Spinal stenosis of the low back

Spinal stenosis is the narrowing of the spinal canal around the the spinal cord (or cauda equina, which is the tail end of the spinal cord) and the nerves leaving the spinal cord and running into the legs. The symptoms of spinal stenosis are back, buttock or leg pain when standing or walking for a period of time. Standing and walking may also cause pins, needles or numbness or cramping of the legs. Pain is relieved by sitting or lying down. The most common onset is after the age of 65.

It is most commonly caused by degenerative changes in the spine. The joints and ligaments thicken, the bone of the vertebrae forms spurs and the disc may bulge or protrude taking up space around the spinal cord and nerves causing compression.

The vertebrae on the left shows a normal spinal canal, while the vertebrae on the right shows the narrowing of the spinal canal by degenerative changes.

The reason why back and leg pain is felt in standing and walking, is that in these positions, the top of the pelvis is tilted forwards, increasing the arch or lordosis of the lumbar spine which narrows the central and lateral canals. In the sitting or lying with knees bent positions, the central and lateral canals are opened out.

If people with spinal stenosis can stand and walk with their pelvis “tucked under” and lower back flattened slightly, they are usually able to stand or walk for longer before they experience their back or leg pain.

Physiotherapists commonly give exercises to patients that “optimize” their standing posture and stretching exercises that will usually relieve pain readily.

Posterior pelvic tilting in standing

The patient stands and bends their knees slightly and drop their tailbone towards their toes – this has the effect of flattening out the lower back and opening the central and lateral spinal canals.

Flexion stretch in lying

The patient brings their knees towards their chest, gently stretching their lower back.

Flexion in sitting

The patient leans forward over knees, taking their weight through their hands . These exercises can be very effective in relieving pain and prolonging the onset of pain in standing and walking.

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