Lumbar Spinal Stenosis: Causes, Symptoms, and Treatments Explained
By Stephen Bunting, Specialist MSK Physiotherapist (UK)
Lumbar spinal stenosis is a common cause of lower back and leg pain, especially in older adults. This article discusses what the condition is, the key symptoms, why it develops and the evidence based treatment options to help you stay active and reduce pain.
What Is Lumbar Spinal Stenosis?
Inside this canal are the nerve roots that travel down into your legs, controlling movement and providing you with sensation. When these nerves become squeezed or irritated due to narrowing, you can experience:
- Pain or aching in the legs
- Tingling or numbness
- Muscle weakness that can affect walking or balance
Although the symptoms can sound similar to sciatica, stenosis is a different condition. Sciatica usually affects one leg due to a single irritated nerve root as it exits the spine, whereas lumbar stenosis typically affects multiple nerve roots within the central spinal canal which usually causes symptoms in both legs, especially during standing or walking.
Typical Symptoms
The hallmark feature of lumbar spinal stenosis is that symptoms change with posture.
When you bend forwards, the spinal canal naturally widens, relieving pressure on the nerves. When you stand tall or walk upright, the canal narrows, increasing pressure and symptoms.
Typical signs include:
- Leg pain or tingling when standing or walking
- Relief when sitting or bending forward
- Heaviness or fatigue in the thighs or calves
- Having to stop and rest frequently when walking
This pattern of symptoms is called neurogenic claudication — exercise-induced leg pain due to nerve compression. People often describe constantly looking for benches or walls to sit and rest on, when out walking.
Vascular vs Neurogenic Claudication
Another condition that can cause similar symptoms is vascular claudication, which happens when blood flow to the legs is reduced due to narrowed arteries (peripheral artery disease).
- ABPI (Ankle-Brachial Pressure Index) to compare blood pressure in the arms and legs
- Doppler ultrasound to check blood flow in the arteries
In clinic, physiotherapists may use a two-stage treadmill test to help tell the difference:
- In vascular claudication, walking uphill (which increases leg muscle demand) makes the leg pain worse and occur sooner.
- In neurogenic claudication, walking uphill can actually delay symptoms because the spine bends slightly forward, creating more space for the nerves.
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| Level Treadmill Uphill Treadmill (feels better in Stenosis) |
A classic sign of spinal stenosis is the “shopping trolley sign” — feeling more comfortable leaning forward on a trolley when walking around a supermarket.
How Is Lumbar Spinal Stenosis Diagnosed?
Diagnosis is based on your symptoms and confirmed with an MRI scan.
MRI imaging can show whether the spinal canal is narrowed and if the nerve roots are compressed.
However, not everyone with a narrow canal on MRI will have symptoms — the nerves can tolerate a surprising amount of pressure before symptoms appear.
Why Does Lumbar Spinal Stenosis Happen?
- Disc degeneration and bulging
- Facet joint arthritis causing bony thickening
- Thickening of spinal ligaments
- Loss of vertebral alignment
Other possible causes include:
- A naturally narrow canal (genetic)
- Previous spinal injury or surgery
Symptoms usually progress slowly over months or years, often showing as a gradual reduction in walking distance before leg pain starts.
What Can You Do About It?
1. Self-Help and Lifestyle Changes
Weight management:
Carrying extra weight, especially around the abdomen, increases the lumbar curve (lordosis), which can worsen canal narrowing.
Losing weight can improve posture and ease symptoms
Daily exercise:
Keep your back flexible and strong. Exercises that promote lumbar flexion (bending forward) often feel most comfortable.
Try:
- Seated spinal flexion
- Lying on your back and bringing both knees up towards your chest
- Pelvic tilts in sitting
- Child’s pose (prayer stretch)
- Cat stretch in kneeling
- Walking and cycling are excellent ways to stay active. Cycling is particularly comfortable because it naturally places your spine in a flexed position.
- Avoid forcing an overly upright posture.
- A cane, walking pole, or rolator walker allows you to lean forward. slightly for comfort and stability — helping you walk further with less pain.
- Staying mobile is far better than staying indoors due to pain or pride.
2. Medication
There’s no single 'cure' in pill form for spinal stenosis, but medication can help manage symptoms:
- NSAIDs or paracetamol for short-term pain relief
- Neuropathic medications (e.g. amitriptyline, duloxetine, gabapentin) for nerve pain — under supervision of a prescriber.
Always discuss long-term medication use with your doctor due to possible side effects.
3. Specialist Treatments
If symptoms persist despite self-management:
- Epidural Steroid Injections can reduce inflammation around the compressed nerves, providing temporary relief.
- Surgery (Laminectomy or Lumbar Decompression): In more severe cases, a spinal surgeon can widen the canal by removing a small section of bone and/or disc material. This routine procedure is performed under general anaesthetic and can greatly improve walking and leg pain for suitable patients.
Smokers and those with poorly controlled diabetes may need to improve their health first, as both can affect healing.
Treatment Summary
Your treatment choices depend on:
- Severity of your symptoms
- MRI findings
- Mobility and general health
- Personal preference
Key Takeaways
- Lumbar spinal stenosis is a narrowing of the spinal canal that compresses the nerves in your lower back.
- It causes leg pain, heaviness, or tingling when walking or standing, relieved by sitting or bending forward.
- It’s usually due to age-related changes and progresses slowly.
- Many people manage symptoms well through exercise, posture, weight management, and physiotherapy.
- Injections or surgery may be needed for more severe cases.
Final Thoughts
For more evidence-based advice on musculoskeletal health, explore the other articles and videos on this site. Stay informed, stay active, and take care of your body.
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This article provides general information related to various medical conditions and their treatment. It is intended for informational purposes only. It is not a substitute for professional advice, diagnosis or treatment provided by a doctor or other qualified health care professional. The information provided does not constitute personal advice or guarantee of outcome and should not be used to diagnose yourself or others. You should never ignore advice provided by a health care professional because of something you have seen or read on this website. You should always consult a doctor or other qualified health care professional for personal medical advice.