Walking Plan for Spinal Stenosis

What you are treating

Lumbar spinal stenosis is narrowing of the canal that carries the nerves to the legs. The narrowing comes from thickened ligament, enlarged joints, and bulging discs, all part of aging. The symptoms are heaviness, aching, tiredness, or tingling in the buttocks and legs when you stand or walk, that eases when you sit, bend forward, or lean on a shopping cart. Many people walk farther in the grocery store than anywhere else, because the cart tips them forward.

That clue is the key to the whole plan. Bending forward opens the canal; arching back closes it. Stenosis rarely becomes a nerve emergency and rarely causes lasting nerve damage, so there is time to work on it. Most people manage well for years without surgery, and symptoms often stay stable rather than steadily worsening.

The walking program

Walking is the treatment. The goal is to walk more total minutes each week, not to push through symptoms.

• Find your baseline: how many minutes you can walk before the legs make you stop. Call it your limit.
• Walk to about three-quarters of your limit, then sit or lean forward for a minute or two until the legs clear, then walk again. Repeat for a total of 20 to 30 minutes, once or twice a day.
• Each week, add a few minutes to each bout. Over two to three months, most people double their walking distance.
• Use what tips you forward: a shopping cart, a wheeled walker with a seat set a little low, hiking poles, a slight uphill or treadmill incline, or walking behind a stroller. These are tools, not signs of giving up.
• A stationary bike, especially a recumbent one, and water walking in a pool are excellent alternatives on days the legs are tired. Both keep you bent forward and build fitness without loading the spine.
• Avoid long periods of standing still, walking downhill, and arching backward.

The exercises: open the canal and strengthen what holds you up

Do these daily. They take about 15 minutes.

• Knee-to-chest: lying on your back, pull one knee toward the chest, hold 20 to 30 seconds, switch, then both knees together. 3 times each.
• Posterior pelvic tilt: lying on your back with knees bent, flatten the low back into the floor by tightening the belly and buttocks, hold 5 seconds, 10 times.
• Child's pose or seated forward lean: on hands and knees, sit back toward the heels and stretch the arms forward, or sit in a chair and lean forward to rest the forearms on the thighs. Hold 30 seconds, 3 times. This is also your rescue position when the legs flare.
• Core work in neutral: lower belly tightening with holds, bridges, and bird-dogs (on hands and knees, extend the opposite arm and leg, hold 5 seconds), 10 each. Progress to side planks on the knees.
• Hip strength: standing hip abduction holding a counter, sit-to-stand from a chair without using the arms, 10 to 15 repeats. Strong hips let you walk upright with less strain on the back.
• Hip flexor and hamstring stretches, because tight hips pull the back into an arch.
• Physical therapy for six to eight weeks helps most people learn this program and progress it. A therapist can also fit a walker correctly.

Medicines and injections

• Acetaminophen on a schedule for pain.
• Anti-inflammatories for flares, with food, if your stomach, kidneys, and heart allow. Not long term.
• Nerve-calming medicines help some people with leg tingling; they do not help walking distance much.
• An epidural steroid injection can calm leg symptoms for weeks to months and is reasonable when a flare is stopping you from doing the program. It works less well for stenosis than for a herniated disc, and relief is usually temporary.
• Opioids have little role.

When surgery makes sense

• Walking distance is limited enough to shrink your life, and three to six months of a genuine effort with this plan has not changed it.
• Leg weakness, or numbness that is getting worse.
• You want to walk farther than this plan can give you, and you are healthy enough for an operation.

For most people the operation is a decompression, done endoscopically through a small incision when the anatomy allows, with same-day discharge. If a vertebra has slipped and the level is unstable, a fusion may be added. Surgery is very effective for leg symptoms and walking distance; it does less for back pain.

Call 911 or go to an emergency room if you have

• New trouble controlling your bladder or bowels.
• Numbness in the groin or inner thighs.
• Weakness in the legs that is getting worse quickly.

Learn more

OrthoInfo, Lumbar Spinal Stenosis: orthoinfo.aaos.org (opens in a new tab)

My guides to lumbar spinal stenosis and endoscopic lumbar decompression.

This plan is general guidance for Dr. Wey's patients and does not replace the advice we discuss in clinic. Stop and call us if walking makes leg symptoms worse day after day, or if you notice the warning signs at the end.