Spinal Stenosis: Causes, Treatment & Recovery

You set off for a walk around the block or a lap of the shopping centre. Ten minutes in, your legs start to ache, burn or feel heavy. You stop and lean on a rail or a trolley, and within a minute or two it eases. Then you start walking again, and so does the pain.

If that pattern sounds familiar, especially if you're over 50, spinal stenosis is worth ruling in or out.

What's actually causing it

Your spinal cord and the nerves branching off it run through a tunnel formed by your vertebrae, called the spinal canal. In spinal stenosis, that tunnel narrows and can put pressure on the nerves inside it ¹. It can happen in the neck too, but this page is about the lower back, where it's most common ¹.

Most often, the narrowing comes from age-related wear and tear or arthritis in the spine ¹. Anyone can develop it, but the chance goes up with age ². Younger people can have it if they were born with a narrower canal or have injured their spine ². A disc prolapse can also narrow the canal, and rarely a tumour is the cause ¹.

Why position changes everything. It usually feels like a burning pain or ache down the buttocks and legs, often with back pain too ^1,2. Symptoms typically build when you stand or walk upright ². Bending forward "opens up" the spinal column and gives the nerves more room ². That's why sitting down or leaning on a trolley brings relief.

About your scan. Imaging doesn't always line up with how bad your symptoms are, and some people with stenosis on a scan have no symptoms at all ¹. A report tells you what the canal looks like. It doesn't tell you how far you'll be able to walk.

Cross-section of a lower back vertebra showing a narrowed spinal canal crowding the nerves

How it's diagnosed

It starts with your own account. You'll be asked exactly where the pain is, whether it travels, what it feels like and when it began ². Then comes the examination: how far you can move, the sensation, strength and reflexes in your legs, your balance, and how you walk ². One check is particular to stenosis. Does bending backwards bring your symptoms on, and does bending forwards ease them ²?

You may then be sent for an X-ray, CT or MRI ¹. Treat the scan as one piece of evidence. Imaging alone won't decide whether your stenosis needs treatment ².

How we treat it

We start with your pattern: how far you can walk, what eases it, and what you want to get back to.

1

Hands-on treatment, as part of a combined plan. We use manual therapy alongside exercise and education, not on its own. That combination gave clinically important short-term improvements in symptoms and function compared with standard medical care or community group exercise ⁴.

2

Strengthening and stretching. Targeted exercise is a core part of physio for stenosis ¹. Our exercise prescription and conditioning work starts from what your back tolerates now and builds from there.

3

Building your walking back up. Delivered with a cognitive-behavioural approach, the combined plan improved walking distance compared with a self-directed home programme ⁴. In plain terms, that means working on how you pace activity and think about the pain, as well as the exercises.

4

Understanding what's going on. Education is part of the treatment, so you can stay active rather than avoid movement ^4,5.

5

Staying in the game. If you still play golf, tennis or bowls, our sports physiotherapy team can help keep you playing.

The honest bit. A clinical practice guideline recommends offering this combined, non-drug care first. It's a conditional recommendation based on evidence ranging from very low to moderate quality ⁵. The moderate-quality evidence is for the combined approach in the short term ⁴. Exercise alone, and most other non-surgical treatments, have only low or very-low-quality evidence ⁴. That makes a structured physio plan the best-supported place to start, but not a guaranteed fix.

Other treatments we may use

A brace.

Physio care sometimes includes a brace ¹. Like most options outside the combined approach, the evidence behind it is low quality ⁴.

A walking aid.

A stick or walker lets you lean forward as you walk ¹, which is the position that eases the nerves. It isn't giving in. It's often the simplest way to walk further.

Medicines and injections are a doctor's conversation, not ours.

Both are among the treatment options ¹, but physiotherapists don't prescribe or give them. Worth knowing: the 2022 review found epidural steroid injections were not effective here ⁴. Your GP can talk you through what suits you.

Surgery.

Most people are advised to try other treatments first ¹. A review comparing surgery with non-surgical care had very little confidence either way and found no clear benefit from surgery. Side effects occurred in 10 to 24% of surgical cases, and none were reported for non-surgical care ³. That review only covered studies up to 2015. Whether surgery is right for you is a conversation to have with a surgeon.

Your recovery path: Reset, Rebuild, Return

The narrowing in spinal stenosis comes with age ¹, so the aim is to manage it well. The Well Motion Recovery Path™ sets the order, and you move up a phase on how far you can walk, not on a date.

