What Is Spinal Stenosis?
Usually the spinal canal has enough room for the spinal cord to sit without pressure on the cord or the nerves branching off it. Certain conditions can cause the canal to narrow and crowd the spinal cord or those nerves, which is what happens in spinal stenosis.
What Does It Feel Like?
Symptoms depend on where the narrowing occurs.
- Cervical (neck) stenosis. Narrowing in the cervical spine can cause numbness, tingling, or weakness in a hand, arm, foot, or leg. It can also lead to trouble walking, balance problems, and neck pain. In severe cases it can cause urinary or fecal incontinence.
- Lumbar (lower back) stenosis. The lower spinal cord carries nerves that connect to the legs, so stenosis in the lumbar region can cause numbness, tingling, or weakness in the foot or leg.
What Causes It?
- Osteoarthritis. As the cartilage between vertebrae breaks down, the body can form bone spurs on the vertebrae that narrow the canal.
- Paget's disease. A condition in which the body's process for replacing bone tissue is flawed, producing new bone that is brittle, weak, or abnormally shaped.
- Herniated discs. When a disc between two vertebrae cracks or tears, the soft material inside can be squeezed out and press on the canal.
- Thickened ligaments. Inflammation of the connective tissue between vertebrae can, over time, cause it to thicken.
- Tumors. Growths in the spinal cord or surrounding soft tissue can put pressure on the cord if undetected.
- Trauma. A significant injury that damages the spinal canal, or leaves debris lodged inside it, can narrow the channel.
Risk Factors
Age is a significant risk factor, since osteoarthritis becomes more common as people grow older. Genetics also play a role.
Complications
Left untreated, spinal stenosis can lead to neurological problems. Severe cases can cause loss of bowel and bladder control, and the most severe cases can result in paralysis.
How Do You Treat It?
Most cases are managed without surgery, through a guided rehabilitation plan and, when appropriate, medical support.
- Guided movement. Gentle, controlled movement can take pressure off the affected nerves.
- Stretching and range-of-motion exercises. To maintain and improve mobility.
- Strength training. Stronger muscles support overall health and can reduce the workload on the spine.
- Aerobic exercise. To support general conditioning and circulation.
- Massage. Our providers use many massage techniques to help loosen muscles and connective tissue.
- Postural education. Learning positions and habits that reduce pressure on the spine.
Pain and anti-inflammatory medication can help control symptoms. A locally injected steroid can provide immediate, temporary relief of inflammation and pain. Some causes of spinal stenosis can also be addressed with surgery when conservative care is not enough.
Choosing Radius
If you or someone you know is dealing with spinal stenosis, our team can help. Every plan starts with a full-hour diagnostic exam, and all of our providers are trained in musculoskeletal rehabilitation.
About the author
Dr. Tristan Ginkel, DC, FRCms
Sports Chiropractor
Dr. Tristan Ginkel is a passionate and skilled sports chiropractor and Functional Range Conditioning mobility specialist based in Nevada City, California, dedicated to helping patients move better, feel stronger, and perform at their best. Originally from Gilroy, CA, Dr. Tristan brings a warm, personable approach to care—blending cutting-edge techniques with a sincere commitment to each patient’s health journey. Known for his kindness, approachability, and family-first values, he strives to create a supportive and empowering experience for every individual he treats.
More from Dr. Tristan Ginkel →Frequently Asked Questions
Common questions about spinal stenosis.
What is spinal stenosis?
Spinal stenosis is a narrowing of one or more of the spaces within the spinal canal, the channel that houses the spinal cord and the nerve roots branching off it. When the central canal, the lateral recess, or a neural foramen narrows, it can put pressure on the spinal cord or nerves. Most cases occur in the lower back (lumbar), where narrowing most frequently happens at the L4–L5 level.
What does lumbar spinal stenosis feel like?
The hallmark symptom of lumbar spinal stenosis is neurogenic claudication: pain, numbness, tingling, weakness, or a heavy feeling in the buttocks and one or both legs. The pain is typically worse with standing or walking and eases with sitting or leaning forward at the waist, such as squatting or leaning on a cart. Some people also have low back pain. Symptoms follow the nerves affected by the narrowing.
