stenosis, grocery cart sign, lumbar stenosis, low back pain

Do You Have Trouble Walking Through The Grocery Store?

Amarillo chiropractor discusses


In today’s article, I am going to give you something to look out for the next time you go to the grocery store. Most of you will be able to immediately identify what is wrong with some of the folks you see walking around the store. 

Before we get into that, I want to set the stage a little. Low back pain is a fairly diverse issue and can be caused by a lot of different things. In fact, for some time now, low back pain has been the leading cause of disability globally. Meaning, around the entire world, the most common reason people are disabled is due to back pain. What is even more worrisome is that it is only getting more and more common. 

In fact, from 1990 until 2017, the number of back pain sufferers at any one time in the world went from 377 million all of the way up to 577 million. All of that pain at a time when opioid painkillers are being basically eliminated. Just to continue with a couple more numbers, and to show you that the news isn’t ALL bad, out of 56 million Americans having back pain at any one time, only about 5% of those actually need any sort of surgery. 

What that means, is that a lot of back pain resolves on its own. It also means that the pain that does not resolve can be treated by professionals that know what they are doing. 

First, the most common reason for back pain are as follows:

    • Disc Conditions (disc degeneration, disc herniation, disc bulge, disc desiccation, etc.)
    • Facet Joint Pain (synovial fold extrapment or entrapment, dysfunction, or age-related facet joint hypertrophy)
    • Sacroiliac Dysfunction - pelvic torsion or movement disorder
    • Sprain/Strain
    • Stenosis
    • All of the rest….

Sometimes, it is a mix of ALL or part of these conditions. It can be complicated, to say the least, but that does not mean we can’t do something about it. 

The American College of Physicians and the American Family Physicians both recommend the services chiropractors commonly offer as first-line therapies for back pain. A knowledgeable and well-educated evidence-based and patient-centered chiropractor can make a huge difference for most of these back pain cases. 

I want to dive in a little deeper on just one of them in today’s article. Let’s shine the spotlight on stenosis since, in my clinical experience, it seems to be the one that patients are the least familiar with. 

I will start by just simply defining the word ‘stenosis’. The word itself just means narrowing. The way I describe it to my patients is that it means that we have a hole that a lot of important stuff runs through. For one reason or another, that hole has become smaller. So, it has essentially become a real estate issue. There are some more common reasons for this narrowing, or real estate issue. They are:


    • Disc bulges, disc herniations, or disc degeneration - as space where the disc exists is reduced by issues of the disc, the space containing the other important stuff like nerves also becomes reduced. 
    • Facet Hypertrophy - over time, the bone of the facet joints of the spine can have the tendency to increase in size. When bone experiences pressure or tension, many times, it responds by laying down more bone. Facet hypertrophy is a build-up of the bone of those joints and the increased size of the joints can be a cause of the narrowing. 
    • Ligamentum Flavum - This is a ligament running down through the canal that holds the spinal cord. It can get inflamed and when it gets inflamed and larger, it can be another source of the real estate issue. 


Grocery Cart Sign

An easy way to identify or remember stenosis is by the Grocery Cart Sign. As I mentioned at the beginning, I am going to give you something to look for at the grocery store on your next visit. Be sure to pay attention to how older folks walk around the store. Stenosis usually hits people over the age of 60 years old. In classic stenosis, people experience pain in the legs and back when the patient stands up and/or walks. On the other hand, it feels MUCH better for a stenosis patient to sit down. 

Basically, sitting, or bending over at the waist, opens the holes that have limited real estate. Standing closes them down even more. The Grocery Cart Sign is when they are leaned forward on the grocery cart as they walk through the aisles. When they bend way over and lean their arms on the cart, it helps open the holes up. It feels better and it allows them to get through the store without being completely miserable. Many don’t even mess with the cart and go straight to the motorized buggy to get their shopping done. 

While pain on walking and pain when bending backward are very common symptoms of stenosis, there is also research from 2009 that suggests leg cramps at night time happens more frequently in those with low back stenosis. 


It's Complicated

Considering the fact that stenosis is a physical restrictive issue, meaning it’s a lack of physical real estate, can anything other than surgery to create more real estate actually be helpful. It turns out that the answer is, “Yes!”

I use the latest hands-on, conservative, non-invasive techniques and our patients are getting excellent results. Nothing is a silver bullet in healthcare so not every patient experiences complete resolution BUT, many do amazing and have a drastically improved quality of life after undergoing treatment. 

The program I use for stenosis treatment comes from researchers at Mount Sinai Hospital and the University of Toronto and has been validated through solid research. It consists of two treatments per week for 6 weeks, exercises done with me or my staff here in the office, as well as a complete protocol of exercises to be done at home. These exercises focus on helping the patient strengthen or stretch specific groups of muscles while teaching the patient how to walk and move about in a much more comfortable way that will create more real estate and reduce pressure in that low back when standing and walking. 

Research has been very clear that it is not necessarily how the holes are narrowed as much as it is what happens to the contents of the holes. If we can help our patients reduce the stress of the contents, the hole can remain the size it is while the patient can still function normally.

Kind of like learning to downsize your house in a sense. 

The most important thing to understand is that stenosis does not always require surgery. Surgery should never take place without first trying nonpharmacological, non-invasive treatment and a solid evidence-based, patient-centered chiropractor is an excellent place to begin searching for solutions. 


Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast ( Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected] Learn more about Dr. Williams and his practice at

Dr. Williams was voted Best Chiropractor In Amarillo in the Best of Amarillo 2020. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109. If you are searching for a chiropractor near me, Dr. Williams is your Amarillo Chiropractor.  

Jeff Williams, DC, FIANM

Jeff Williams, DC, FIANM


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