What are Spinal Stenosis and Foraminal Stenosis?

Open pathways keep your body moving freely and feeling good. Spinal stenosis and foraminal stenosis describe the narrowing of the canals in your spine. Spinal stenosis is the narrowing of the canals through which the spinal cord travels, foraminal stenosis is the narrowing through which the spinal nerves travel before exiting the spine. This narrowing is caused by the degenerative process that unfortunately occurs as we age, and can be associated with bulging discs, arthritic bone spurs, or the thickening of tissues such as ligaments. When the canals get too narrow, pain and/or loss of function can occur.


The Spine and Stenosis

The spine, or vertebral column, is made up of 33 vertebrae (individual bone segments) that are stacked one on top of the other and spaced apart by small, shock-absorbing, sponge-like structures called intervertebral discs. The purpose of the spine is to support the body’s weight, protect the spinal cord, and support us in standing, sitting, walking, and all other activities of daily life. The spinal cord runs the length of the spine down to the upper portion of the low back and is encased within the hollow sections of these vertebrae. Spinal nerves branch off of the spinal cord at each level and exit the spinal column through holes between each pair of vertebrae called “foramen.” It is in these two areas—the hollow part of the vertebrae where the spinal cord runs down our backs and the holes between the vertebrae where the spinal nerves exit the vertebral column—that stenosis occurs.


A View Into Spinal Stenosis

Diagram showing spinal stenosis

A View into Foraminal Stenosis

A diagram showing foraminal stenosis

The Degenerative Process

As people age, the forces of gravity and muscle contractions press the vertebrae together and compress the intervertebral discs. Years and years of pressure dehydrate the discs, causing them to shrink and wear down. As a result, the holes through which the spinal nerves travel get smaller. It is here where the process of stenosis begins. Once one part of the spine deteriorates, it directly affects other nearby regions, setting off a chain reaction. As you lose disc height and function, the vertebral facet joints take on more of your body weight. Because these joints are constantly involved with spine motion, they wear down and lose cartilage, a process that is quickened by the additional weight loads they now carry—a job that was supposed to be fulfilled by your discs. This in turn can cause bone spurs to form and ligaments to thicken. The result is spinal or foraminal stenosis.

What Causes Stenosis Back and Neck Pain?

Pain from spinal or foraminal stenosis happens when the canals get so narrow certain movements cause compression of the spinal cord or spinal nerves. Pain is usually felt in the back, neck, or in the areas to which the affected nerve (or the part of the spinal cord) supply sensation and function. Typically, the pain occurs in the arms or hands in the case of cervical (neck) stenosis, or in the legs and feet with lumbar (low back) stenosis. When the compression is severe, there can be a loss of sensation or tingling in the associated skin area or a loss of function in the associated muscles.

Treatment for Spinal Stenosis and Foraminal Stenosis

In mild, moderate, and sometimes even severe cases of spinal or foraminal stenosis, exercise therapy and behavioral modification are the best forms of treatment. The goals of treatment are to: 1) build strength in the muscles that support the spine and 2) change the way you move to better support the spine and take pressure off of the areas of stenosis. Injections of inflammation reducing drugs can also be successful for the short-term reduction of symptoms from spinal and foraminal stenosis. A comprehensive plan can lead to significantly reduced or completely relieved symptoms. Those with pain, tingling or numbness in the buttocks, legs, feet, arms, or hands should always visit a doctor before undertaking any exercise program to make sure that it’s safe for you. Those who are experiencing a loss of function (inability or lessened ability to lift the foot, squeeze hand, etc.) should consult a doctor immediately as this can be an irreversible loss of function. Surgery may be required for cases of stenosis that have resulted in severe symptoms , especially a loss of function. If your doctor recommends surgery, a second opinion with a trusted surgeon is strongly recommended before committing to the procedure.

Dr. Jeremy James

Written by Dr. Jeremy James. Dr. James founded and was director of the Aspen Club Back Institute in Aspen, Colorado, is the coauthor of the bestselling The Younger Next Year Back Book and earned his Doctor of Chiropractic from the University of Western States. Learn more about Dr. James here.

How BACKFOREVER Stops Pain Associated with Spinal or Foraminal Stenosis

As with any program involving physical activity, consult your physician prior to starting

BACKFOREVER can help if you have spinal stenosis or foraminal stenosis. Building strength in key muscle groups that support the spine and changing the way you move can stop the irritation in the areas of the spine affected by stenosis, resulting in significantly decreased or completely resolved pain. Researchers agree that in most cases of mild to moderate stenosis and in many cases of severe stenosis, this type of behavioral approach is the most effective and least risky.

BACKFOREVER uses a proprietary comprehensive self-assessment to produce online digital programs unique to each user’s specific condition and beginning fitness level. Your BACKFOREVER program is tailored to you and teaches you how to rebuild your body, end back pain, and change your life.

End the Pain – Start Today

I have had serious neck stenosis issues for years and to put it simply: Jeremy James’s BACKFOREVER protocol has fixed me. A combination of neck and back strengthening exercises, patiently rolled out over time, has made the difference.

-Bob Hurst, NY, former Vice Chairman, Goldman Sachs

My career as a senior Army Special Forces officer (Green Beret) was ended too early by spine damage and pain. If I had known Dr. Jeremy James, DC, CSCS, and his BACKFOREVER program, my career would have been saved, and I would have avoided years of back pain. Decades of parachuting, carrying heavy mission loads in rough terrain, high risk training and special operations changed my life for the worse. I was in pain from from my spine damage every waking minute. I searched for and found the best physical therapists, spine doctors, yoga therapists and so on. But it was only when I found Dr. Jeremy James and his great team at BACKFOREVER that anything changed. Thanks to him and his BACKFOREVER program, I was out of pain for the first time in 20 years. BACKFOREVER is a tremendously effective rehabilitation program. It will change your life! It did mine!

-Tim Whalen, Colonel (Retired), U.S. Army Special Forces