Lumbar spinal stenosis
Why do my legs ache when I walk but feel better when I sit or lean forward?
Narrowing around the nerves in the lower back that causes leg symptoms when walking. Structured exercise and education are first-line care.
What it feels like
Heaviness, aching, tingling or weakness in the buttocks and legs that comes on with standing or walking and eases with sitting or bending forward, for example leaning on a shopping cart. It is most common after the age of 60.
What is actually happening
Age-related changes in the discs, joints and ligaments narrow the space around the nerves in the lower back. Standing upright narrows it further, which is why bending forward eases symptoms. This pattern is called neurogenic claudication.
When to see a doctor urgently
Go to an emergency department straight away for numbness around the groin, new bladder or bowel changes, or rapidly worsening leg weakness. See your doctor if leg pain with walking could be from circulation problems, especially if you smoke or have diabetes, because that needs a different assessment.
How it is assessed
Assessment includes how far you can walk and what eases it, movement testing, a neurological examination, and screening for other causes of leg pain with walking, such as circulation problems or hip arthritis.
How it is treated
A clinical practice guideline on non-surgical care for lumbar spinal stenosis recommends a structured programme combining education, exercise and manual therapy. Systematic reviews support exercise and multimodal care for improving walking and symptoms. Treatment typically includes flexion-based exercises, strengthening, cycling or walking programmes built up gradually, and hands-on treatment. If symptoms remain severe, referral to a spine surgeon may be discussed.
What to do first
Keep active with walking in manageable bouts, sit or lean forward to rest when symptoms build, and try cycling, which is often comfortable. Have it assessed to build a programme.
Where this is assessed
- Athlete's Care Sports Medicine Centres Yonge & Eglinton · Mon/Wed/Fri · 8:00 AM – 2:00 PM Book at Athlete's Care
- Push Pounds Sports Medicine Downtown Toronto · Tue/Thu · 8:30 AM – 6:30 PM Call Push Pounds to book
- Country Lane Physio Home office & virtual · Sat · By appointment only Message me to book
References
This page is based on the following clinical practice guidelines and research.
- Bussières A, Cancelliere C, Ammendolia C, et al. Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline. J Pain. 2021;22(9):1015-1039.
- Ammendolia C, Hofkirchner C, Plener J, et al. Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review. BMJ Open. 2022;12(1):e057724.