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Cervical Stenosis: Is when the spinal canal is too small for the spinal cord. A normal canal diameter is approximately 13-15mm and a narrowing of the canal of less than 10mm diameter is associated with cervical stenosis. A canal of below 13mm is considered at risk for stenosis. Symptoms of cervical stenosis include neck pain and numbness, pain in one or both arms, and an electrical sensation that radiates downwards when the head moves. Radiculopathy are pinched nerves as they exit the spinal canal.
Management of spinal stenosis is aimed toward symptom relief and prevention of neurologic complications. Physical therapy with traction and strengthening exercises help relieve symptoms, muscular spasms and back pain. Decompression and inversion tables have also been used with success and varying amounts of benefit. Epidural steroids are also used to treat stenosis. Surgical interventions may be required in some cases.
Cervical stenosis can progress to myelopathy in one third of affected individuals. Myelopathy is defined as pathology of the spinal cord and spondylosis refers to the degenerative changes that occur in the spine.
Cervical Spondylosis Myelopathy (CSM) refers to the clinical presentation from these degenerative processes and is a common degenerative condition of the cervical spine. Degenerative changes of the cervical spine include degeneration of the joints, intervertebral discs, ligaments and connective tissue of the cervical vertebrae and symptoms can include neck and shoulder pain, suboccipital pain and headache, radicular (radiating nerve pain) symptoms. CSM is the most common cause of spinal cord dysfunction in adults older than 55 years has been observed in as many as 95% of asymptomatic individuals older than 65 years.
Lists are straightforward and make educated choices accessible. Here are a few commendable lists from Harvard Women’s Health Watch Newsletters:
October 2012 (volume 20, #2)
5 of the best exercises you’ll ever do:
Swimming: The perfect workout as the buoyancy of the water takes strain off joints. Good for individuals with osteoarthritis.
Tai Chi: Moving meditation good for body and mind and balance.
Strength Training: Strengthens age related muscle loss and increases metabolism.
Walking: Simple and effective
Kegels: Strengthens pelvic floor and supports the bladder
March 2013 (volume 20 #2)
12 Super foods you should be eating:
Salmon: Omega 3 fatty acids
Blueberries: High in antioxidants
Broccoli/Cruciferous Veggies: High Vitamin C and cancer fighting capabilities
Eggs: 6 grams of protein, Lutein (vision) & Choline (memory)
Greek Yogurt: Calcium, Vitamin D and Protein
Beans: Low fat protein, folate, potassium, magnesium & fiber
Walnuts: Healthiest of all nuts with high antioxidants, and omega 3 fatty acids
Oatmeal: Ideal breakfast because high in fiber and lowers cholesterol
Olive Oil: Monounsaturated fats can reduce cholesterol, prevent blood clots and helpcontrol blood sugar.
Tea: All types of tea are high in antioxidants
Quinoa: High in protein and essential amino acids (luecine), vitamins and minerals
Dark Chocolate: Beneficial for cholesterol, blood sugar and blood pressure (buy chocolate with 70% or more cocoa and no more than one ounce a day)
June 2013 (volume 20 #2)
8 Things you can do to prevent a stroke:
Lower Blood Pressure: maintain a BP of less than 120/80. No more than 1,500 milligrams of salt (1/2 a teaspoon) a day. Avoid high cholesterol foods (red meat, cheese, ice cream). Eat 4-5 cups of fruit and veggies every day and fish 2-3x a week plus daily servings of whole grains and low fat dairy. Exercise more – at least 30 minutes a day. QUIT SMOKING. Take BP medicine if you need it.
Lose Weight: Obesity raises odds of having a stroke (losing even 10 pounds makes a difference). Keep BMI at 25 or less. Limit trans fats, eat less than 2,0000 calories a day, daily exercise.
Exercise More: Exercise stands on its own as a stroke reducer.
Drink – in moderation: No more than one glass of red wine per day (5 ounces).
Take a baby aspirin: Aspirin helps blood clots from forming (check with your MD first!)
Treat Atrial Fibrillation: A-Fib is an irregular heartbeat which can cause clots to form in the heart and travel to the brain. If you have shortness of breath or heart palpitations SEE YOUR DOCTOR!
Treat Diabetes: Over time high blood sugar damages blood vessels.
Quit Smoking: Smoking thickens blood and increases arterial plaque build up. Use patches, pills, counseling, medicine… whatever works!
Dr Loren Fishman, a back-pain and rehabilitative medicine specialist who has long incorporated yoga into patient care and studies Iyengar Yoga, published an article in the New York Times on 5/8/13 called Advice on Practicing Yoga in Middle age.
Responding to questions about practicing yoga with herniated disc Dr. Fishman made the following statements:
– A herniated disc responds to extension, and may be worsened by flexion
– DGR, with bulging discs, is inhibited from back bends by a yoga-phobic physician. But back bends will very likely help.
