STOP Flexing Your Stenotic Patients…..

Welcome everyone to today’s podcast. I’m your host, Dr. Scott Gray.

Today I want to talk about my issue when you are treating spinal stenosis patients for, let’s just say, lumbar spine.

And so one of the big mistakes that I see amongst clinicians is that they just flex them, right?

They’ll have them flex their spines till they’re blue in the face and that’s all that they, they give ’em. And I’m all four openings up the foramen if they’re pretty symptomatic and if we need to calm stuff down.

But here’s my beef with it, right? And so, in normal function, walking, human movement, twisting, you’re going to get closure of that foramen at some point in time.

And so flexion just alleviates the symptom, right, unless they’ve had some severe symptoms going on.

You still need to fix the cause of it if you can.

Not every stenosis patient you can do that, just because of the changes that may have happened at the disk, hypertrophy of ligament flavum, or they’ve had maybe an osteophyte that sort of thing.

But those patients that you can potentially fix, that are stuck, let’s say, in an anterior pelvic tilt or they have maybe too much motion at a couple of sections and not enough by the adjacent ones.

You need to think like, “Okay, they’re eventually gonna have the closure of that spine and that foramen at some point in time. So what is constantly keeping it closed is how we need to think.”

Obviously, if they’re in an anterior tilt, we need to strengthen the glutes, you need to get some more hip extension.

You may even need to get some more mobility of the groin and adductor muscles.

So they also limit hip extension and I think we tend to forget that. The same thing goes for ankle dorsal flexion, right? So someone who lacks ankle dorsal flexion is not going to go through full hip extension.

They’re going into an extension moment of the spine and they’re gonna close off that foramen, right?

So, also, you need to think, “Okay, is L123 moving optimally,” right? Relative to the L45 S1.

So those are things that you really need to fix. I would also add your multifidus muscles are the only muscles that actually control the spinal segment directly, for the most part.

Your abs are indirectly working on the spine, so working on getting multifidus moving. You may even work the thoracic spine into extension.

You’ll be surprised at how many people have a lumbar extension and they don’t have a thoracic extension.

Those are some really big mistakes that I’m seeing amongst clinicians, is that when they have lateral femoral stenosis or central stenosis, we’re just working on opening that up, and that’s good.

I’m all for that to decrease symptoms and get them feeling good, but at the end of the day, you need to kind of figure out and take a step back and say, “Hey, how can I help fix the causes,” Because when they leave this clinic, they’re going to go turn left or right and into extension.

And so, how do we get rid of those forces and moments so that I can help open them up enough where they’re maybe not getting closed off as much, or maybe not at that segment?

So, that’s my little spiel for today. If you’re treating a stenosis patient, I want you to think back and reflect and be sure to check the hip, the abdominals, the ankle, and the thoracic spine.

Do they need to get more stability with multifidus to control those segments?

Those are just some of the things that you, need to consider.

That’s it for today, make those changes and I think you’ll see a better outcome with your stenosis patients.