Top 5 Exercises For Spinal Stenosis [Videos]

Low Back Pain with Radiating Pain in the Legs

Man with spinal stenosis

Has your low back been bothering you in recent weeks, months, even years? Do you have pain in your legs when you stand or walk? Maybe you’ve found yourself leaning forward to rest your arms on the grocery cart at the market. How about long outings where you know you’ll be stuck on your feet – been avoiding them? These are all signs that you may be experiencing Spinal Stenosis.

Let’s talk about what Spinal Stenosis is, what the outcomes look like, and five exercises you can start doing now to get moving in the right direction…

What is Spinal Stenosis?

Lumbar Spinal Stenosis is a process that happens over time and is mostly present in the older population.

Your nerves and some vascular structures exit your spine through canals called foramina. Stenosis is the narrowing of these canals. This narrowing can lead to symptoms in the back and in the legs1, including pain, tension, and even weakness.

Oftentimes, these symptoms are felt during standing and walking and relieved with sitting2,3.

Lumbar Spinal Stenosis happens gradually over time. As with any other type of long-standing low back pain, your brain plays a significant role in how you process pain4. It’s important for you to remember that pain is an output of the brain and there are things you can do to influence that output.

We’ll talk about one step in particular – exercise – that can improve your function significantly.

Treatment Options For Spinal Stenosis

Surgery vs. Conservative Treatment

At some point, if you haven’t already, you might have the discussion with your doctor about the option for surgery. Although I’m not against surgery, I’m always in favor of seeking ways to avoid it if there are other, less invasive, successful options available.

But how do the outcomes compare – surgery vs. conservative treatment – for Spinal Stenosis?

Interestingly, long-term results are often no different between those who opt for surgery and those who are treated non-surgically for Spinal Stenosis5.

That’s right – looking at 8 to 10 year follow-up studies6, patients who received surgery compared with those who underwent conservative treatment had similar results for:

  • Low back pain relief
  • Predominant symptom improvement
  • Satisfaction ratings

The surgery group did have slightly better results when it came to:

  • Leg pain relief
  • Back related functional status

Okay, now let’s think hypothetically for a moment…

What would happen if you didn’t seek any treatment for Spinal Stenosis? Common sense would suggest your symptoms would get worse over time, right?

Actually, a recent study looked at the natural course of Spinal Stenosis over 4 years7 and found:

  • 70% of people had unchanged symptoms
  • 15% of people’s symptoms improved
  • 15% of people’s symptoms worsened
  • No proof of deterioration was found

So, what does this information tell us?

Seeing that you have a good likelihood of improving with conservative treatment and a good likelihood of NOT worsening over time, it makes good sense to try conservative treatment first – and to give it all you’ve got. There’s always the option for surgery later, and even then, outcomes are good8.”

What Can Your Physical Therapist Help You With?

In addition to educating you about what you can do on your own, you’re Physical Therapist can help by providing some proven9,10, hands-on, manual therapy techniques.

These techniques mainly focus on improving the mobility in your:

  • Lumbar spine (lower back)
  • Thoracic spine (mid and upper back)
  • Pelvis
  • Hips

Improving your mobility – not only in the lumbar region, but in surrounding body regions, as well – can dramatically improve your function11.

Knowledge is Power

Education about what you can do to help yourself might be the most valuable tool of all. Here are a few nuggets of advice:

  • Identify activities and situations that cause you discomfort and discuss with your Physical Therapist how to modify your movement strategies and find positions of comfort.
  • Change positions frequently. Try not to sit or stand for too long. Keep moving!
  • Always look for ways to increase your function.

Exercise is Key for Spinal Stenosis

Exercise has positive, symptom-reducing effects12 and is very important in the plan of care for Spinal Stenosis13.

Which types of exercises are best?

As for aerobic exercise, cycling has been proven to be very effective14,15. I’m’ not suggesting you start training for the Tour de France – but I would recommend trying a simple stationary recumbent bike.

Any gym you go to will have a slough of these types of bikes. I might also recommend looking at your local senior center.

If you decide to look into purchasing one for yourself, you’ll find a range of prices even into the thousands of dollars. I’d recommend searching online for something simple and affordable – you don’t need all the fancy bells and whistles – just look for something with a comfortable, adjustable seat and adjustable resistance – that’s about all you need.

When it comes to specific exercises you can do to improve your mobility and function, here are some of the best…

1. Lumbar Rotation Stretch

2. Double Knee-To-Chest

3. Quadruped Thoracic Extensions

4. Hip Flexor Stretch

5. Bridges

 

Question: What exercises have you found to be the most effective for Lumbar Spinal Stenosis? You can leave a comment by clicking here.

