In this video I'm going to tell you the top seven absolute worst activities that you can do
for lumbar spinal stenosis. lumbar spinal stenosis treatments often involve medications, injections,
and even surgery. treatments that are less mainstream include exercises and
stretches given by physical therapists. There are also spinal adjustment techniques
given by chiropractors and spinal manipulation techniques given by physical therapists.
Some of these treatments might be absolutely right for you at the right time, while others
could be completely wrong, and you need to stay away from them. I'll be guiding you through
these activities coming up here next. 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 every week. Let's get right into it guys, the number one
absolute worst activity that you could be doing for lumbar spinal stenosis is back extension
exercises. These exercises are usually given to you by physical therapists that aren't 100%
sure how to treat a lumbar spinal stenosis case. Because in lumbar spinal stenosis, the back
muscles that run up and down the spine, me pull my skeleton here, here's the spine and the back
muscles that go right up and down the sides of the spine, if you were to just reach over to your
back, those are the muscles that you feel those are usually rock hard and very big and developed.
And you don't want to be exercising those but the thinking is that
if the back hurts, then work the muscles right next door to the back, which are those muscles and
that it should make your back pain better. And the fact is that it does tend to help a teeny tiny bit
temporarily very temporarily. But it feeds into the long term problems.
So you need to avoid doing back extension exercises. Let me show what these look like.
For these extension exercises, you'll be lying on your stomach just like so.
And then you're either picking up your arms and head or your feet or both together the arms and
head and feet at the same time and focusing on these muscles that are in the lower back.
But do you feel those back muscles burning on any other exercise that you might do,
whether you get it from the internet or from a healthcare professional,
you generally should be staying away from those exercises because they're going to feed into the
problem that got you the lumbar spinal stenosis. Number two is twisting exercises for the spine.
Now there's gentle ways to twist the spine and release it. And if you feel like you're
not being aggressive or not holding any weights doing it, then that probably will be okay for
you that if there's any aggressive twisting exercises, especially against resistance or
holding some sort of weights while doing it, you need to avoid that exercise because in that spine,
the way I showed you, those muscles get real stiff. Usually when there's a lot of
stiffness in the muscles around the spine, it keeps splitting for moving very well.
But there's one or two segments in the lower back. That ended up moving too much. And if you
practice that twisting motion or activity, which I'll show you some common movements in a second,
it'll cause those ones that are moving the segments in the spine that are actually mobile
to move excessively to move way too much, causing further stenosis problems in the long term.
So let me show you a couple of twisting exercises that are commonly done so that you can avoid
them. The first one is typically what's called a Russian Twist or an abdominal twist exercise.
And people sit just like this, you're instructed to be like this, sometimes
you're holding a little weights right here and you're twisting this way touching the way down or
reaching your hands down to the sides of yourself. That is a way to twist the exercise that you need
to avoid. The second most commonly done one that is it tends to be more gentle and this one can
be done gently, but it can also get aggressive is lying down like this with the hips and knees bent
just like so. And then twisting the legs over to twist the spine. Now if you do this slowly
and easily, it might actually be okay. But if you do it aggressively to where
you're throwing your legs over or with resistance I've seen some people do it
while holding a band around their knees to try to open their legs as they go over or while holding
a ball between their legs and squeezing inwards as it goes over. That ends up causing too much
muscle use in the back and feeds into the problem. Number three spinal adjustments and manipulations
which is like joint popping techniques that are offered to patients by chiropractors and
physical therapists specially trained in how to do that. Now these techniques these joint popping
techniques in the spine alone are to be avoided. And here's why whenever you go to pop the spine,
and you just leave the patient there, you don't do any sort of follow up exercise, there needs to be
a combination of joint techniques in the spine with exercise, you might get relief from popping
the joints because they're stuck and need to move. And so for that benefit, it could be okay.
But if you're repetitively doing these techniques over and over and over again, for
weeks or months on end, without doing some sort of exercise, it treats the root of the problem,
which is usually abdominal strengthening. And I'll speak more to that towards the end
of this video. If you're not doing some sort of abdominal strengthening or gluteal strengthening
as well to treat the root problem of lumbar spinal stenosis, then getting the adjustments or
the manipulations in the spine, popping the joints all the time, could cause some of the joints there
to become extra loose, and actually feed into that spinal stenosis problem, which puts people further
towards having to get some sort of surgery. So if you're attending a clinic right now, that is
just popping your spine, I would go and ask them, you know, what kind of exercises can I get, or
watch to the end of this video to learn more about the root problem, because maybe you need to get
it from outside that clinic, because it's just not something they specialize in, or that they offer.,
Because you might actually benefit from the spinal adjustments or manipulations, you just
need to find the right exercises that work for you to progress your lumbar spinal stenosis into the
right direction, to heal without surgery. And one more thing I'll say about this
is most people, most healthcare professionals that are trained on doing adjustments or spinal
manipulations, join popping techniques are trained on doing a general technique,
meaning they just kind of twist your whole spine without identifying the movement at each specific
level of the spine and the direction, that does take somebody with some extra qualifications.
