As spinal stenosis progresses, the patient gets increasingly hunched over when walking.
Wouldn’t repeatedly standing straight help reverse this situation or at least make erect posture more tolerable?
“Stand up straight!” my mother has often told my father, who has spinal stenosis.
It’s not uncommon to see senior aged people walking with the distinct hunching over of spinal stenosis (narrowing of the spinal canal through which the spinal cord fits).
Hunching over is called lumbar flexion and relieves the pain, which is why patients do this.
There is actually nothing mechanical blocking their ability to straighten out more.
However, this doesn’t mean in severe cases that they can straighten out all the way and stand perfectly vertical.
In my father’s case he can straighten to nearly vertical but claims that this position is intolerable. But when he lies on his back in bed, his back is perfectly straight.
Straightening the back is called lumbar extension. Many times I’ve seen him sleeping or napping on his firm mattress, on his back, as flat (straight) as can be.
But trying to stand with a “straight” back, let alone walk straight, compresses the discs, causing pain. This makes patients hunch over, some severely.
From an intuitive standpoint, it seems as though an effective exercise would be to stand in one spot and very briefly straighten (extend), to retrain the back for good posture and strengthen the lumbar area.
It seems logical that over time, the duration of extension would increase due to a higher tolerance of this position that would come with time.
Exercises for Spinal Stenosis that Involve Straightening the Back while Standing
“Stop doing only flexion exercises,” says Brett Sears at verywell.com.
Sears is owner and senior physical therapist at a private clinic and has 15 years’ experience in hospital based physical and orthopedic therapy.
He points out that historically, only back flexion exercises were recommended.
“But you may also benefit from bending backwards with an exercise called sustained standing lumbar extension,” says Sears.
This can gently press against spinal discs, “moving them away from your spinal canal and nerves to give them more room,” he says in his article.
He advises to check about this with your physical therapist first.
In another article on that site, Sears recommends the “standing back extension exercise,” but to first get clearance from your doctor.
• Stand with feet apart and place hands behind back just above hips.
• Slowly bend backwards. Do this against a kitchen counter for stability.
It would be impossible for my father and many others with spinal stenosis to do this.
This isn’t a straight back. It is lumbar HYPER-extension. Hyper is the key term here.
I just wanted my father to practice merely standing normal.
Sears says hold the hyperextension for up to a minute. Only if symptoms decrease during this time is it a good clue that this exercise should be done a few times daily to help prevent further hunching over time.
Intuitively, it seems that patients should restrict themselves 100 percent to flexion-based exercise, as flexion relieves painful compression.
But Sears says that “some patients, though, benefit from bending backwards.” This sounds encouraging.
“By performing standing lumbar extension,” explains Sears in his article, “you may be able to quickly get pressure off spinal nerves and rapidly reverse your symptoms.”
His article does not distinguish between mild and severe spinal stenosis or any age groups.
Rheumatology Network’s Take
“Patients are encouraged to avoid aggravating activities, such as heavy lifting and excessive trunk extension,” says rheumatologynetwork.com.
But “excessive” trunk (spine) extension is NOT the same as simply standing straight.
So this directive is open to some interpretation. Get your doctor’s perspective.
If you have spinal stenosis, don’t assume anything. ASK your doctor and physical therapist if practicing standing straight for a few seconds at a time can be beneficial—or harmful.