  1. Amundsen T, et al. Lumbar spinal stenosis: conservative or surgical management? : a prospective 10-year study. Spine. 2000;25(11):1424-1436. ↩︎
  2. Porter R. Spinal stenosis and neurogenic claudication. Spine. 1996;21(17):2046-52. ↩︎
  3. Akuthota V, et al. Pathogenesis of lumbar spinal stenosis pain: why does an asymptomatic stenotic patient flare? Physical Medicine and Rehabilitation Clinics of North America. 2003;14:17-28. ↩︎
  4. Giesecke J, Wadell G. Surgery for degenerative lumbar spondylosis. Cochrane Database Systematic Reviews. 2005. CD001352. ↩︎
  5. Atlas S, et al. The Maine Lumbar Spine study, part III: 1-year outcome of surgical and non surgical management of lumbar spine stenosis. Spine. 2000;25:556-62. ↩︎
  6. Atlas S, et al. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the Maine lumbar spine study. Spine. 2005;30(8):936-943. ↩︎
  7. Johnsson KE, et al. The natural course of lumbar spinal stenosis. Clin Orthop Relat Res. 1992;279:82-6. ↩︎
  8. Amundsen T, et al. Lumbar spinal stenosis: conservative or surgical management? : a prospective 10-year study. Spine. 2000;25(11):1424-1436. ↩︎
  9. Whitman J, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis. A randomized clinical trial. Spine. 2006;31:2541-9. ↩︎
  10. Reiman M, et al. Manual therapy interventions for patients with lumbar spinal stenosis: a systematic review. New Zealand Journal of Physiotherapy. 2009;37:17-28. ↩︎
  11. Hoeksma H, et al. Comparison of manual therapy and exercise therapy in osteoarthritis of the hip; a randomized clinical trial. Arthritis and Rheumatism. 2004;51:722-9. ↩︎
  12. Watanabe R, Parke W. Vascular and neural pathology of lumbosacral spinal stenosis. Journal of Neurosurgery. 1086;10:677-701. ↩︎
  13. Watters W, et al. Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. The Spine Journal. 2008;8:305-10. ↩︎
  14. Fritz J, et al. Preliminary results of the use of a two-stage treadmill test as a clinical diagnostic tool in the differential diagnosis of lumbar spinal stenosis. Journal of Spinal Disorders. 1997a;10(5):410-6. ↩︎
  15. Pua Y, et al. Treadmill walking with body weight support is no more effective than cycling when added to an exercise program for lumbar spinal stenosis: a randomized controlled trial. Australian Journal of Physiotherapy. 2007;53:83-9. ↩︎
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  • John R Celestino

    While the spinal exercises discussed here thoughtfully accomplish improvement in spinal mobility…any EXTENSION exercises must be approved with caution. Since we know that that the anterior to posterior dimensions of the spinal canal must be at least 12 mm to prevent symptoms of intermittent neurogenic claudication ( spinal stenosis ) it is imperative that the two EXTENSION ex you suggest not be done too aggressively. To neutral is sufficient I suspect! All extension seems to crimp the ligamentum flavum and further narrow the canal…so proceed with caution! Respectfully, John Celestino PT, GCS, MTC, OCS, CSCS

    • Michael Curtis

      Thanks John, the two extension exercises are for thoracic and hip extension. I agree the Lumbar spine should be kept in neutral…thank you for underscoring this important point!

  • Susan Ragsdale King

    Nice job. I personally love the lumbar rotation stretch you demonstrate.
    In the past, I’ve made the mistake of not modifying the upper body rotation component for frail older women. In addition to a propensity for global muscle atrophy, anterior shoulder musculature (and prox rotator cuff tendons) are atrophied. They already present with anterior and IR humeral head as well as some degree of impinged rotator cuff tendons. Unless I block the upper body and the upper arm to prevent shoulder extension and ER, I’ve created at best a flare of tendonitis and at worst a tendon tear. Now I rarely open the upper quadrant (initially) more than 25% and only with adequate upper arm and elbow support and positioning. I only bring this up because the treatment for spinal stenosis is typically for older individuals.
    Thank you…

    • Michael Curtis

      Thanks for pointing this out Susan. This can easily be modified, like you said, by either limiting the amount of upper body rotation, or by keeping the top arm crossed in front of the patient’s chest while the upper body rotates.

  • Ahmad Ali

    It is very useful article ,Can you elaborate please how Hip flexors stretching exercises can help in reliving spinal stenosis symptoms?

    • Michael Curtis

      Thanks Ahmad! Some of the hip flexor muscles cross the hip and attach to the lumbar spine. When the hip extends, if the hip flexors are stiff, they will pull the lumbar spine into extension, exacerbating Stenosis symptoms.

      • Ahmad Ali

        Thanks Michael I got your point

  • Ahmad Ali

    Is there any specific Questionnaire which measures physical therapy outcome in spinal stenosis patients ?please share.I found Zurich Qlaudication questionnaire but I think it is used for Spinal stenosis post surgical cases only.

    • Michael Curtis

      The Lumbar Spinal Specific Symptom Scale and the Swiss Spinal Stenosis Questionnaire are two specific ones. I tend to go with the Oswestry, though, as it is considered the gold standard for functional outcomes.

      • Ahmad Ali

        ok Thanks