And more advanced training, it depends where they went to school. And there's many factors to that.
But the easiest way that you can tell if somebody is doing a specific technique or not, is one,
they'll tell you, you know, the lips, you know, I'm manipulating L two, and L three, l one and
l two, they'll tell you specific levels like that, or I'm adjusting this vertebrae or that vertebrae.
But if they don't really talk about it, and if you ask, they don't really have much to say about it,
or the other way, that number two way to figure it out is if the if they just kind of poke around,
but don't really wiggle each segment, because that's how I figure it out, I wiggle
each segment and I compare one of the other. And I can then tell this one's tight, this one's
loose down here. And then I focus on this one. And I don't worry about the loose one, because if I
move that loose one, it's going to get looser and cause more stenosis problems, you got to
consider the way that you're treated. Oftentimes in clinics that do adjustments and manipulations.
There isn't a whole lot of checking or assessment or evaluation every visit, it's just get to
the techniques right away and push you along the system to get through the treatment. And
it does help temporarily. But like I said, in the long term, you might only be loosening up
the already loose segments of the spine. And the ones that really need to move,
they're usually up here in this area, don't get the joint popping technique to them,
they don't get the effect that's needed to really progress that lumbar spinal stenosis.
Let's go on to number four. This was super common in anywhere you could find this all
over the internet, hamstring stretches. Everyone wants to do hamstring stretches whenever anything
feels tight or painful on the back of the leg. And the fact is, if you've got lumbar spinal stenosis,
you probably have some pain, numbness, tingling, or achiness. That goes down into your legs.
And so the initial thought of any healthcare professional is will stretch it out.
But what you need to know is if this is nerve related pain, like it usually is with lumbar
spinal stenosis, nerves don't like to be stretched. Now nerves do connect to muscles
and muscles might get tight as a result of the stenosis. And so when you go to stretch, you might
be stretching up a muscle, but you're probably also stretching the nerve. And that's going to
affect the nerves long term. You don't want to be stretching an injured or irritated nerve.
It just leaves it more irritated. As time goes on. You may not feel the irritation or bother
in the moment. In fact, you'll probably feel relief because you got the muscles
to loosen up a bit. But then the symptoms stay for longer. If you've been stretching for a week
or more. Usually people are like, Oh, I've been stretching for months already and haven't really
moved the needle on your lumbar spinal stenosis. Symptoms like you haven't improved week to week.
Then you need to stop stretching, you need to end it and you need to move on to some
core strengthening exercises, some something that treats the root of the problem which I'm
getting to here soon. I do need to forewarn you if you're going to a clinic and they have you
doing hamstring stretches, and you tell them that you saw this video or even show them this video,
they might look at you cockeyed and think that this is blasphemous.
And this is very countercultural as far as how the healthcare culture is it's very heavy
on hamstring stretching. But there's more deeper science to this. And hamstring stretching is just
old news, it is not a good thing to be doing hamstring stretches, stretch it because it's
tight is an old mantra that's been around in the in the healthcare industry. And we're moving past
that there's way better information that helps people for the long term.
Let's move on to number five. And this is back extension stretches,
also known as Cobra stretches, there's different ways to do these exercises or stretches,
a lot of people start with them laying down facedown and then some
people do them standing up to let me show you what they look like.
The most common back stretch is done just like this, you're lying face down. And you might start
by just getting up on your elbows to push your back into extension or bending it backwards.
Often, if you do a progressive series of stretching, they'll tell you to get up
on your hands, and then push up in this direction. And the feeling you get is a
stretch and maybe some compression to your back. And that feeling that that stretch.
And that compression is often what kind of gates the pain or in other words, what
distracts your body from the pain. But in all reality, it's compressing the spine further,
and pinching the nerves more. And it's doing it at a gradual pace, you're not you don't always
have a lot of pain going in that direction. But it can, it can irritate the nerves for the long term.
Now, more often not people that have lumbar spinal stenosis prefer to be bending over forward.
But when this exercise or stretch is given to them, sometimes we're told to
grit through the discomfort and force it just to get more spinal mobility.
But it is highly advisable to push the spine in that direction. Like I said earlier, you've got
big muscles here in the back that are already compressing the spine, you don't
want to push it further in that direction. And the way this is done in standing,
let me show you that next, people are holding standing to put their hands on their hips and lean
backwards like this and even repeat the motion just like so. And that can be very aggravating
for people for the same reasons, it's the exact same motion, you're compressing the spine.