– And about 5 percent of the time, the treatments reverse: extension helps stenosis, flexion is good for herniated discs.
– Unfortunately, Cate in NY, who also has sciatica and a herniated disk, cannot do either forward or backward bends. But she can do sideways poses like vasisthasana (side plank), which we have shown with M.R.I.s to reduce stenosis and herniated discs.
So I looked in my anatomy books to understand this more specifically:
Intervertebral Discs and Vertebrae: IV discs join the vertebra together. The fluid, gelatinous inner part of the disc is the nucleus pulposus, and is confined by a fibrous ring called the anulus fibrosus. The discs account for 20-25% of the length of the spinal column and at birth the central core of the disc is 88% water. In middle and older age there is a decrease in vertebral bone density, which causes the superior and inferior surface (top and bottom) of the vertebrae to become increasingly concave. Due to this concavity, the IV disc bodies actually increase in size; women 10% and men 2% (front to back) and in thickness about 10% in both genders. Interestingly, this bone loss and thinning of the vertebral mass are believed to account for the majority of age related height loss. The IV discs become circumferentially broader when the spine is compressed and thinner when stretched (as in hanging or suspended).
Herniation: As we age (20-70), the disc dehydrates and the inner and outer part merge together, forcing the outer ring to take more weight with compressive forces. Flexion of the vertebral column creates pressure anteriorly and over stretches the posterior spine squeezing the nucleus pulposus backwards (posterolateral) towards the thin and overstretched anulus fibrosus. Herniation occurs when the nucleus pulposus pushes in to the anulus fibrosus, which in turn pushes on the nerve roots. Posterolateral herniations are the most common and typically the cause of nerve pain due to the proximity of the nerve root. Approximately 95% of posterolateral lumbar herniations are at the L4-L5 or L5-S1 vertebral level.
Sciatica: Is often caused by a herniated L4 disc which compresses the L5 or S1 sciatic nerve root. Chronic sciatica causes pain, which can shoot down the posterior leg, and acute sciatica can be the result of localized nerve inflammation. Other causes include a tight piriformis muscle and spinal stenosis. Hip flexion with knee extension can exacerbate or relieve sciatica. Stretching the piriformis/rotator muscles can relieve sciatic as well.
Spinal Stenosis: The canal (foramina) of the spinal cord can narrow with age and compress the nerve roots as they leave the spine. Lumbar Stenosis is most common in the L4 vertebrae. If there is herniation of L4 along with stenosis it further compromises the already limited vertebral canal.
Moore and Dalley (2006) Clinically Oriented Anatomy, 5th edition, Lippincott Williams & Wilkins, Baltimore, MD.
Lasater, Judith (2009). Yogabody: Anatomy, Kinesiology, and Asana. Rodmell Press, Berkeley, CA.
Brene Brown, in her CD series called The Power of Vulnerability, discusses 10 guideposts for what she calls “wholehearted” living; cultivating authenticity, cultivating self compassion, cultivating a resilient spirit, cultivating gratitude and joy, cultivating intuition and trusting faith, cultivating creativity, cultivating play and rest, cultivating calm and stillness, cultivating meaningful work and cultivating laughter song and dance.
Though all of the topics are rich and resonate with meaning, I have to confess that two of them really surprised me, and in turn, that surprise surprised me! How could I – a dancer, music lover, parent and Occupational Therapist be so surprised and utterly charmed that cultivating play and rest and cultivating laughter, song and dance make it to the top ten list?
And out of that list, the one that I think surprised me most of all was the word play. In Occupational Therapy literature, play gets lumped under the category leisure time, which immediately sucks some of the fun out of it. Leisure time can be any meaningful activity: watching TV, cooking, exercising, dinner with friends – all great to do but maybe different from play. For me, the word play conjures up fun, laughter, connectivity, losing sense of time, wanting to do nothing else but what you are doing, enjoying the moment fully and with abandon.
Play is fun, and leisure time is meaningful time spent.
How do we remember to play? What if it is not meaningful? Are we allowed to spend time not doing something for a purpose?
Brene Brown talked about making a pie chart with overlapping play areas amongst her family members to see which of their play experiences could be authentically shared. We haven’t done that yet, but as the summer floods in the season feels right to think about how we can, with a sweet push, fill it with play. And because my running list of meaningful work stomps on my play gene, I am trying to approach play not as a therapist, mother, or productive member of society, but with a deep exhalation to remind me that its ok to relax and cultivate play for myself.