Why do the symptoms ease when I sit or lean forward?
Symptoms of lumbar spinal stenosis are closely tied to posture. Bending the lower back forward (flexion) opens up space in the narrowed canal and decreases pressure on the nerves, so pain tends to lessen with sitting, squatting, leaning forward, or lying down. Straightening or arching the back (extension) narrows that space further and tends to increase pain, which is why standing and walking often make symptoms worse.
What causes spinal stenosis?
Spinal stenosis is most commonly caused by degenerative osteoarthritis of the spine. As the spine ages, changes such as bulging or herniated discs, loss of disc height, bone spurs, enlarged (arthritic) facet joints, and thickening of the ligamentum flavum can all encroach on the canal and narrow it. Less common causes include spinal fractures or injuries, and cysts or tumors. In the lumbar spine, narrowing most often occurs at the L4–L5 level.
Who is at risk for spinal stenosis?
Spinal stenosis occurs most frequently in individuals over the age of 60, because the degenerative changes that cause it become more common with age. Additional risk factors include obesity and a family history of the condition. Because it develops from gradual, age-related wear on the spine, stenosis usually develops slowly over time, and some people may have no symptoms for a while.
Does spinal stenosis get worse over time?
Spinal stenosis usually develops slowly, and its course varies. While some patients may improve with time, the majority have a progression of the condition that can lead to disability. Because of this, symptoms are worth evaluating and managing early. In some cases, spinal stenosis can lead to cauda equina syndrome, a serious complication.
How is spinal stenosis treated without surgery?
Most cases of spinal stenosis are managed without surgery. Initial treatment includes physical therapy—such as stretching, strengthening, and aerobic fitness to improve and stabilize the muscles and posture—along with anti-inflammatory and pain medications, and, when appropriate, epidural steroid injections. In physical therapy, gentle guided movements may help take pressure off the affected nerve root, and manual therapy can improve the mobility of stiff joints contributing to symptoms.
When is surgery considered for spinal stenosis?
Surgery is generally reserved for people who fail repeated nonsurgical treatments. Only the most severe cases of spinal stenosis need surgery. However, rapidly progressive neurological deficits or the presence of bladder dysfunction are signs that urgent surgery may be necessary. The decision to operate depends on the individual case and is made with a physician.
What are the warning signs of a spinal stenosis emergency?
Loss of bladder or bowel control, saddle-area numbness, or rapidly worsening leg weakness can signal cauda equina syndrome, a rare but serious complication of spinal stenosis that requires urgent medical care. Cauda equina syndrome is a medical emergency because it can cause permanent nerve damage if not treated promptly. Anyone with these symptoms should seek emergency evaluation rather than wait.
Sources
- StatPearls / PubMed Central (NCBI), "Spinal Stenosis and Neurogenic Claudication" — tier 2 peer-reviewed condition overview; definition, symptoms, posture relationship, causes, epidemiology, natural history, conservative management, surgery, cauda equina
- APTA / ChoosePT, "Physical Therapy Guide to Spinal Stenosis" — tier 3 professional-body patient education; definition, symptoms, causes, PT treatment components, conservative vs. surgery framing
- Cleveland Clinic, "Spinal Stenosis" — tier 4 general clinical reference; symptoms including leg heaviness and posture-related pain, causes, slow progression, treatment, and bowel/bladder red flags
The information on this website is general education about musculoskeletal and movement-related conditions. It is not medical advice or a diagnosis, and it cannot tell you what is causing your symptoms. Reading it is not a substitute for an in-person evaluation, and booking a visit does not confirm that your condition is right for our care until a provider has examined you. This information cannot identify every condition, and some urgent problems can feel like musculoskeletal pain. If your symptoms are severe or getting worse, or you are unsure how urgent they are, contact your physician, call 911, or go to the nearest emergency room. When in doubt, seek emergency care.