What's even worse about the standing one is that you're having to use your back muscles
to go in that direction. So it actually feeds into the strengthening of the back muscles,
which is what you don't want to do. Number six is medications and injections. Now you this
one's kind of an if you want I am okay telling patients here in the clinic to go get medications
for the lumbar stenosis problems or even get an injection they have a lot of back pain.
But I always tell them this while you're under the effects of that medication or injection, if
you have a relief from it, if it actually works, and you do get some relief, you need to be working
on the root problem because those medications are the injection which is medication just injected to
a specific area to affect it a bit better. While you're under the effects of those
medications, your pain is improving. That doesn't mean that it's curing the problem.
It's just a band aid solution is just taking away the pain temporarily, during which time you need
to be working on fixing the root problem, so that when the effects of the medication wears off,
you've progressed a bit you've gotten stronger, you've gotten more mobile, you've begun to
address the problem and you can keep going. Because if you have lumbar spinal stenosis,
this has been years in the making likely it's something that needs to be done gradually over
time, and you're not going to affect it in in one week or a couple of weeks even, you've got
to be treating it over time in order to affect it for the long term. Number seven is decompression
surgery for the spine. And let me just show you what this looks like. Here on the spine.
You see these things that stick out in the back of the bones. These are called the spinous processes.
In decompression surgery for spinal stenosis. They make a cut on the side of this spine, this process
right here on either side, and they take it off. And the theory is that if they take that off,
they take the pressure off the spinal cord on the inside of the spine. You know the success rates of
this surgery are mixed. Some people get relieved. Some people don't a lot of people do get relief.
But where I disagree with this surgery if you're not having severe symptoms,
because if your symptoms are just severe enough, you've tried the right exercises,
you've tried the right treatment approach. You've done things right then by all means, I'm going
to tell you go get the laminectomy surgery because it's probably the best thing for you.
But if you've been doing the wrong exercises, if you've been doing the Cobra stretches, if you
just been relying on pain medication, getting spinal manipulations or adjustments without
doing any sort of core exercise strengthening, then you're not done, you need to go do that
first to make sure that you can effectively treat your lumbar stenosis without surgery.
But if you did all that, and you have to have the surgery, and they're going to take pressure off,
it might actually benefit you. But think about what you're losing. Because it seems easy. And
the surgeon might make it seem really easy. Oh yeah, we just cut this off, remove that suture
you back up, and you're going to have a chunk of your bone missing, but you'll be just fine.
People get along just fine. There are important stabilizing structures all over the spine and
your body was built very specifically to have all the structures in there. And when they
take off that bone, that bone has important ligaments that help to stabilize the spine,
connection points for muscles, there's muscles in the area that just aren't going to be there
anymore. And not only that, but now your spinal cord, your nerves are exposed.
Because the whole point of the these muscles I'm sorry, these bones here in the back, is to protect
the spinal cord. There's all kinds of side effects that happen as a result of getting a laminectomy
surgery. And it might be a right decision for you. But it's definitely a last resort. And even
if you get the spinal laminectomy surgery, you still need to address the root problem.
Because if you still have dominance of these back muscles, they're big and hard and not
freed up and you have a bunch of stiffness in the area. It's just a matter of time before you get
stenosis somewhere else in your spine. And you're visiting the surgeon's office again to see what
else can be done. And they can only remove so much before they tell you know, it's dangerous
to do any further procedures on your spine. So if you're looking at surgery, to rely on it,
and you really haven't thoroughly tried everything out, I put the brakes on surgery,
go try out some core strengthening, which I'm going to talk to you about next. And I'm giving
you a bunch of things that you should avoid. But what should you actually do and we've got more
videos to talk about exercises and stretches that are appropriate for lumbar stenosis.
But I want to highlight one of our programs called the 28 Day Back Health And Wellness
Boost Program. This program is designed to treat the root of many different back
problems including lumbar spinal stenosis. Oftentimes, abdominal muscles are extremely weak.
And the way to strengthen abdominal muscles can get confusing in the healthcare field,
we've got a very specific way to get you to fire the right muscles to decompress the spine
and take pressure off nerves, discs and bones and joints in the area.
This program is 100% On Demand, it's online. So anywhere that you've got internet access,
you can get onto this program, and do it wherever you are in the world. The program is 28 days long,
but you have access to it past 28 days. And what I encourage people to do is
if you get some improvement and relief, during the first 28 days that you do this,
go again and go again and again until you keep chipping away at the problem because
if you've got something like lumbar spinal stenosis, it's not going away in 28 days,
you've got to treat the root of the problem over the course of months.
The better part of a year is probably what it's going to take for you to defeat this problem,
get it under control and begin to thrive again in life without surgery fixing this problem
naturally. You can learn more about it in the link in the description below. And we've got
other playlists for videos on our channel that are completely free. Go check those out
in the description below as well. I'll see you in the next video friends. Bye