Physical Therapy for Lumbar Spinal Stenosis

Photo of a man holding his back.
If you have spinal stenosis, physical therapy can help. Yagi Studio/Getty Images

If you have low back pain along with pain, numbness, or tingling in both of your legs, you may have lumbar spinal stenosis.  The pain may make walking difficult, and you may have a hard time enjoying normal work and recreational activities.  You may benefit from physical therapy to treat your symptoms and help get back to normal activities if you have spinal stenosis.

What is Lumbar Spinal Stenosis?

Lumbar spinal stenosis is a progressive spinal condition caused by narrowing of your spinal canal.

 This narrowing pinches on your spinal nerves.  These nerves exit your spinal canal and travel down your legs.

Spinal stenosis is not caused by one specific injury.  Some people are born with a congenitally narrow spinal canal, and as time passes, arthritis and disc degeneration may make the canal even narrower, pinching on nerves in the process.

Symptoms of Spinal Stenosis

Symptoms of spinal stenosis include, but are not limited to:

  • Low back pain
  • Pain in both legs
  • Numbness or tingling in both legs
  • Difficulty walking for any length of time
  • Improved symptoms with sitting or bending forward
  • A flat-back posture

For most people, the symptoms of lumbar spinal stenosis are worse with walking for more than a few hundred feet and are immediately improved with sitting down or bending forward.  Many people also feel better when walking in a forward bent position - walking in the grocery store while bending over the shopping cart is typically no problem for people with spinal stenosis.

Diagnosis of lumbar spinal stenosis is made by your doctor by a simple plain film x-ray.   An MRI may be ordered to further investigate your problem, but often your symptom behavior combined with the images of your spine on x-ray are enough to confirm a diagnosis of lumbar spinal stenosis.

If you are having back pain and pain in both legs while walking, see your doctor who can confirm your diagnosis.

Physical Therapy Evaluation for Spinal Stenosis

If you have spinal stenosis, working with your physical therapist is a good idea.  Your first session with your PT is called an initial evaluation.  During this session, your physical therapist will perform specific tests and measures to get a baseline of your condition.  Specific tests that your PT may perform include:

Your physical therapist will use the results of your initial evaluation to formulate a treatment plan for your spinal stenosis.  He or she should discuss with you the plan and work with you to develop reasonable physical therapy goals.  This is a good time to ask questions about your condition and about physical therapy for stenosis.

Once you have a plan of care in place for your spinal stenosis, it's time to work with your PT to start treating your condition.

Physical Therapy Treatment for Lumbar Spinal Stenosis

Physical therapy  for lumbar spinal stenosis may include many different treatments.  These may be:

  • Exercises to improve lumbar ROM: Many people benefit from performing stretching and lumbar ROM exercises for spinal stenosis.  Historically, people have used lumbar flexion exercises to increase the diameter of the spinal canal and take pressure off of spinal nerves.  Your physical therapist can teach you the proper way to progress your lumbar flexion exercise program.  A small subset of people with lumbar spinal stenosis benefit from lumbar extension, or bending backwards, so trying this first as part of your PT exercises may be recommended.
  • Strengthening exercises: Your PT may prescribe specific exercises to help improve your strength.  Posterior pelvic tilts may be incorporated to help change the position of your spine, and hip strengthening can help improve your mobility and walking.
  • Home exercise program:  Any good PT program should include exercises and stretches that you can do at home.  That way, you can be sure to have a strategy to continue working on maintaining your spinal health after your official rehab program has ended.
  • Postural correction: Attaining and maintaining proper low back posture is an important component of your spinal stenosis rehab.  Your PT may suggest you use an external support like a lumbar roll when sitting.  Exercises like the slouch-overcorrect may be used to help you learn what good posture feels like when sitting or standing.
  • Therapeutic modalities to help decrease pain:  Your physical therapist may use therapeutic modalities like heat, ice, or ultrasound to treat your spinal stenosis.  Heat and ultrasound can help improve circulation to your back muscles, and ice can help treat pain or inflammation.  Caution should be used - many studies indicate that passive treatments are not the most effective use of time and resources in PT.  You should be sure to engage in an active treatment program geared towards changing the biomechanics of your condition to get pressure off of your spinal nerves.  This can help decrease your pain and improve your mobility.
  • Joint mobilizations:  Your physical therapist may perform hands-on treatment techniques to help improve the way your spine moves.  Massage may help improve flexibility, and mobilizations can improve the way your spinals joints move, making your exercises more effective.  Caution should be used -  your PT program should largely focus on active movement and exercise to change the mechanics of your spine and improve your functional mobility.

How Long Should Physical Therapy Take?

In general, you should notice a positive change in your spinal stenosis symptoms within a few weeks of starting physical therapy.  After 4 to 6 weeks, you should be able to manage your spinal stenosis on your own and discontinue PT.  Some people take a bit longer, and others require less time in PT to manage their condition.  Talk with your physical therapist and doctor to understand your specific condition and prognosis.

If your symptoms persist, you may need to explore other treatments for your spinal stenosis including more invasive treatments like injections or surgery.  Your doctor can help guide you in the correct direction if your pain and mobility limitations persist after physical therapy.

Bottom Line

Lumbar spinal stenosis can cause back pain, leg pain, or numbness and tingling and may make walking difficult or impossible.  Engaging in an active course of physical therapy for your stenosis may help control your symptoms and improve your overall functional mobility so you can get back to your normal lifestyle and activities.

Source: McKenzie, R., & May, S. (2003). The lumbar spine mechanical diagnosis and therapy. (2nd ed., Vol. One). Waikanae: Spinal Publications New Zealand.

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