Spinal Stenosis

Physical therapy (core strengthening, flexion-based exercises—spinal stenosis often improves with forward bending, extension worsens symptoms, McKenzie method sometimes helpful but flexion bias usually better), Stretching (hamstrings, hip flexors—tight muscles worsen spinal loading), Walking (maintain cardiovascular fitness, but may need to take breaks—'neurogenic claudication' causes leg pain with walking that improves with rest or forward bending), Cycling or recumbent bike (forward-leaning position opens spinal canal—often tolerated better than walking), Aquatic therapy (water supports body weight, allows exercise with less pain), Core strengthening (Pilates, yoga—stabilizes spine, reduces load on degenerative segments), Avoid: prolonged standing, walking downhill (extension worsens canal narrowing), activities that extend spine (overhead reaching, back-bending yoga poses), heavy lifting, high-impact activities, Positional relief: sitting or leaning forward opens spinal canal (use shopping cart when shopping to lean on, sit down to rest when walking), sleeping position (side-lying with pillow between knees, or reclined—flat on back may worsen symptoms), Spinal decompression therapy (traction—some patients find relief, evidence mixed, chiropractors and physical therapists offer), Epidural steroid injections (if conservative treatment insufficient—provides temporary relief 3-6 months, allows participation in physical therapy, can repeat but limit number—steroids weaken bone/soft tissue over time), TENS unit (transcutaneous electrical nerve stimulation—pain relief), Heat/ice (muscle spasm relief), Maintain healthy weight (weight loss significantly reduces symptoms), Assistive devices: cane or walker (provides support, allows forward-leaning posture), lumbar corset (short-term use—provides support but long-term weakens core muscles), Surgery (decompressive laminectomy with or without fusion): for progressive neurological deficits (weakness, bowel/bladder dysfunction), intractable pain after 6-12 months aggressive conservative treatment, severe functional limitations—surgery effective (70-80% good outcomes) but risks: infection, bleeding, dural tear (spinal fluid leak), nerve damage, failed back surgery syndrome (chronic pain), adjacent segment disease (degeneration above/below surgery site), fusion increases stress on adjacent levels (often leads to additional surgery within 5-10 years), long recovery, Many patients improve with conservative management (physical therapy, weight loss, anti-inflammatory diet/supplements, activity modification, epidural injections)—avoid or delay surgery when possible.