My 74 year-old father was in town for Memorial Day weekend and I made him take a yoga class. Though fit from years of tennis, gardening, and ballroom dancing, his basic stance on yoga is not atypical of his generation; one of dismissal and moderate disdain. He had his head in his laptop until 2 minutes before we had to leave and then asked me if it was ok to take yoga in jeans. To dad’s credit, he pulled it together nicely and ended up fashion forward in a Patagonia top and a pair of ladies size small sweats from Target.
In class, as the teacher, I saw his competition win over his attitude. He diligently tried to stand up straight, open his chest, position his shoulder girdle and head, straighten his arms and breathe. In supine, he grunted with his neighbor Mike as he attempted to lengthen the back of his legs, open his pelvis and twist his spine. The comments (“I feel like I am in Auschwitz”) began to ebb as he became more internally focused and physically oriented. When seated in a chair for a twist, I saw his tight asthmatic back ribcage begin to open and his energy significantly change.
As the class went into supported shoulder stand, dad insisted he try it. I pretty much assumed he wouldn’t be able to do it, but thought we could give it a go, as I know his health history. I was amazed; he got in it, complained very little, and stayed in it for over 5 minutes! The initial twinge of the chair in his back receded, and afterwards he sunk into a self proclaimed deep and very peaceful final relaxation (he confessed later because he was afraid I was going to make him stand up again, he capitalized on the moment).
When asked by the other class members how he felt after class, dad stated (faint praise is his style) that he “felt better” and “could understand how this could help your body and be good for you” and “would consider doing yoga again if it were available” (he lives in Fargo). Mike, a solid weekly yoga practitioner of over 3 years called him out and made him name his experience.
“Come on Dennis, admit it, you don’t just feel better, you feel good, you feel GOOD” – and the man of faint praise concurred. Total success all around.
Laura was recently featured on Yoga City. Read the entire article below about a visit to Jennifer Brilliant’s studio for Laura’s Yoga Therapeutics class.
From Yoga City:
On a sunny winter afternoon, Sleuth expanded her horizons, entering a therapeutics yoga class for the first time. Not knowing what to expect, I placed my mat in the back of the room – but there was going to be no hiding from the eagle eyes of Laura Staton! She invited the small group of us to move forward, creating an intimate environment in Jennifer Brilliant’s cozy brownstone-basement studio.
The class was an in-depth exploration of a series of simple postures, focusing on shoulder opening. Laura gave us time to settle into each pose and showed us how to arrange the props to bring more ease and balance. Going slowly and de-constructing the poses gave me a chance to analyze the movements and notice their effects, bringing more awareness to my practice.
In our opening pose, we sat on two twice-folded blankets and used a strap around our knees and sacrum in Sukhasana to give support and help us maintain a concave lumbar spine. My lower limbs felt cradled by this arrangement, and my breath began to relax and deepen. “Create length by descending,” Laura told us.
“Feel the energy move up your front body and down your back – like an anti-depressant,” Laura extolled. “Notice the tendency to extend our reach too far in the shoulders and hips. We can move the bones deeper into the joints to create stability.” Laura diligently offered suggestions to bring stability to the hyper-mobile areas of our bodies and mobility for the stuck or tight places.
We moved into Urdvha Hastasana using a strap around our forearms. “Move your shoulder blades down your back; let your neck emerge; lift your pinkie fingers up!” Laura dynamically intoned. Her subtle hands-on adjustments corrected my protruding lower rib cage, giving me a greater sense of integrity in the pose. Lifting my arms against the resistance of the strap while making the effort to plug my humerus bones deeper into my shoulder sockets, I was taken aback by how hard I was working in this therapeutics class!
Sleuth was confirming her suspicion that therapeutics classes are not only for novices or people with injuries – they are a great laboratory for learning. Paying close attention to the fine details of each posture was a refreshing complement to my usual practice of breezing from one pose to another. I savored the highly individualized adjustments tailored to each person’s different body type and tendencies. I was able to refine my alignment in basic but tricky poses like Janu Sirsasana and Ardha Matsyendrasana.
“That’s too much twist,” Laura told me, releasing my rib cage with a strong lift. “Activate the kneecaps and lengthen the hamstrings,” she coached me, to fine-tune my Upavista Konasana.
I could tell that Laura really gets to know her students, and she has a dedicated following of regulars. She was not shy about pointing out our areas for growth. She also enthusiastically celebrated each student’s successes, giving voice to the changes she observed in stamina and range of motion. “You couldn’t do this just a few months ago!” she raved to a consistent student who had made giant leaps in thoracic spinal mobility.
Although no mention was made of yoga philosophy or spirituality other than chanting OM at the beginning and end of class, I found that the attention to the details of the physical body and the slow deliberate placement of each pose helped me focus on my breath and dive more deeply into contact with myself than I sometimes can amidst the hectic pacing of a faster class. Savasana was brief, but my mind felt tranquil as we moved gently to reprise our opening seat and chant a final OM.