these nerves come out. If you've had an MRI telling
you have stenosis, or your doctor explained to you that you have stenosis, that is most often
coming from lateral stenosis, or it's also known as foraminal stenosis, because the holes in the
side here are called the lateral femoral. So they'll call it lateral stenosis or
foraminal stenosis. And then the second kind of stenosis that you can get is central stenosis,
which is also caused by compression from these muscles, it's going to same root problem,
it just is a matter of where's the body going to break down first, for central stenosis,
that just means the spinal cord in the inside in the middle of the spine bones here
is getting compressed. And it could be because you have a slippage of the bones, you have a disc
going into the area, or the actual space itself can be narrowing. And that's the body's response
to excessive compression in the area. That compression from those muscles
causes abnormal forces to go through the joints to go through the discs to go through the entire
bones and the nerves as well. And over time, this is what causes the bones to change,
you can get bone spurs, you can get degenerative disc disease, which is a loss of disc height,
where the bones, the discs are between the bones, those discs can get smashed,
and it's because of these muscles back here that directly cause compression forces to go through
the spine. And none of this happens overnight. It doesn't happen from one instance to the next
or even from one week to the next. It's usually developing slowly over time, like the course of
months and years. But people usually don't really get over the threshold where they start feeling
legs symptoms or back pain until it's been festering for a time. Usually people that have
lumbar spinal stenosis have had back problems off and on for years, maybe even decades.
And then they finally gets bad enough to where it's not going away like it used to. And they
go to the doctor and get the MRI or the X ray. And that's when they're told that they have stenosis,
they've probably already had it for a while. It's just a now it's
bad enough to where it's bothering your legs, you can't sleep at night, it's causing some serious
symptoms, you can't straighten up all the way because it gets worse being in that position.
Those are the classic signs and symptoms of having a stenosis. Now let's talk about how
that root problem connects to hip pain. Well, if you've got these nerves compressed in the area,
that's the most direct way you're going to get pain into the hip because a lot of these
nerves that come off the side of the spine here, these yellow things that come out of the side,
they run down all of them. In fact, they come off the lower back the lumbar spine here,
they run down into the leg, some go all the way down to the feet.
Some only go to the hip, especially the ones that come off the sciatic nerve, which they
bundled together and they pop out right here my finger is on the edge of this bone and they're
closed in by a big ligament on the other side. So you're getting nerves compressed up here.
It can that pain that the compression can travel down and affect the hip joints through the nerves
directly. The secondary way that your hip can be affected is those same nerves that are being
compressed up here can cause the muscles that they're connected to not operate. efficiently.
Just think of like a water hose. If you were to turn on the water hose
at your home or somewhere, and then you go step on the hose or put a heavy rock on the hose,
it's going to decrease the flow of water to the end of the hose, maybe not completely cut it off.
But where you had a full flow coming out of the end of the hose, it reduces down to halfway or
even a trickle, which if you think of this signal going to the muscles, it's just not going to allow
the muscle to operate normally, which then changes the way the hip joint down here is affected so
that the hip joint doesn't move normally anymore. And then you have a joint problem on top of
a stenosis problem. So oftentimes, people with lumbar spinal stenosis end up with some sort of
hip joint problem like arthritis. And sometimes arthritis was already there before the back
problems started. So it's kind of a difficult thing to analyze and assess and figure out
where did the problem begin. But usually, it's coming
from that muscle imbalance, I'm telling you about the back muscles being too strong.
Now, another important factor that you need to know here is the muscles that support and
stabilize and move the lower back because if you look at the skeleton here, there's just
five bones 1, 2, 3, 4, 5. In this part of the body versus up here, you have all these
ribs in addition to the to the spine bones. Down here you have the pelvis bones. So this
area of the body is kind of vulnerable to losing stability and getting imbalances because you just
don't have a lot of other bones in the area or hard structures, its reliance on your muscles. So
there's three main groups the back muscles, and then you have your abdominal muscles that come
around from the front and attached to the back. Those can offer movement and stability. And
then you have your hip flexors that run from the thigh bones, the top of the thigh bones
here in the run up into the lower back. those hip flexors, the big ones are so as
and the iliacus muscle, the iliacus muscle ends up right here on the front part of the pelvis bone,
those two can offer a lot of compressive forces as well, of the three muscle groups, you should have
a relative balance between the three, that doesn't mean that they all have to have equal strength.
It just means that the forces on the lower back should be such that everything's moving uniformly,
you don't have excessive compression in the area. And not one muscle group is overworked
or working too hard. And if you have a history of your back muscles, getting tight and achy and you
you have spasms that happen you get you have instances where your back gets stuck and you can't
move you have to go to the chiropractor, you need to just stretch it out and move over some time.
That's a sign that your back muscles have been taking on too much work.