Reset: the first sessions. We find the positions and pacing that ease your legs, start your education ⁴, and may add a walking aid or a brace ¹. Expect symptoms to still come on when you stand or walk upright ². We move you on once you can settle them yourself.
Rebuild: the structured part. Manual therapy together with exercise prescription and conditioning, with your walking built up in stages. Expect good days and bad days. We move you on when your walking covers what your daily tasks ask of it.
Return: back to the shops, the garden, or golf and bowls. We recheck your walking distance against where you started. You leave with a home program and a pacing plan for flare-ups.

How long it usually takes. The best supported program ran for 6 weeks, with benefit measured between 1 week and 3 months ⁴. That rests on one trial of 259 people ⁴. Stenosis can gradually get worse ¹, so the home plan carries on. After surgery, your surgeon sets the timeline.

Reducing the risk of flare-ups

The narrowing itself comes with age and can't always be prevented ¹, and no trial has tested how to head off flare-ups. Each of these goes after something known to drive symptoms:

Choose exercise that lets you bend forward. Flexing your spine opens up the spaces in it and takes pressure off the nerves ². Swimming and the exercise bike are the aerobic options US National Institutes of Health guidance names, and it suggests 30 minutes at least three times a week ².
Keep your strength up. Stenosis can cost you muscle strength over time, and that affects balance and walking ¹. Physio works on the abdominal and back muscles and on endurance, which helps stabilise the spine ².
Pace the day. Change the routines that set your pain off, and spread activity out so you don't overdo it ².
Lighten the load. Excess weight puts extra load on your spine, and losing weight can help reduce pain ¹.

When to get it checked properly

Book a proper assessment rather than managing it on your own if:

Your symptoms are gradually getting worse ¹
How far you can walk keeps shrinking, or you're not sure what's causing your leg pain

Go to your nearest emergency department if you have back pain along with any of these ¹:

Changes in bladder or bowel control
Numbness around your bottom or inner thighs
Sudden, significant weakness or numbness in your legs
A fever

Those signs need same-day emergency care, not a booking. If you're unsure whether something is urgent, healthdirect's free helpline is 1800 022 222. Otherwise, a proper assessment and a plan you can follow is the place to start.

Your first appointment

We start by listening: how it began, what makes it worse, and what it's stopping you from doing. Then we examine the area, explain what we find in plain English, and agree a plan with you. Your first visit is 40 minutes at Engadine and 30 minutes at our other clinics.

We see patients at Engadine, Mount Annan, Narellan and Appin, and at home through our mobile physiotherapy service. If you have private health cover, here's how health fund rebates work for physiotherapy.

FAQs

What is the typical prognosis for spinal stenosis?

Symptoms can gradually get worse over time, but how narrow your canal looks on a scan doesn't decide how you'll feel ¹. In the trials reviewed, non-surgical care had no reported side effects, and surgery showed no clear advantage ³. There's no reliable figure for how any one person's stenosis will progress, and we won't guess.

What not to do if you have spinal stenosis?

There's no official list, but a few things follow from how stenosis works. Don't push through long spells of standing or walking upright while symptoms build ^1,2. Don't let a scan report decide how active you can be ¹. Don't stop moving, because exercise is part of the treatment ¹. And don't ignore the emergency signs above ¹.

Does walking make spinal stenosis worse?

Walking and standing upright typically make symptoms worse, and leaning forward or sitting eases them ^1,2. That doesn't mean you should stop walking. A walking aid lets you lean forward as you go ¹, and a combined physio programme has improved walking distance ⁴. Shorter walks with planned rests usually get you further than one long, painful push.

What is the best position to sleep in if I have spinal stenosis?

A back spasm is the muscles of your back tightening suddenly and refusing to let go. It's one of the ways low back pain shows up

Reviewed by Ahmed Elsayed Principal Physiotherapist at Well Motion

References

Spinal stenosis. healthdirect (Australian Government-funded). Last reviewed February 2024. https://www.healthdirect.gov.au/spinal-stenosis
Spinal Stenosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), US National Institutes of Health. https://www.niams.nih.gov/health-topics/spinal-stenosis
Zaina F, et al. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database of Systematic Reviews, 2016 (CD010264). https://www.cochrane.org/evidence/CD010264_surgical-versus-non-surgical-treatment-lumbar-spinal-stenosis
Ammendolia C, et al. Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review. BMJ Open, 2022;12(1):e057724. https://bmjopen.bmj.com/content/12/1/e057724
Bussières A, et al. Non-Surgical Interventions for Lumbar Spinal Stenosis Leading to Neurogenic Claudication: A Clinical Practice Guideline. The Journal of Pain, 2021;22(9):1015-1039. https://www.sciencedirect.com/science/article/pii/S1526590021001887