Lower back
Lumbar Spinal Stenosis
Spinal stenosis is narrowing of the spinal canal in the lower back, causing leg pain, heaviness or numbness when walking or standing. Mostly affects people over 60.
Common symptoms
- Aching, heaviness or cramping in the buttocks and legs that starts after walking a certain distance
- Symptoms ease when sitting down, bending forward or leaning on a trolley
- Numbness or tingling in the legs or feet when standing for long periods
- Lower back pain that is worse standing upright and better when sitting
- Finding cycling or walking uphill easier than walking on the flat
- Legs feeling weak or unsteady after a longer walk
Overview
The spinal canal is the tunnel formed by the vertebrae through which the spinal cord and nerve roots travel. Lumbar spinal stenosis means this tunnel, or the smaller side openings where nerves exit, has become narrower. The nerves then have less room, especially when you stand upright or walk, and the result is pain, heaviness, cramping or tingling in the buttocks and legs.
Stenosis is largely a condition of later life. It develops gradually as discs lose height, facet joints enlarge with arthritis, and the ligaments inside the canal thicken. Most people we see with it are over 60, though it can appear earlier in those born with a naturally narrow canal.
The hallmark pattern is called neurogenic claudication: leg symptoms come on after walking a certain distance and ease when you sit down or lean forward, for example on a shopping trolley. Many people find walking uphill or cycling is easier than walking on the flat. Symptoms tend to fluctuate rather than steadily worsen, and conservative care can help many people stay active and independent.
Causes and risk factors
- Age-related wear of the discs and facet joints (the most common cause)
- Thickening of the ligaments inside the spinal canal
- Degenerative spondylolisthesis, where a vertebra slips forward and narrows the canal
- Disc bulges adding to the narrowing
- A naturally narrow canal from birth
- Previous spinal injury or surgery
How we may be able to help
We begin with a detailed assessment of your walking tolerance, posture, lumbar and hip movement, and a neurological examination of your legs. We also check the circulation in your legs, because vascular claudication can mimic stenosis and needs a different pathway.
Our physiotherapists focus on what evidence supports: flexion-based mobility exercises to open the canal, hip and leg strengthening to improve walking capacity, and a graded walking programme. Manual therapy to the hips and lumbar spine can reduce stiffness that adds to the load. Our chiropractor may use gentle mobilisation techniques; forceful extension-based manipulation is generally avoided in stenosis.
Interferential therapy may help with pain and muscle tightness as an adjunct. A 3D posture scan can document the forward-flexed stance and pelvic position that stenosis often produces, giving a baseline to work from. Because stenosis is a structural condition, we may suggest an online private GP consultation to discuss medication, imaging or a spinal specialist opinion if symptoms significantly limit your daily life.
What you can do at home
- Keep walking regularly, resting on a bench or leaning forward when symptoms start, then continuing
- Try a stationary bike or walking in a swimming pool, which keep the spine slightly flexed
- Do daily knees-to-chest and pelvic tilt stretches to open the lower back
- Use a slightly reclined or supported sitting position for rest breaks
- Strengthen your hips and thighs with sit-to-stand practice and step-ups
- Keep a note of your walking distance so you can track progress
When to seek urgent help
If you have any of the following, call us straight away for an urgent same-day appointment — we can examine you and arrange fast-track X-ray or MRI through our imaging partner. If you cannot reach us, go to A&E. For loss of bladder or bowel control, numbness around the groin, chest pain, a sudden severe headache or rapidly worsening weakness, call 999 or go to A&E immediately:
- New loss of bladder or bowel control, numbness in the saddle area (genitals, back passage, inner thighs), new numbness or weakness in both legs, or new problems with sexual function — go to A&E immediately (possible cauda equina syndrome)
- Rapidly progressive leg weakness, frequent falls or a foot that drags
- Leg pain with a cold, pale or discoloured foot, or calf pain that may be circulation-related — seek same-day medical review
- Back pain with fever, feeling unwell or unexplained weight loss
- Symptoms starting after a significant fall or trauma
Frequently asked questions
Is spinal stenosis the same as sciatica?
Stenosis is one of the causes of sciatica-type leg symptoms, but the pattern is different: it usually affects both legs, comes on with walking or standing, and eases with sitting or bending forward. Disc-related sciatica is more often one-sided and worse with sitting.
Will I need an operation?
Many people manage well with exercise, activity modification and hands-on treatment. Surgery is usually considered only when symptoms seriously limit walking and daily life despite a good trial of conservative care. We can arrange a private GP consultation if a specialist opinion is appropriate.
Should I stop walking if it brings on the symptoms?
No — walking is one of the most helpful things you can do. The approach is to walk to the point where symptoms start, rest or lean forward until they ease, then continue. Over time most people can extend their distance.
Is it safe to have my back manipulated?
Our chiropractor will assess you first. Gentle mobilisation can be helpful, but forceful extension-based adjustments are generally avoided with stenosis. We will explain what is and is not suitable in your case.
This page is general information, not a diagnosis. A clinician will assess you before recommending any treatment. Outcomes vary from person to person. Written with reference to NHS and other peer-reviewed guidance.
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