Lumbar spinal stenosis: leg pain on walking, treatment and outlook

NHS inform explains that most narrowing is a normal part of ageing and often does not cause problems, but in some people it irritates or compresses nerves. South Tees Hospitals NHS Foundation Trust describes how the central spinal tunnel protects the spinal cord, which in the lower back gives off nerve roots that travel on into the legs. As the tunnel narrows with age these roots can be crowded and irritated.

Causes other than ageing, listed by NHS inform, include injury, rheumatoid arthritis, certain bone diseases and being born with a narrow spinal canal.

NHS inform says lumbar stenosis symptoms affect the legs and may include pain, aching, cramping, heaviness or weakness, tingling, pins and needles and numbness, usually worse with walking or standing and relieved by sitting or leaning forward. South Tees adds the example of leaning on a shopping trolley, explaining that bending forward increases the size of the spinal tunnel. It also lists cramps in the legs at night.

Many people have no symptoms at all. NHS inform notes that low back pain without leg symptoms is usually not thought to be caused by stenosis.

NHS inform says spinal stenosis can be diagnosed following an assessment where a healthcare professional asks about symptoms and carries out a physical examination. Scans may be considered for people with severe and worsening symptoms to help decide whether spinal surgery could help. The pattern of symptoms matters more than the scan alone, because narrowing seen on an MRI is common in people without symptoms.

South Tees describes the two treatment options as exercise therapy and surgical decompression, with treatment aimed at relieving symptoms and improving quality of life. Exercise is first-line: its purpose is not to change the narrowing but to reduce nerve irritation, improve nerve resilience to movement and support general function, strength and balance. Examples include a progressive cycling programme, an adjusted walking programme or a stretching routine, with swimming for those with intense pain.

NHS inform lists physiotherapy, staying active, pacing, a healthy weight, stopping smoking, managing stress, and pain management strategies including medication, heat and ice. It says it is safe to keep walking if symptoms remain manageable, that short regular walks are encouraged, and that regular breaks leaning on a wall or sitting can help. A walking aid is worth discussing if walking is a struggle. Continuing or returning to work as soon as possible helps recovery.

If symptoms are not improving after other treatments, NHS inform lists spinal injections, spinal surgery and specialist pain services as options. South Tees describes surgical decompression, usually laminectomy, in which a small part of the spinal tunnel wall is removed. It may be considered if symptoms are severe, there is progressive neurological decline or after a period of exercise therapy.

South Tees states that there is currently no definitive evidence that laminectomy improves symptoms of lumbar stenosis; some people improve and others do not, and studies are under way. It also says injections are not usually recommended. This is why the decision is made with a surgeon after weighing risks and benefits.

NHS inform says stenosis can occasionally lead to cauda equina syndrome or cervical myelopathy, rare but serious conditions that can cause permanent damage and need an emergency specialist team. Contact your GP practice urgently, or use emergency services, for new or worsening bladder or bowel changes, changed sensation around the bottom or genitals or sexual dysfunction, reduced balance or difficulty walking, or increasing weakness, heaviness or altered sensation in the legs. If you cannot reach a GP urgently, use NHS 111 or call 999.