Spinal stenosis means the space around the nerves in your lower back has narrowed. The classic sign is leg pain, heaviness or numbness when you walk or stand, which EASES when you sit down or lean forward.
Most people don’t need surgery straight away. In a major trial comparing decompression surgery with a physical therapy program, both groups had similar results two years later, and the physio group had fewer complications.
Surgery is a reasonable choice when symptoms keep shrinking your life despite good nonsurgical care. It is rarely urgent, unless you have the warning signs at the end of this page.
What causes it
- Wear and tear with age. Discs flatten, joints thicken and ligaments bulge inward. Together they crowd the canal the nerves run through
- It usually shows up after about 50. Many people have narrowing on a scan with no symptoms at all
- It’s not a slipped disc, although both can press on nerves. With a disc, sitting often hurts more. With stenosis, sitting usually brings relief. See sciatica and slipped disc
Symptoms
- Leg pain or cramping when you walk, often in both legs, in the buttocks, thighs or calves. Doctors call this neurogenic claudication
- Heavy, tired or numb legs the longer you stand
- Relief when you sit or bend forward. Bending forward opens up the space around the nerves
- The shopping cart sign. Many people find they can walk much further leaning on a cart, or cycle with no trouble, but can’t walk upright for long
- Back pain is often there too, but the legs are usually the main complaint
Poor blood flow to the legs can cause similar walking pain. The difference: with blood flow problems, standing still eases the pain. With stenosis, you usually need to sit or bend forward.
Will it get worse?
Not necessarily. For many people, symptoms stay about the same for years. Some improve, and some slowly worsen. Sudden decline is uncommon.
What helps
- Exercises that bend you forward, such as knee-to-chest stretches and pelvic tilts, can ease the nerves
- Stay fit in positions that don’t hurt. A stationary bike, walking on an incline or water walking lets you build stamina while leaning slightly forward
- Strengthen your hips and trunk. Stronger legs and a steadier core help you stand and walk longer
- Walk in short bouts. Walk until symptoms start, sit or lean for a minute, then go again. Your distance often grows over weeks
- Use a walking aid if it helps. A cane or walker encourages that slight forward lean and keeps you out and about
- Pain relief and injections: may take the edge off for a while. Steroid injections for stenosis give modest, short-lived relief for some people and none for others
Physio or surgery?
In the trial that compared them head to head, people who had agreed to surgery were randomly given either decompression surgery or six weeks of physio, twice a week. The physio focused on bending exercises and general conditioning.
- At two years, pain and function had improved by a similar amount in both groups
- The physio group had fewer complications
- More than half the physio group went on to have surgery anyway, most of them within the first few months. So physio first doesn’t always mean no surgery
- Not every study agrees. Some have found people who choose surgery do somewhat better, so the honest answer is that both are reasonable
Trying physio first costs you very little, and surgery will still be there if you need it.
When surgery makes sense
- Your walking distance keeps shrinking despite a good trial of exercise
- You can’t do the things that matter to you, such as shopping, walking the dog or traveling
- Leg weakness is getting worse
- You have the emergency signs below
Decompression surgery removes bone and thickened tissue to give the nerves more room. It usually helps leg pain more than back pain. If a vertebra has slipped forward, your surgeon may also suggest fusing two bones together.
Many people with stenosis also have hip arthritis, and the two can feel alike. Groin pain and trouble putting on socks point more to the hip. See hip arthritis.
Go to the emergency department now if
- Numbness around your genitals or buttocks, the area that would touch a saddle
- New trouble peeing, not being able to pee, or leaking pee or poo without knowing
- Sudden or severe weakness in one or both legs
- New problems getting an erection or loss of feeling during sex, alongside back or leg symptoms
Get it checked if
- How far you can walk is getting steadily shorter
- Your foot catches or slaps when you walk
- You’re falling or feel unsteady
- You also have a fever, weight loss you can’t explain, or a history of cancer
- Your legs hurt when you walk and your feet are cold or pale, which may point to blood flow instead
Stenosis is a narrowing you live with, and for most people exercise keeps the legs going as well as surgery does.