What Is Spinal Stenosis?

Spinal stenosis refers to narrowing of the spaces within the spine. These spaces include the central spinal canal and the smaller openings on each side of the spine where nerves exit, known as the intervertebral foramina.

The spinal cord and nerve roots need adequate space to travel without excessive compression or irritation. When these spaces narrow, nearby nerves may become more sensitive, especially during certain positions or activities.

Spinal stenosis most commonly affects the lower back and neck, but symptoms are often discussed in relation to the lumbar spine because narrowing in the lower back can affect the nerves travelling into the hips, legs, and feet.

The condition often develops gradually over time. Some people may have narrowing on imaging without significant symptoms, while others may experience back pain, leg heaviness, tingling, numbness, or difficulty walking for long periods. Symptoms may feel worse with standing or walking and may ease when sitting or bending forward.

Diagnosis of spinal stenosis should be made by a licensed medical professional through proper assessment and imaging when needed.

Individuals May Experience

• Lower back discomfort

• Stiffness in the lower back

• Pain, heaviness, or fatigue in the legs when walking

• Tingling or numbness in the legs or feet

• Symptoms that improve when bending forward or sitting

• Reduced walking distance

• Difficulty standing upright for long periods

• Discomfort while grocery shopping, walking, or standing in lines

• Symptoms that improve when leaning on a shopping cart

• Tightness through the hips, glutes, or lower back

• Balance changes or reduced confidence walking

• Weakness or tiredness in the legs during activity

• Pain that changes depending on posture

• Difficulty with stairs, hills, or prolonged standing

More urgent medical assessment is needed if symptoms include progressive leg weakness, numbness in the groin or saddle region, loss of bladder or bowel control, severe unrelenting pain, major trauma, or rapidly worsening neurological symptoms.

Why the Space Narrows in Spinal Stenosis

The spine is made of bones, discs, joints, ligaments, muscles, and nerve pathways. The nerves exit through openings between the vertebrae. These openings must stay large enough for the nerves to move and function comfortably.

Over time, several structural and mechanical changes may reduce the available space around the nerves.

One common factor is disc height loss. The discs sit between the vertebrae and help maintain space between spinal segments. When discs lose height or hydration over time, the distance between vertebrae may decrease. This can reduce the size of the foramina where nerves exit the spine.

Another factor is facet joint change. The facet joints are small joints at the back of the spine that guide movement. If these joints become enlarged, irritated, arthritic, or compressed over time, they may take up more space near the nerve pathway.

The surrounding ligaments may also thicken. One important ligament inside the spinal canal, the ligamentum flavum, can become thicker or less elastic with age and mechanical stress. As this tissue thickens, it may reduce space in the spinal canal.

Posture and spinal positioning also matter. Lumbar extension, or arching the lower back, can reduce the available space around nerves in some individuals. Flexion, or bending forward, may temporarily create more room, which is why some people feel better sitting or leaning forward.

In simple terms, the foramina and spinal canal may narrow because of a combination of:

• Reduced disc height

• Disc bulging or disc changes

• Facet joint enlargement or irritation

• Thickening of spinal ligaments

• Degenerative joint changes

• Bone spur formation

• Reduced mobility between spinal segments

• Increased lumbar extension or compression

• Pelvic mechanics that increase load through the lower back

• Protective muscle guarding that limits movement options

When the available nerve space becomes smaller, the nerves may become more sensitive to standing, walking, extension, or prolonged upright posture.

What Contributes to Spinal Stenosis?

Several factors may influence spinal stenosis or symptoms related to nerve space narrowing, including:

• Degenerative changes in the spine

• Thickening of surrounding ligaments

• Disc changes

• Reduced spinal mobility

• Age-related structural changes

• Facet joint irritation or enlargement

• Reduced disc height

• Repetitive spinal compression

• Poor load distribution through the spine

• Limited hip mobility

• Pelvic mechanics that increase lumbar strain

• Core and hip weakness

• Prolonged standing or extension-based posture

• Protective muscle guarding

• Reduced walking tolerance from deconditioning

These factors may influence the space available for nerves within the spine and how well the body tolerates daily movement.

