McKenzie-MRI-Spine

Response to a reader’s questions on cervical stenosis

A comment was posted to my blog on “Cervical Stenosis” with some very good questions:

“I am wondering which Mckenzie neck exercises did you perform? All 7? 8 times a day? I am concerned about doing #2 and #7. I am in the same situation that you were in: I started with pain in my right side-arm and leg all the way to fingers and toes with no neck pain. Neurosurgeons found formainal and moderate central stenosis at C4-5 and C5-7. They want to perform cervical discectomy and fusion. I want to try other avenues first. Thanks for the information.”

Stenosis is quite an interesting syndrome.  Many people with their MRI reporting stenotic findings have no stenotic symptoms, while others have the symptoms without indication on MRI.  Within the group that have symptoms of stenosis and the confirming MRI, there is a number of them that can be treated conservatively, and the rest can only be managed surgically.  The McKenzie method for the neck, and actually all other joints as well, is not merely the 7 or 8 exercises, but a comprehensive systematic methodology to solve orthopedic problems.

Many mechanical problems in the spine, such as herniated disc and stenosis, will require a thorough McKenzie assessment to determine the extensiveness, in order for the most precise and appropriate therapy to be prescribed.   With the symptoms you presented, the 7 exercises listed in the book, “Treat Your Own Neck”, are not beneficial without a McKenzie assessment by an experienced certified McKenzie therapist or diplomat.  Those exercises are excellent for posterior herniated disc and not stenosis.  The McKenzie method is able to determine:

  • Whether the patient can benefit from conservative intervention
  • Which exercise is appropriate
  • The necessary movement intensity for recovery

If your problem is beyond that which a conservative approach can offer, you will find out in one, or a few visits.  This should save precious time in your critical decision-making process.

In the meantime, my first recommendation for you would be: Let the symptoms guide you. This is one of the McKenzie principles to treatment.  My MRI was extremely alarming and depressing at one point.  However, my symptoms were not constant nor severe.  I had strong tingling and numbness only if I extended my neck–i.e. a movement to look up, or to lift one’s head up above neutral position.  Therefore, I avoided the activities and positions that would aggravate any symptom.

Furthermore, the component of the stenosis in my case was compounded with a severe bilateral disc herniation (toward the back)–the nerve roots and spinal cord.  Therefore, I also avoided flexion–the movement that brings the head down or forward.  Please keep in mind though–for severe stenotic symptoms, many times it is only flexion that can alleviate symptoms.  So this may seem contradicting, but indeed it is not. The need to see a certified McKenzie professional is in this–knowing in what direction to exercise and how far to go to reduce the mechanical problem, but don’t go too far to worsen the symptoms.  In my case, I performed retraction hourly as long as it did not provoke symptoms.  But I would not tell all my stenosis patients to do the same thing. It greatly depends upon the specific condition and limitation of each individual condition.

Without knowing all the aspect of your symptom behavior, I cannot, and should not, tell you which exercise to do.  I would urge you to consult a certified McKenzie professional (http://www.mckenziemdt.org/) to get the right exercises to do at the right time and with the right amount of force.  Hope this helps and best of luck to you!

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