Lumbar spinal stenosis is a common cause of lower back and leg pain, especially in adults over 60. It involves narrowing of the spinal canal and/or intervertebral foramina in the lumbar spine leading to compression or irritation of the exiting nerve roots most commonly at L3-5. Degenerative changes such as facet joint hypertrophy, ligamentum flavum thickening, and disc bulging reduce available space for the nerve roots and cauda equina which produces neurogenic claudication. This is defined as leg pain, heaviness, or numbness with standing and walking that improves with sitting or bending forward into lumbar flexion.
Current best evidence supports a multimodal physical therapy approach combining flexion-biased exercise, progressive walking or cycling programs, trunk and hip strengthening, and manual therapy. Flexion-based exercises can temporarily increase canal space and reduce neural compression symptoms. Strengthening the abdominals, gluteals, and hip musculature improves load distribution and walking tolerance, while aerobic conditioning enhances overall function and endurance. Manual therapy techniques such as lumbar, thoracic, and hip mobilizations help improve joint mobility, and soft tissue techniques help reduce paraspinal and hip flexor tone. Education on activity modification including the use of forward-lean strategies (such as treadmill walking at an incline or the use of a walker when appropriate), and graded exposure to walking can significantly improve quality of life.
At Accel Physical Therapy, our comprehensive examination includes a detailed health history, neurologic screening, lumbar range of motion testing, hip mobility assessment, strength testing of the torso and legs, and functional measures such as walking endurance. Lumbar spinal stenosis is typically a mechanical and movement-based disorder that responds well to individualized physical therapy treatment.