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When OTs Wore White Shoes

Spinal Stenosis

Published February 17, 2016 12:16 PM by Debra Karplus

One of my relatives, who is in his eighties, shared with me that though he is in excellent health, he was recently diagnosed with spinal stenosis. He now uses a walker at times to keep him steady on his feet, but he does have a sense of relief that at least now he has a medical explanation for the frequent pain in his lower back, hip and leg. He feels unsteady sometimes and is very fearful of falling, as he should be, given the high incidence of falls in older adults.

To be honest, I don't really remember learning about spinal stenosis when I was in occupational therapy school in the early 1970s. And as a semi-retired OT, it is been a few years since I have worked in a clinical setting. So, I have little professional experience with spinal stenosis. But always curious, I started searching online to learn more about spinal stenosis in hopes of being helpful in some way to my relative.

I discovered that spinal stenosis involves the narrowing of the spaces in the spine (backbone). Of course, I already knew that was what happened to people as they age; I may have learned about it under some other name perhaps. In addition to an aging skeletal system, spinal stenosis can occur as the result of arthritis, either rheumatoid arthritis or osteoarthritis, in people of all ages. Trauma to the spine can lead to spinal stenosis. And like many maladies, there is a genetic component to the occurrence of spinal stenosis.

The lumbar region, the lower portion of the spine, is where 75% of spinal stenosis occurs, I learned. And I already knew that the compression of nerves from the closeness of the spinal bones, is what caused discomfort and pain in the leg for the sufferer.

They say that spinal stenosis is sometimes difficult to diagnose, as are many disorders with similar symptoms. The treatment, according to WebMD is to change standing, sitting and sleeping positions to aim for less discomfort. Medications such as anti-inflammatory products can help, as can simply resting the area that is in pain.

Given that spinal stenosis is very common, especially in our geriatric patients, I am wondering what occupational therapy practitioners are currently doing for these people in the clinical setting. It seems that the same regiment we use with our patients with arthritis would be appropriate with our patients who have spinal stenosis, whether it is their only documented diagnosis or one of many health problems.

Addressing activities of daily living, in my opinion, might be the basis for an OT program for someone with spinal stenosis with focus on work simplification, energy conservation, body positioning and adaptive equipment as needed. Also, I think a good OT program would involve upper extremity strengthening, especially if use of a cane, walker or wheelchair would require stronger arms.

I would like to hear from other occupational therapy practitioners regarding their clinical work with spinal stenosis.

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