ASK THE GP: DR MARTIN SCURR on how Tai Chi may soothe your numbed limbs
I have numbness and coldness in my feet, and my right hip and left shoulder feel heavy. I also get pins and needles in my left arm. A scan showed stenosis in my spine, but I’ve been told that alone isn’t the trouble. Is there any remedy? I’m 80, and otherwise in good health.
Mrs Carina Young, Ruislip, Middlesex.
From your description, I cannot disagree with the diagnosis of lumbar spinal stenosis.
Stenosis is most commonly caused by degenerative arthritis, better known as osteoarthritis.
This wear and tear is often age‑related and leads to a narrowing of the central canal in the column which houses the spinal cord.
As a result, the spinal cord and nerves can become pinched, causing the numbness and coldness you mention, as well as pain and disability which gradually encroach on quality of life.
It is a very common problem, yet resolving it is not straightforward — as you are finding. Physiotherapy is the mainstay of treatment, but evidence about the best procedures — from exercises to deep tissue massage or ultrasound treatments (to heat the surrounding muscles and ease pain) — is lacking.
In some cases of lumbar spinal stenosis, exercises such as Yoga and Tai Chi can work wonders to un-pinch the nerves causing numbness
There are no standard regimens, and different physios will use different methods, with varied results. The aim is to improve muscle stability and posture, as this will better support the spine and lessen the load on it.
Drug treatments include non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, and opiates to address the pain.
But there are concerns about some NSAIDs causing heart problems, and opiates should not be used long term. In your longer letter, you mention having had a ‘nerve and lumbar injection’, which gave you no relief. I would guess this was a corticosteroid jab, intended to relieve pain and swelling.
While there are some small studies suggesting these injections may reduce pain in the short term, I don’t think this is evidence enough.
In severe cases, spinal surgery to relieve nerve pressure by widening the narrowed spinal canal may be offered. But this is reserved for those with disabling pain, which doesn’t seem to apply in your case. Were you to have surgery, there is still little evidence that it would be of substantial benefit.
There are potential risks to consider, such as nerve damage, and the usual post-operative risks of infection, deep vein thrombosis and more.
Given that you also describe some symptoms in your left shoulder, arm and hand, degenerative changes in the cervical spine (the neck) might be developing as well as the stenosis in the lower back or lumbar spine.
We do not have clear treatment options or guidelines for spinal stenosis, and the best I can suggest is that you seek out an experienced physiotherapist.
Or you could consider a gentle form of yoga or tai chi which might, in time, reduce symptoms by aiding mobility and balance.
IN MY VIEW: Trump has the right idea on vapes
The more I learn about e-cigarettes, the greater my wariness about them — the one opinion I share with President Trump, who has just spoken out against flavoured vaping because of its appeal to young people.
We are not alone; the U.S. state of Michigan has just banned flavoured e-cigarettes due to a teen addiction problem; and a separate study has linked traditional and electronic cigarettes to poor sleep.
Yet Public Health England (PHE) continues to promote the use of e‑cigarettes over tobacco.
Research being done on vaping is still relatively in its infancy, Dr Scurr asks: ‘why be a guinea pig on the vape experiment?’
In the U.S. there have been more than 200 cases of vaping-related acute eosinophilic pneumonia since June, with several deaths. it appears to be down to hypersensitivity to an unidentified component of vaping.
Vapes contain not only nicotine but also propylene glycol, which carries the fruity flavourings, as well as compounds involving tin, lead, nickel, manganese, chromium and other inevitable contaminants.
Anybody who persists in using e‑cigarettes must find a way of doing so that avoids all additives apart from the necessary nicotine. Even flavour-free vape users might not be safe because of the other unavoidable contents, some of which are listed above, and others of which we as yet know nothing. Why be a guinea pig in the vape experiment?