Condition guide
Lumbar spinal stenosis is a narrowing, with age, of the canal in the lower back that the nerves pass through. Its most typical symptom is pain and numbness that spread into the buttocks and legs when you stand and walk, and ease when you sit down or bend forwards. For most people the symptoms do not get worse over the years; the first treatment is exercise, adjusting your activity and pain control.
With age, the discs between the vertebrae bulge, the small joints at the back of the spine enlarge and the ligament inside the canal thickens; sometimes one vertebra slips forwards on the one below. Together, these narrow the canal in the lower back that the nerves pass through.
When you stand and walk, your lower back arches backwards; symptoms get worse in this posture. They ease when you sit down or bend forwards. Narrowing seen on imaging, however, does not always cause symptoms: one in five people over 60 show narrowing of the canal, and more than 80% of them have no symptoms at all.
Narrowing of the arteries in the legs also causes leg pain when you walk. But pain that comes from the arteries is not usually made worse by standing alone; in lumbar spinal stenosis, even standing can bring on symptoms, and you need to sit down or bend forwards to get relief. The two conditions can also occur together; a doctor's examination is needed to tell them apart.
According to a review published in the journal JAMA in 2022, the first treatment is adjusting your activity, pain control and physiotherapy. In a US study of 259 patients with an average age of 72, manual therapy combined with an individual exercise programme improved symptoms and walking capacity more than medical care or group exercise at 2 months. At 6 months there was no difference between the groups; walking distance had increased from the start in all three.
In another study, 169 patients who were candidates for surgery were assigned either to surgery (decompression) or to a standard physiotherapy programme. After 2 years there was no meaningful difference in physical function between the two groups; however, a substantial share of the patients in the physiotherapy group had surgery during that time. A Cochrane review of five studies (643 patients) states that no firm conclusion can be drawn on whether surgery or non-surgical treatment is better; complications occurred in 10–24% of those who had surgery, while no side effects were reported for the non-surgical treatments.
That is why the decision is an individual one. For most patients, a regular exercise programme is tried first. For patients whose pain continues despite this and whose daily life is clearly limited, surgery is an option and is assessed by a spinal surgeon. If there is worsening weakness in the legs or loss of bladder or bowel control, do not wait.
Exercises at home
Do the movements slowly and within a pain-free range. If pain or numbness spreading into your leg gets worse, stop that movement. Movements that arch the lower back backwards can make symptoms worse.
Lie on your back. Hold one knee with both hands and slowly pull it towards your chest; feel your lower back flatten towards the floor. If it is comfortable, pull both knees up together. Positions that bend the lower back forwards usually bring relief in lumbar spinal stenosis.
Hold for 20–30 seconds, 3–5 reps, twice a dayLie on your back with your knees bent and the soles of your feet on the floor. Tighten your abdominal muscles to press the hollow of your lower back down towards the floor, hold for 5 seconds, then relax. You can also do the same movement standing, with your back against a wall.
10 reps, twice a dayStart on your hands and knees. Without moving your hands, slowly take your hips back towards your heels and feel your lower back round and stretch. If your knees do not allow it, skip this movement and do the seated forward bend instead.
Hold for 20–30 seconds, 3 repsSit on a sturdy chair with your feet a little apart. Slide your hands down your legs, slowly bend your trunk forwards and reach towards your ankles. Stay for a few breaths, then push up with your hands to sit upright. When your legs hurt while walking, you can sit down on a bench and do this movement.
Hold for 10–15 seconds, 5 repsLie on your back with your knees bent and your feet on the floor. First press your lower back into the floor, then squeeze your buttocks and lift your hips until there is a straight line from your shoulders to your knees. Do not arch your lower back; hold for 3 seconds and lower slowly.
10 reps, 1–2 times a dayDo not give up walking; break it up. Just before your leg symptoms start, sit down and rest for a few minutes or bend forwards, then carry on. Increase the time little by little from week to week. A stationary bike is also a good option; because you sit leaning forwards, it is usually better tolerated than walking.
20–30 minutes a day in total, with breaksIf you have osteoporosis or a compression fracture in your spine, talk to your doctor or physiotherapist before starting forward-bending movements; the programme will be adapted for you.
Video
From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.
Basic movements aimed at easing back and leg pain.
Stretches you can do lying down, sitting and standing.
A canal that has narrowed does not widen again; but for most people the symptoms do not get worse over the years. About one third of patients followed without surgery report improvement within 3 years, and about half report that their symptoms stay the same; in 10–20%, symptoms get worse.
Not always. One in five people over 60 show narrowing of the canal on imaging, and more than 80% of them have no symptoms at all. It is your symptoms and how much your daily life is limited, not the MRI, that decide your treatment. Exercise, adjusting your activity and pain control are usually tried first.
No. Giving up walking weakens your leg muscles and your endurance. Break your walk into short stretches, sit down and rest before your symptoms start, and build up the time gradually. Activities done leaning forwards, such as a stationary bike, are usually better tolerated.
With a lumbar disc herniation, leg pain usually gets worse when you sit and bend forwards. With lumbar spinal stenosis it is the opposite: standing and walking make the symptoms worse, and sitting and bending forwards bring relief. Lumbar spinal stenosis usually occurs in older age and often affects both legs at once.
See a doctor without delay if you have any of the following:
Sources
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