stenosis of spineSpinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine.  Others may experience pain, tingling, numbness and muscle weakness. Symptoms often start gradually and worsen over time. Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves. Most people with spinal stenosis are over the age of 50. There are two main types of spinal stenosis: 1. Cervical stenosis. where the narrowing occurs in  your neck. 2. Lumbar stenosis where the narrowing occurs in the lower back.


Symptoms of spinal stenosis

Neck (cervical spine)

  • Numbness or tingling in a hand, arm, foot or leg
  • Weakness in a hand, arm, foot or leg
  • Problems with walking and balance
  • Neck pain
  • In severe cases, bowel or bladder dysfunction (urinary urgency and incontinence)

Lower back (lumbar spine)

  • Numbness or tingling in a foot or leg
  • Weakness in a foot or leg
  • Pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit
  • Back pain

Causes of spinal stenosis

The backbone (spine) runs from your neck to your lower back. The bones of your spine form a spinal canal, which protects your spinal cord (nerves). Some people are born with a small spinal canal. But most spinal stenosis occurs when something happens to narrow the open space within the spine, such as the following :

  • Overgrowth of bone. Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal.
  • Herniated disks. The soft cushions that act as shock absorbers between your vertebrae tend to dry out with age. Cracks in a disk’s exterior may allow some of the soft inner material to escape and press on the spinal cord or nerves.
  • Thickened ligaments. The tough cords that help hold the bones of your spine together can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal.
  • Tumors. Abnormal growths can form inside the spinal cord, within the membranes that cover the spinal cord or in the space between the spinal cord and vertebrae. These are uncommon and identifiable on spine imaging with an MRI or CT.
  • Spinal injuries. Car accidents and other trauma can cause dislocations or fractures of one or more vertebrae. Displaced bone from a spinal fracture may damage the contents of the spinal canal. Swelling of nearby tissue immediately after back surgery also can put pressure on the spinal cord or nerves.


In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.


See video below for some tips.



Physio in Tralee specializing in the treatment of back pain, neck pain, foot pain and sports injuries.



Suboccipital Muscles & Trigger Point Pain

Suboccipital muscles (see image) are a group of four muscles located on each side of the upper cervical spines, just below the base of the skull. The muscles connect the base of the skull with the top two vertebrae (C1 and C2) of the neck.

Poor posture in general especially with the increased use of portable electronic devices, which include mobile phones, laptops, and tablets has increased the prevalence of neck pain in both children and adults. Increased screen time on these devices is not only correlated with depression, sleep interruption, and poor food choices, but also rising rates of neck pain, especially in adolescents and young adults. This form of neck pain, including dysfunction of C1 and altered mechanics of the cervical spine due to poor posture, can also lead to headaches. Reading in bed is also a big offender. Any position where your head and neck are positioned forward and in a stationary position for long periods on time increases the likelihood of postural related spinal issues(ie. kyphosis, discogenic disorders etc.), neck pain and headaches.

These suboccipital muscles play an important role in controlling movements of your head and neck, providing sensory input and are also linked closely to vestibular and balance functions. However, when the suboccipital muscles become tightened, the following symptoms may occur. These could include:

  • Stiff neck
  • Neck pain
  • Headaches with a band of pain on the side of the head that extends from the back of the head to the eye as a result of active trigger points. This type of pain feels deep in the head, and often it is difficult to describe.

Messages sent to the brain may be altered, which is also why sometimes headache sufferers may also experience sensory symptoms, including dizziness and visual disturbances.


Physiotherapy Treatment

Treatment includes deep tissue work, trigger point release, manipulation, mobilisation, postural education and a rehabilitation program.


suboccipttal trigger points
Referred pain from suboccipital trigger points











Physiotherapists in Tralee Phone 0867700191







Levator Scupula Muscle Related Neck pain

When you wake up in the morning with neck pain, a crick in your neck, feel a burning pain on the top inner corner of your shoulder blade, or have trouble turning your head to look behind you while driving etc., the culprit may be a Levator Scapula muscle in spasm. The pain can be described as a throbbing, ache, or tightness. It usually presents from the top inner corner of the shoulder blade up along the neck. The Levator Scapulae muscles are located on either side of the neck. They originate on the four upper vertebrae of the cervical spine (neck). They insert, or attach, to the scapula, also known as the shoulder blade at the superior, medial border. These two muscles are involved in elevation, downward rotation and abduction of the scapulae. They are also involved in flexion and extension of the cervical spine(neck), turning of the neck slightly left and right, along with side bending of the neck left and right.


Neck pain
Levator Scapula Muscle Trigger points (Xs)
Neck pain
Levator Scapula Muscle

What Causes Levator Scapula Spasm / Trigger Points?

A trigger point is a tight area within muscle tissue that causes pain in that area and/or other parts of the body. The trigger points are shown above as two dark red circles, with the pain referral area also shaded in. Muscle spasm is a tightening of a muscle usually, due to overuse or overstress. It  can in itself cause pain and loss of mobility.


The following events and activities are likely to activate, or reactivate, tension / pain and trigger points in the levator scapulae.

  • whiplash from an automobile accident
  • sleeping on the stomach with the head turned/or sleeping in an odd position
  • chilling of the muscle during sleep from an air conditioner or draft from an open window
  • working at a computer with the head turned for long periods
  • holding a phone between the shoulder and ear
  • carrying a heavy bag with a shoulder strap
  • use of crutches that are too tall and elevate the shoulder
  • emotional and mental stress
  • Working with your arms raised above your head for prolonged periods of time can also irritate the Levator Scapula. To help reduce neck pain, stabilize your shoulder blade when you raise your arm.
  • poor posture with a forward head position puts this muscle under continuous strain causing overuse.

Treatment for Levator Scapula Muscle Spasm / Trigger points

Usually the condition settles after a few days if it is only a once off. Proper hands-on deep tissue massage and dry needling, when used together, can be great to settle the condition either in the short term, or if the condition has become more chronic. Also for the long term, correcting posture, stretching and strengthening of the upper back(particularly middle / lower traps, serratus posterior, rhomboids etc.) and the neck muscles(specifically the posterior neck muscles) can help prevent the condition from returning.


Posture is key to a healthy neck and spine. Try and sit up straight on a comfortable supportive chair, when at work or at home. Allow your shoulders to relax by using the arm rests of the chair. When at a computer, pull the screen close and try to get the screen up at eye level (say using books underneath it). This will mean your head won’t have to be protruding forward. The same applies when driving a car. Pull the seat in close to the steering wheel(within reason). Try to position yourself so the shoulders are relaxed and the head isn’t jutting forward. Activities like reading in bed, playing computer games for hours etc. can really tighten up the levator muscles. They are a disaster for thoracic and cervical posture in the long term.

For more information click to see this video


Physiotherapist in Tralee Phone 086-7700191