Spinal Stenosis
Lumbar spinal stenosis is a narrowing of the spinal canal or the spaces where nerve roots exit the spine. This narrows the available space for the spinal cord and nerves, causing compression that produces symptoms — particularly with walking and standing upright.
It’s most common in adults over 50 and tends to develop gradually as part of age-related spinal changes (disc degeneration, facet joint enlargement, ligament thickening). While it cannot be fully reversed without surgery, physiotherapy is highly effective at managing symptoms and maintaining function.
The Characteristic Pattern
The hallmark of lumbar stenosis is neurogenic claudication:
- Leg heaviness, aching, cramping or weakness that comes on after walking a certain distance
- Symptoms that ease quickly when you sit down or lean forward (on a shopping trolley, for example)
- Relief from flexed postures — explaining why cycling is usually tolerated better than walking
This pattern occurs because a flexed lumbar spine opens the spinal canal; an extended spine closes it.
Symptoms
- Back and leg pain, heaviness or cramping during walking or prolonged standing
- A specific walking distance before symptoms start (which shortens over time without treatment)
- Leg numbness or tingling with activity
- Relief when sitting, cycling or walking bent forward
- In severe cases, weakness in the legs
How Physiotherapy Helps
Physiotherapy won’t narrow the canal back, but it can significantly improve how much you can do and how comfortable you are doing it.
Exercise Program
- Flexion-biased exercises (cycling, abdominal work, hip flexion) to improve tolerance
- Core and lumbar stabilisation to reduce load on the narrowed segments
- Aquatic therapy is excellent for spinal stenosis (buoyancy reduces loading)
- Progressive walking program — gradually extending distance with appropriate pacing
Manual Therapy
- Lumbar mobilisation in pain-relieving directions
- Soft tissue work to reduce muscle guarding
- Neural mobilisation to improve nerve mobility where appropriate
Education
- Posture and activity modification strategies
- Pacing techniques to extend walking tolerance
- Advice on walking aids and assistive devices where appropriate
When Surgery Is Considered
Surgery (decompressive laminectomy) is considered when symptoms are severe, significantly limiting quality of life, and conservative management has been thoroughly trialled. For most people, a well-designed physiotherapy program is sufficient to maintain good function.
