[Physical therapy to treat spinal stenosis]

Spinal stenosis mainly is a disease of the elderly. In most cases the lumbar spine is affected. The assessment is based on the typical constellation of symptoms (neurogenic claudication, subjective weakness) and physical findings (abnormal reflex status, loss of strength, sensory deficits, impairment in balance and coordination). The diagnosis is further supported by the radiologic proof of a stenosis of the spinal canal, the lateral recess, and the intervertebral foramina. The main targets of physical and rehabilitative medicine are the relief of pain and an improvement in the activities of daily living, which are especially impaired by reduced walking distance and difficulties in climbing stairs. These can be achieved by multimodal, conservative management: physiotherapy, occupational therapy, treatment of myofascial disorders, and oral medication/local injections. Physiotherapy aims at a stabilization of the lumbar spine in a flexed posture rather than in lumbar lordosis and at an increase of overall physical fitness. Oral analgetic and/or anti-inflammatory medical management is based on the three-step scheme of the World Health Organization, which also can be applied for low back pain. Local injections can help to control symptoms. Myofascial disorders are treated by techniques and procedures such as traditional massage.