Boot Camp Program For Lumbar Spinal Stenosis
An interview with Dr. Robert Pinto, a chiropractor in Williamsburg, Virginia
Lumbar spinal stenosis is a leading cause of pain and disability in older adults. This narrowing of the spinal canal usually results from age-related changes to the lower spine.
It can lead to compression of the spinal nerves, which can cause pain, numbness and weakness in the legs. Some people also experience low back pain. Symptoms often worsen while people are walking, which can limit a person’s independence.
While surgery is available for lumbar spinal stenosis, doctors usually recommend that people first try nonsurgical treatments. These include physical therapy, medications, steroid injections, and chiropractic treatment.
The Spinemobility Boot Camp Program for Lumbar Spinal Stenosis was developed specifically for people with this condition. It was designed by Dr. Carlo Ammendolia, director of the Chiropractic Spine Clinic at Mount Sinai Hospital in Toronto, Canada.
This six-week program has four components — behavioral change strategies, manual therapy, at-home exercises for strength and flexibility, and postural techniques to reduce symptoms.
Research on the benefits of the program show that it is effective at reducing symptoms of lumbar spinal stenosis. In a 2015 study, people who completed the program had lower levels of disability and pain, and were able to walk further without symptoms.
Dr. Robert Pinto, a chiropractor in Williamsburg, Virginia, recently started using the Spinemobility Boot Camp Program for Lumbar Spinal Stenosis in his own practice, with good results. He spoke with BackerNation about the program and the benefits for his patients.
Who is this program designed for?
Dr. Pinto: The group of patients that usually gets spinal stenosis is elderly people. So the vast majority of patients that we see in our clinic are in their mid to late 70s, or older.
However, I do have one 52-year-old patient who developed lumbar spinal stenosis as a result of a spinal fusion surgery. This program worked beautifully for her.
How long is the program?
Dr. Pinto: We meet with patients for six weeks, twice a week. Then we do follow-up for the next year, which includes checking in with patients and treating them if needed.
What is the behavioral change part of the program?
Dr. Pinto: This involves explaining to patients that if they get on board with the program and we work through the steps together, they can have a big impact on their own health.
Putting them in control like this is hugely beneficial. It’s pretty powerful when you go from having this horrible condition that you have no control over to knowing that you can take steps that will impact it and make your life better.
What kind of manual therapy do you use?
Dr. Pinto: We use chiropractic manipulation to very gently take away the restrictions in the joints. We use a lot of contract-relax techniques for the muscles. And we use a lot of soft tissue mobilization. This is all done to help patients flex their spine.
We also use a technique called sciatic nerve flossing. Basically, there’s a sheath on the outside of each spinal nerve, and the nerve moves inside this sheath. When there are adhesions between the nerve and the sheath, it can cause symptoms when you move. With flossing, we break up these adhesions, which allows the nerves to move more freely.
How does flexing the spine help with lumbar spinal stenosis?
Dr. Pinto: One of the signs of lumbar spinal stenosis is called the “grocery cart” sign — people with this condition often feel better when they lean on a grocery cart while walking. This is because this position flexes the spine, which relieves the symptoms.
However, this flexion from the top — what we call loaded flexion — is pretty bad for the spine. While people get benefit from this position, it may actually make their condition worse over time.
What we teach people to do is flex the spine from the bottom by doing a reverse pelvic tilt. So instead of bending at the top, they bend at the pelvis. We also teach them how to maintain this as they walk.
How do people learn to do the reverse pelvic tilt?
Dr. Pinto: Through manual therapy, we free up a person’s spine so they can move it into flexion. This involves working on the contractile muscles, as well as the joint capsules, ligaments and other non-contractile parts of the body.
As we do this manual therapy we’re stretching these components, which allows people to start activating the muscles needed to do the reverse pelvic tilt motion. Most people are just too stiff to flex those muscles on their own on the first day, so the manual therapy is needed.
Then the exercise component comes in. Many people are so deconditioned at the start that there’s no way they can do these movements on their own. But after a few weeks of targeted exercises, they’re doing it pretty well.
How often do people need to do the exercises?
Dr. Pinto: We ask people to do the exercises two times a day, six days a week. We also ask them to ride a stationary bicycle each day. The exercises don’t take very long to do, maybe 20 minutes. But as people progress, they don’t have to keep doing the beginning exercises.
What kind of postural techniques do people learn?
Dr. Pinto: This is about teaching people how to do the reverse pelvic tilt and maintain it as they walk. It feels a little unnatural to do this when you first start doing it, but over time people learn to keep the tilt there.
We also ask people to monitor how far they can walk before they start to have symptoms. This reinforces the behavioral change component, because when people monitor themselves, they see how far they’ve progressed.
How soon until people see results from the program?
Dr. Pinto: Every patient that we’ve seen has commented that they felt better the first time we worked on them. They often say that they feel like there’s circulation in their legs again.
But what’s really exciting to me about this program is that people who keep doing the exercises continue to get better over time. We’re not just getting them to a certain point and keeping them there.