| What We Treat
Spinal Stenosis
Narrowing around the nerves in your spine can leave your legs feeling heavy, achy or numb the longer you’re on your feet. Find out exactly what’s driving it, and build a plan that gets you walking further, more comfortably.
Overview
What Is Spinal Stenosis?
Spinal stenosis is a gradual narrowing of the spaces within your spine, which puts pressure on the nerves travelling through it. It most commonly affects the lower back, though it can occur in the neck too. It’s a very common finding as we get older, and having it on a scan doesn’t automatically mean it’s the cause of your pain — but when it is symptomatic, it has a fairly recognisable pattern.
Tap a region of the spine to see how stenosis presents there.
Lumbar Stenosis (Lower Back)
By far the most common form. Narrowing around the nerves as they exit the lower spine typically causes aching, heaviness, cramping or numbness in the buttocks, thighs and calves that builds the longer you stand or walk, and eases when you sit or lean forward — over a shopping trolley, for example.
Symptoms
How It Tends to Feel
Symptoms vary from person to person, but there’s a pattern that comes up again and again with lumbar stenosis:
Walking Intolerance
Aching, heavy or weak legs that build the further you walk, sometimes forcing you to stop — known as neurogenic claudication.
Relief on Bending Forward
Sitting, or leaning on something like a trolley or bike, opens the space around the nerves and eases symptoms quickly.
Worse on Standing
Standing upright or walking downhill extends the spine slightly, narrowing the canal further and bringing symptoms on sooner.
Leg Pain, Pins & Needles
Pain, tingling or numbness spreading into the buttocks, thighs and lower legs, sometimes on both sides.
Better on a Bike
Many people can cycle much further than they can walk, since a forward-leaning posture keeps the canal open.
Variable Back Pain
Lower back pain may or may not be present — leg symptoms are often the dominant, most limiting feature.
Causes & Risk Factors
What Drives the Narrowing
Spinal stenosis is usually the result of gradual, age-related change rather than a single injury — though certain factors speed it up.
Degenerative Change
Thickening of the ligaments and joints of the spine, along with bony overgrowth, is the most common cause and develops over years.
Disc Changes
As discs lose height and bulge with age, they take up space in the canal and contribute to narrowing around the nerves.
Spondylolisthesis
Where one vertebra slips forward over another, it can narrow the space the nerves pass through.
Congenital Narrow Canal
Some people are simply built with a naturally narrower canal, making them more likely to become symptomatic earlier.
Age & Lifestyle
Most common from the fifties onwards; risk increases with previous spinal surgery and with lower overall activity levels.
How We Can Help You
Treatment & Management
Most people with spinal stenosis manage very well without surgery. The goal is to reduce irritation around the nerves, build the capacity of the muscles supporting your spine, and get you moving further and more comfortably.
What the evidence says
Randomised trials comparing surgical decompression with structured non-surgical care show that surgery can produce faster improvement in leg symptoms for people with significant, persistent stenosis — but the gap narrows over time, and a substantial proportion of people managed non-surgically do well and never need an operation.
That makes a properly delivered exercise and walking programme a sensible first step for most people, with surgery a considered option rather than an inevitability.
When to Seek Help
Red Flags — Don’t Wait
Spinal stenosis itself is very rarely an emergency. But in rare cases, severe central narrowing can compress the bundle of nerves at the base of the spine — Cauda Equina Syndrome — which needs urgent hospital assessment.
⚠ Seek emergency care (A&E / 999) immediately if you notice:
- Numbness or pins and needles around the saddle area — inner thighs, buttocks or genitals
- New difficulty controlling your bladder or bowel, or loss of sensation when going to the toilet
- Loss of sexual sensation
- Severe or rapidly worsening weakness in both legs
- Sudden, severe back pain combined with any of the above
These symptoms can indicate Cauda Equina Syndrome, which requires assessment and, where confirmed, surgery within hours to prevent permanent nerve damage. Please do not wait for a physiotherapy appointment — go straight to A&E.
Common Questions
Frequently Asked Questions
My scan says severe stenosis — does that mean surgery?
Not automatically. The correlation between how narrow a canal looks and how much trouble it causes is surprisingly weak, and plenty of people with severe-looking scans walk well. The decision is driven by your symptoms, your walking distance and your response to a proper programme — not the report.
Why can I cycle for miles but not walk to the shop?
Because cycling puts your spine into slight flexion, which opens the canal and takes pressure off the nerves. Walking upright does the opposite. It’s one of the most characteristic features of stenosis, and it’s useful — cycling lets you keep your fitness while we work on walking tolerance.
Will it keep getting worse?
Not necessarily. Studies following people with stenosis over several years find that symptoms often remain stable, and a proportion improve. Progressive decline is not the default outcome, particularly if strength and activity are maintained.
Are injections worth trying?
Epidural injections can give short-term relief in some people, which occasionally creates a useful window for rehabilitation. The effect is generally modest and temporary, so they work best as part of a plan rather than as a treatment in themselves.
Ready to Get Moving Again?
Your physio will assess your pattern of symptoms, confirm what’s driving them, and build a plan that gets you walking further and back to doing more of what matters to you.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the red flag symptoms above, seek emergency medical care immediately.