What is stenosis?

Stenosis means “narrowing”. Spinal stenosis is a narrowing in either the spinal canal where your spinal cord is located (central stenosis), or in the lateral foramen (foraminal stenosis). The lateral foramen is the space where the nerve roots and vasculature exit the spine between each vertebrae. Over time stenosis can cause irritated or compressed nerves that produce nerve-like symptoms into the lower back and legs.

Stenosis can occur for various reasons. Stenosis in the central canal is most often caused by a degenerative disc or a herniated disc that reduces the space in the spinal canal. Foraminal stenosis can come about due to loss of disc height and degenerative discs due to aging, as well as due to osteophytes (bony growths) in the facet joint and osteoarthritis. Facet joints are the small joints that join one vertebrae to the next and make up the small opening where the nerve roots exit the spine.

What are the symptoms of lumbar spinal stenosis?

Classic symptoms of lumbar spinal stenosis are:

• Increased pain with prolonged walking and standing
• Pain when extending backward
• Numbness and tingling in a broad area in the legs and/or feet
• Weakness into the foot or leg
• Ease of pain and symptoms when sitting or leaning forward (like on a shopping cart)
• Symptoms can occur into both legs, or just one

Physical therapy for lumbar spinal stenosis

Physical therapy is often the first management strategy for mild to moderate lumbar spinal stenosis. While physiotherapy cannot change the structures in your back, it can help to provide strategies to keep you moving to reduce your pain and symptoms. Often cycling or supported walking is beneficial, these activities cause a slight forward bend in the back which opens up the space between the vertebrae. For some people, pool exercises are ideal because when you are in water it reduces the amount of weight going through your spine, and allows you to potentially move more with less pain. Exercises that can assist with strengthening and stretching muscles and nerves can improve postural control and help to alleviate symptoms and improve walking distance.¹ There is even some research that has shown that acupuncture can be more effective in managing pain and function than a course of acetaminophen.²

If you do require surgery for lumbar spinal stenosis there is still a benefit to completing a course of physiotherapy prior to surgery. Programs that start before an operation are referred to as prehab. Some research has shown that people undertaking a 6 week prehab program while awaiting surgery were able to reduce their pain, improve their walking tolerance, and increase the strength and endurance of their back muscles.³

So if you have lumbar spinal stenosis and are wondering where to start, an assessment with a physiotherapist can start you on your road to recovery.

1. Singh G, Chahal A, Singh M, Samuel AJ. Physiotherapy versus alternative medicine for pain and quality of life in patients with lumbar spinal stenosis: a systematic review with meta-analysis. Physiotherapy Quarterly. 2024;32(1):25-34. doi:10.5114/pq.2024.135419.

2. Oka, H., Matsudaira, K., Takano, Y. et al. A comparative study of three conservative treatments in patients with lumbar spinal stenosis: lumbar spinal stenosis with acupuncture and physical therapy study (LAP study). BMC Complement Altern Med 18, 19 (2018). https://doi.org/10.1186/s12906-018-2087-y

3. Marchand AA, Houle M, O'Shaughnessy J, Châtillon CÉ, Cantin V, Descarreaux M. Effectiveness of an exercise-based prehabilitation program for patients awaiting surgery for lumbar spinal stenosis: a randomized clinical trial. Sci Rep. 2021 May 26;11(1):11080. doi: 10.1038/s41598-021-90537-4. PMID: 34040109; PMCID: PMC8155114.