Overview of Lumbar Spinal Stenosis: What is the Best Treatment

Constantly, people complain of back pain, mostly when people age and many times we ignore it till one day it is no longer bearable. In many situations, these disturbances to our daily living are the result of a more severe prognosis than just back pain and this may be lumbar spinal stenosis.

 

What is lumbar spinal stenosis (LSS)?

LSS is the narrowing of the spinal cord in the lumbar (lower) section of the spine. This results primarily in pressure on the spinal cord or nerves causing burning pain or numbness running down the buttocks and legs (sciatica), difficulty walking, and leaning forward to ease pressure.

 

    

 Physical therapy techniques: 

Various different physical therapy techniques including exercises and manual therapy reduce symptoms of LSS primarily reducing pain and improvements in function. A 2018 study found significant improvements in walking, pain, and function with education on managing symptoms, body repositioning with pelvic tilt, 18 exercises for a structured home exercise program for stretching, strengthening, and conditioning, and manual therapy including spinal manipulation, lumbar flexion-distraction, and mobilization for joint, soft tissue, and neural. Then the 2024 study found conventional PT with the addition of electrical dry needling and thrust spinal manipulation compared to only conventional PT resulted in a greater reduction in overall pain in low back, buttock, and leg. 

    

In 2022, a systematic review found various PT approaches demonstrated various outcomes for LSS patients. Weight-supported walking for three weeks resulted in less pain and disability while aquatic exercise for eight weeks again had less pain, but also a tolerance for walking. Cycling conducted for six weeks concluded with reduced disability compared with supported walking and six weeks of manual therapy with exercise improved pain, tolerance for walking, disability, and overall quality of life when this was compared to home/group exercises, however, the approach was not found to be more effective than supervised exercise. Finally, there was less evidence to support the use of TENS and ultrasound because no effect was shown for the two-week study of electromagnetic fields.

Surgical vs non-surgical intervention: 

There are specific situations where surgical intervention will be necessary to reduce symptoms of LSS and other situations, non-surgical interventions are more beneficial. In 2014 and 2017, two studies conducted found the use of nonsurgical intervention more beneficial with tolerable symptoms, but the use of surgical intervention is more effective in LSS patients who also have other associated back issues such as degenerative lumbar scoliotic deformity. The 2014 study found patients had higher self-rate major improvements with PT and had less bothersome leg pain after the 12 months with higher physical functioning outcome resulting in more likely not needing surgery after one year. The main nonconservative methods used for these results were PT and injections. The study in 2017 found nonsurgical intervention resulted in significant increases in physical function and pain, but no significant change in general health perceptions, vitality, emotional role functioning, and mental health. 

Guidelines for clinicians:

For physicians: 

• Understand when surgery is necessary: when nonoperative methods (PT, injections, oral medications, etc.) does not result in benefits and if there are numerous back issues
• Understand when non-operative (specifically PT) is necessary: in less severe LSS and as a first attempt for treatment

For physical therapist (PT techniques):

• Supervision and understanding from a PT  
• Manual therapy especially spinal manipulation, dry electrical needling, lumbar flexion-distraction, and mobilization 
• Education on managing symptoms 
• Body repositioning with pelvic tilt
• Structured home exercise program for stretching, strengthening, and conditioning
• Longer and more sessions (twice a week) 
• Individualized programs
• Weight-supported walking
• Aquatic exercise
• Cycling 

Other clinicians (other techniques):

• Spinal injections (epidural)
• Oral medication

 

To learn more: 

• Learn more on what lumbar spinal stenosis is here 
• Listen to this podcast to learn more about non-operative treatment of low back pain for LSS here 
• Watch this video to understand how a lumbar laminectomy surgery works to relieve LSS symptoms here 

About the author:


Sarah Janssens is a senior at Westfield State graduating in May of 2025 with a bachelor's degree in movement science with a concentration in sports medicine and minor in biology. She is a certified personal trainer through the American College of Sports Medicine (ACSM). Sarah plans on attending graduate school after graduation to pursue a career in physical therapy. She can be reached at sarahjanssens8151@gmail.com.

 

References

Ammendolia, C., Côté, P., Southerst, D., Schneider, M., Budgell, B., Bombardier, C., Hawker, G., & Rampersaud, Y. R. (2018). Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial. Archives of Physical Medicine and Rehabilitation, 99(12), 2408-2419.e2. https://doi.org/10.1016/j.apmr.2018.05.014

Fritz, J. M., Lurie, J. D., Zhao, W., Whitman, J. M., Delitto, A., Brennan, G. P., & Weinstein, J. N. (2014). Associations between physical therapy and long-term outcomes for individuals with lumbar spinal stenosis in the SPORT study. The Spine Journal, 14(8), 1611–1621. https://doi.org/10.1016/j.spinee.2013.09.044

Temporiti, F., Ferrari, S., Kieser, M., & Gatti, R. (2022). Efficacy and characteristics of physiotherapy interventions in patients with lumbar spinal stenosis: a systematic review. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 31(6), 1370–1390. https://doi.org/10.1007/s00586-022-07222-x

Wessberg, P., & Frennered, K. (2017). Central lumbar spinal stenosis: Natural history of non-surgical patients. European Spine Journal, 26(10), 2536–2542. https://doi.org/10.1007/s00586-017-5075-x

Young, I., Dunning, J., Butts, R., Bliton, P., Zacharko, N., Garcia, J., Mourad, F., Charlebois, C., Gorby, P., & Fernández-de-las-Peñas, C. (2024). Spinal manipulation and electrical dry needling as an adjunct to conventional physical therapy in patients with lumbar spinal stenosis: A multi-center randomized clinical trial. The Spine Journal, 24(4), 590–600. https://doi.org/10.1016/j.spinee.2023.12.002