Question
QUESTION: Hello,

I have pitiformis and low back pain. I have had this for quite sometime. I know the floor exercises.
My question is about walking. When standing or walking I get unbearable pain and have to sit down. I used to walk my dog for an hour everyday but now I take him to the mail box 3 doors away and by the time I get home I need to sit down. However a surprising thing happened to me today. I have a treadmill that I hadn't used for a long time because of my walking problem. Today I decided to give it a try. I put it on 1 and then increased it to 2. I held on to the handle bars and was on it for15 minutes and my back didn't hurt at all. I was shocked and wondered why. Could it be that holding on keeps me upright and in correct walking form if so will this help to strengthen my legs, hips and abdomen and hopefully help to take my pain away? Please let me know what you think. Looking forward to your answer.

ANSWER: Hi Pat,

If you are having these symptoms which include low back pain and piriformis syndrome, I am assuming you have had an x-ray or MRI to confirm or deny disc injury or degenerative discs. The symptoms you describe point to a possible spinal stenosis occurring in your lumbar spine. Spinal stenosis is narrowing of the spinal sac that carries the spine and nerves. The typical pattern of spinal stenosis occurs in middle age to older individuals with a history of arthritis or disc problems. The pain from stenosis is increased when walking and alleviated by sitting. Most people with stenosis say that pain feels better while hunching or leaning forward like leaning on a shopping cart or walking on a treadmill while holding on with arms which supports the spine and takes pressure off spine. The piriformis is a referred pain due to sciatic nerve irritation occurring at spine. Otherwise the piriformis stretching floor exercise would have alleviated it. Again, this is all under the assumption that you have disc involvement in your spine. Walking on the treadmill is good for you to strengthen the spine as well as certain floor exercises. Chiropractic care, traction, and/or inversion tables help to alleviate nerve pressure. Medically, they will recommend cortisone or oral steroid to take away inflammation from spinal areas. Feel free to follow up and let me know some more detail so I can point you in the right direction.

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QUESTION: Hi Dr. Verma,
Thank you so much for answering my question so quickly. I truly believe it is spinal stenosis. Everything you said is what my symptom's are.

I am a healthy 71 year old female. This all started with my leg. I know what exercises to do but haven't been too diligent about them. That is probably why it is still with me. I felt I could cure myself but I would need to work harder and now with the treadmill it sure should help.

I haven't had an MRI. I did read about the injections and want that to be my last resort. I am full of arthritis and know that is probably half my problem. if I didn't have Ibuprophen I wouldn't be walking.

In your experience do you think it is possible for me to do this on my own? I was a medical assistant for 30 years and do know that they would be sending me to PT. anyway. I am thinking with using the treadmill 20 minutes two times a day I should be able to loosen and strengthen my hips and maybe take the pressure off my low back. Please let me know what you think.  Thanks again.   Pat

Answer
Hi Pat,

I agree with you about the arthritis being half the problem. Arthritis is generally a contributor to the pain but never the cause in my opinion. If you were a patient of mine, I would have you walking on that treadmill with an interval style. In other words, walk 2-5 minutes flat and then 30 sec-1 min on an incline of let's say 1 or 2. By doing this, you are challenging your body to strengthen itself as well as getting conditioning of your muscles and heart. Also if you look up exercises for spinal stenosis, they involve bringing your knees to your chest or bending forward to alleviate pressure. Physical therapy will make you do the same thing. As far as injections go, I also agree that it should be a last ditch effort. It's a temporary pain reliever and you will still have to exercise. Stenosis, as with any arthritic condition, requires activity within the pain free zone so you can get stronger without aggravating the condition. Good luck with this.