For example, if the hips are stiff, the lower back may compensate during walking or standing. If the pelvis is tilted in a way that increases lumbar extension, symptoms may worsen because the spinal canal and foraminal spaces may become more compressed. If the muscles surrounding the spine are weak or guarded, the spine may not distribute load efficiently.

Spinal stenosis is not only about the narrowing itself. Symptoms are also influenced by mobility, strength, posture, walking mechanics, inflammation, nerve sensitivity, and the body’s ability to adapt around the narrowed spaces.

How Manual Therapy May Help

Manual therapy and rehabilitation do not reverse structural narrowing or remove bone spurs. The goal is to improve the mechanical environment around the spine, reduce unnecessary tension, and help the body move in ways that place less stress on sensitive nerve pathways.

Supportive care may focus on:

• Improving spinal mobility

• Reducing muscle guarding

• Improving hip and pelvic mechanics

• Supporting more comfortable posture

• Building spinal and hip strength

• Improving walking tolerance

• Reducing compensation patterns

• Helping the body find positions that ease symptoms

A conservative care plan should be adapted to the person’s symptoms, medical diagnosis, walking tolerance, activity level, and movement response.

Osteopathic Manual Therapy

Osteopathic Manual Therapy may focus on improving movement in the spine and surrounding joints. Since spinal stenosis symptoms can be influenced by how the spine, pelvis, hips, and surrounding tissues distribute load, osteopathic care may assess the whole mechanical system rather than only the narrowed region.

Treatment may include:

• Improving lumbar spine mobility within comfortable ranges

• Addressing pelvic mechanics

• Reducing fascial tension in surrounding tissues

• Supporting coordinated spinal movement

• Improving hip mobility to reduce lumbar compensation

• Addressing sacroiliac joint mechanics

• Reducing protective muscle guarding in the lower back and hips

• Improving thoracic and rib mobility when posture contributes to lumbar strain

• Supporting more balanced load distribution through the spine and pelvis

• Identifying positions and movement patterns that reduce mechanical irritation

Osteopathic care often focuses on improving overall spinal mobility and tissue flexibility. The goal is to help reduce compression forces, improve movement options, and support more comfortable function without forcing the spine into positions that aggravate symptoms.

Physiotherapy

Physiotherapy rehabilitation may involve exercises that support spinal movement, strength, posture, and walking tolerance. Since symptoms often worsen with prolonged standing or walking, rehab may focus on improving how the spine is supported during upright activity.

Treatment may include:

• Core stabilization exercises

• Hip and glute strengthening

• Flexibility and mobility training

• Walking and activity progression

• Postural retraining

• Flexion-biased exercises when appropriate

• Strengthening for the legs and trunk

• Balance and coordination exercises

• Education on pacing and rest positions

• Gait retraining when walking mechanics are affected

• Gradual conditioning to improve walking tolerance

• Home exercise programming for long-term management

These exercises help improve spinal support and movement tolerance. Physiotherapy may also help patients learn which positions reduce symptoms and how to gradually build capacity without triggering repeated flare-ups.

For some individuals, leaning slightly forward or using supported walking positions may improve comfort. Rehab may use this information to guide practical movement strategies for daily life.

Massage Therapy

Massage therapy may help address muscular tension associated with spinal discomfort. When the spine or nerves are irritated, the lower back, glutes, hips, and surrounding muscles may tighten protectively. This guarding can increase stiffness and reduce movement options.

Treatment may include:

• Reducing tightness in the lower back muscles

• Improving circulation in surrounding soft tissues

• Supporting relaxation of protective muscle guarding

• Addressing hip, glute, or pelvic muscle tension

• Reducing compensatory tension patterns

• Helping improve comfort during flare-ups

• Supporting relaxation alongside mobility and strengthening work

Massage therapy may help relieve muscular tension surrounding the affected area of the spine. It is supportive care and is often most effective when combined with exercise, pacing strategies, and mobility work.

Book an Assessment

If back or leg discomfort is affecting your ability to walk, stand, or remain active, our team can assess spinal movement and guide appropriate care.

A comprehensive assessment can help identify whether your symptoms may be influenced by spinal mobility, foraminal narrowing, pelvic mechanics, hip mobility, muscle guarding, posture, walking mechanics, strength, or nerve sensitivity.