And other muscle groups like the abdominals or the hip flexors are not doing their job. Now, another
way that this happens is the hip flexors. The muscles here in the front of the hips,
can get overworked and that usually presents as hip pain. People often get hip injuries
like sprains and their hip bursitis tendinitis in their hips, labrum tears in the hip joint,
there's a piece of cartilage that wraps around the socket, right here in the hip joint.
It's called the labrum. And that cartilage can get damaged or injured. If there's a hip muscle
imbalance, that where those psoas muscles and the iliacus muscles are being overused,
those are going to compress the lumbar spine and cause the stenosis problem up here. Eventually, if
you're susceptible to it, that's why it's possible for you to get hip joint problems and hip muscle
problems like tendinitis, bursitis hip arthritis. Of course, if you've got lumbar spinal stenosis,
now we've got tons of videos that go into detail about how to find if you've got a hip bursitis hip
tendinitis problem, or a hip arthritis problem, and how to get help for those as well. You can
go check those out in the description below here. And let's talk about the connection to the knee
problem. So along the same lines, the muscles that are part of the hip flexors I only mentioned
to the iliopsoas the so as in the iliacus. But there's another one called the rectus
femoris muscle, which is the muscle that's right on the front of your
thigh right in the top in the middle. If you look at my leg right here, it
runs from my hip joint right here, straight down over the top, it's superficial and it attaches to
the kneecap right here on the front. That muscle crosses the hip joints, so it's technically a hip
flexor muscle, and it often gets overused as well. In order to stabilize the hip and pelvis,
it really offers stability to the pelvis because it attaches right here in this part of the bone.
But if it starts to get too short or too tight, too overactive, it can tilt the pelvis forward and
cause the spine to curve too much to curve this way. Let me show you my body what that looks like.
If this muscle here in the front gets too short, it yanks my pelvis forward makes me want to
do that, like I'm sticking out my butt, which makes my back muscles shorten and work extra.
So it's a chain reaction effect. And sometimes it's in the back that it starts sometimes it's
in the hip and knees that it starts. At the end of the day, we just had to fix it all. Finding
where it started isn't always beneficial, we just need to fix it. So then, if you have,
if you have a shorting of that rectus femoris muscle because it attaches to the kneecap right
here, it's going to yank the kneecap into the thigh bone causing compression right here.
And not only that, but that kneecap has a ligament that attaches to this part of the
shin bone down here. And if you have that rectus femoris pulling, and is pulling that kneecap up,
it's going to pull that ligament up and compress the shin bone up into the thigh bone,
which compresses the knee joint and sets things up like knee arthritis and knee meniscus problems.
So the joint problem can develop from the muscle imbalance that contributes to lumbar stenosis.
And then similar to the hip problem that I explained, the same nerves that are up here in the
lower back, they end up going into the knee so you can actually get direct compression of the nerve
that travels down into the knee around the knee. And that can cause knee pain as well.
So I hope this helps you to understand the connections between the back and the
hip, it because it's not just nerves, a lot of people just focus on the nerves.
But there's huge connections in the muscles that can lead to hip arthritis,
and knee arthritis and other structures like the meniscus, the labrum tendinitis,
bursitis problems to occur in the hips and knees. And oftentimes in the healthcare field, people
separate them and they say, Well, you have a stenosis problem. And then yeah,
I know you have that knee arthritis problem that's separate, that's something else.
We never separate them here in the clinic, we always look to see how they're connected,
there has to be a connection because your hip connects to your knee and your back.
So that needs to be part of the assessment needs to be looked at and seeing if there's any possible
connections. Here in the clinic, we're looking at what's the priority to treat and if you've got
this kind of setup where you're you've got a stenosis diagnosis.
And then you've been told that you have maybe hip arthritis or near arthritis or
you have some sort of hip and knee pain, they all have to be addressed and usually
treating the stenosis problem, the problem that's closest to your spine or directly on your spine
is going to be the priority. In some cases, less so you might look at the foot,
there might be some foot problems that set up a knee, hip and back problem. But more often than
not, the priority is going to be up in the lower back, you've got to treat the root problem which
is going to be like an abdominal weakness, which leads me to fixing the root problem.
We've got a program that we offer online here it's a 28 Day Back Health And Wellness Boost Program.
This program is completely focused on treating the root problem for back conditions like lumbar
stenosis, disc herniations, degenerative disc disease, your common everyday back spasms.
This program is me coaching you and walking you through specific exercises, teaching you about
how to avoid situations and certain movements and postures to improve the pressure is in your spine
so that we can decompress it and take pressure off discs, nerves, joints,
all that stuff to optimize your back health. It's programs 100% online and it's accessible
to you 24 hours a day, 365 days a year. You can find out more details about it in the
description below. As well as other playlists that we've got through our YouTube channel.
They're also linked in the description below for more specific help for specific hip, knee and back
problems of this video was helpful for you and I hope to see you in the next video. Thanks bye