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PTupdate.com -> RE: "Mature" adults and spinal stenosis (April 21, 2008 9:00:15 AM)
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KAK: Not really easy to put everything in a post regarding treatment of this patient population, but I will put down what I find works the majority of the time
First, I find that patients are pretty much "resolved" when I have them at the point where they can lie prone on elbows for 5-10 minutes, and quad flexibility is full to the point where their foot can touch their buttock.
I will make note to seperate those who have radicular or unilateral symptoms versus those with central pain. The ones with radicular symptoms are pretty much guaranteed success. Those with pain right where L5 is mashed down on the sacrum on radiographs, are obese, are much more difficult to fix.
My typical program will use modalities as needed. I utilize seated flexion, LE flexibility, pelvic stabilization, manual therapy to increase segmental motion to those hypomobile levels (my theory is that if L4 and/or 5 are degenerated and perhaps even unstable, the fact that L3 and above are all very stiff means these hypermobile levels have to do that much more). I may use manual or mechanical traction, based on relief provided. I utilize weight loss, reminding them that the fit and trim 20 year old gym chick has back pain when pregnant and carrying 20 xtra pounds, so their 75 year old degenerated back with a 40 lb gut isn't going to tolerate very much.
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