What is spinal stenosis?
Spinal stenosis is a condition where the spaces in your spine become too narrow. This narrowing can put pressure on your spinal cord or the nerves that branch out from it. When these nerves are pinched, you may feel pain, numbness, or weakness in your back, legs, arms, or hands, depending on where the narrowing occurs.
Although it can affect any part of the spine, it most often happens in the lower back (lumbar stenosis) and neck (cervical stenosis). Lumbar spinal stenosis commonly causes leg pain and difficulty walking, while cervical stenosis can lead to neck pain and arm symptoms. Most cases develop slowly over several years as part of ageing or “wear and tear.”
How spinal stenosis develops
Spinal stenosis develops when changes in the spine reduce the space available for the spinal cord and nerve roots. The main mechanisms include:
- Thickening of ligaments: Over time, the ligaments which connect the vertebrae, can thicken and buckle into the canal.
- Bone spur formation (osteophytes): Wear-and-tear arthritis (osteoarthritis) leads to bony growths around facet joints and disc edges, encroaching on the nerve pathways.
- Degenerative disc changes: Discs lose height and flexibility with age; bulging or herniated discs can protrude into the spinal canal.
- Facet joint enlargement: The small joints at the back of vertebrae can enlarge and stiffen, narrowing the canal and nerve exits.
- Scar tissue: After surgery or injury, fibrous tissue can form and press on nerves.
These changes often occur together, gradually narrowing the spinal canal until nerves become pinched and symptoms appear.
Who is affected?
Spinal stenosis is quite common in older adults but can sometimes occur in younger people for different reasons. Those at higher risk include:
- People aged 50 and over: Natural ageing often leads to small changes in the spine, like thickened ligaments and bone spurs that narrow the canal.
- Individuals with arthritis: Osteoarthritis (wear and tear) in the spine can cause bone spurs and joint enlargement that pinch nerves.
- People with a history of spine injury or surgery: Previous trauma or operations can lead to scar tissue or alignment changes.
- Those born with a naturally small spinal canal (congenital stenosis): Some people have a narrower canal from birth, which can become problematic later in life.
- Individuals with conditions like spondylolisthesis or scoliosis: Spinal slippage or curvature can change how much space the canal has.
Lumbar spinal stenosis affects up to 8% of the general population, rising steeply after age 60. Cervical stenosis is less common but still significant in older adults.
Signs and symptoms of spinal stenosis
Common signs and symptoms
Symptoms of spinal stenosis often develop gradually and can vary based on where in the spine the narrowing occurs. Common symptoms include:
- Pain: In the lower back or neck. Leg or arm pain may also occur, often described as aching, burning, or “electric-shock” sensations.
- Numbness and tingling: A “pins and needles” feeling in the arms, hands, legs, or feet following the path of the affected nerve.
- Weakness: Difficulty lifting the foot (foot drop), gripping objects, or holding your arms up.
- Balance problems: Feeling unsteady on your feet, especially when walking on uneven ground.
- Neurogenic claudication (lower back): Leg pain, heaviness, or cramping that comes on after walking a short distance and eases when you sit down or bend forward.
When symptoms may worsen
Certain activities and conditions can make symptoms of spinal stenosis flare up:
- Standing or walking for long periods: Puts extra pressure on nerves in the lower back.
- Extending the spine (leaning back): Narrows the canal further and can trigger neck or leg symptoms.
- Coughing or sneezing: Quickly raises pressure inside the spine.
- Hot weather or fatigue: Can increase discomfort and heaviness in the legs.
Causes and risk factors
Common causes
Spinal stenosis most often occurs due to structural changes in the spine that narrow the spinal canal. Common causes include:
- Age-related changes (degenerative stenosis): Over time, spinal discs lose height, ligaments thicken, and bone spurs form, narrowing the space for nerves.
- Osteoarthritis: Wear-and-tear arthritis leads to bony growths (osteophytes) around the facet joints and disc edges.
- Bulging or herniated discs: Discs between vertebrae can bulge or rupture into the canal space.
- Spondylolisthesis: One vertebra slips forward over the one below, squeezing the canal or nerve exits.
- Congenital factors: A naturally small spinal canal or abnormal spine shapes present from birth.
- Spine injuries or surgeries: Scar tissue or bone fragments can press on nerves.
- Other conditions: Spinal tumours, Paget’s disease of bone, and inflammatory arthritis (like rheumatoid arthritis).
Identifying which of these factors applies to you can help tailor treatment to relieve nerve pressure and improve function.
Risk factors you should know
Several factors can increase your likelihood of spinal stenosis. These include:
- Age: Changes begin around age 40–50 and worsen over time.
- Genetics: A family history of narrow canals or spine problems can increase your risk.
- Occupational load: Jobs requiring heavy lifting, bending, or twisting can accelerate wear.
- Sedentary lifestyle: Weak back muscles and poor posture may contribute to symptoms.
- Smoking: Reduces blood flow to spinal tissues and slows healing.
- Obesity: Extra weight places more stress on spinal structures.
By understanding these risk factors, you can make lifestyle changes, like strengthening your core, maintaining a healthy weight, and quitting smoking, to support your spinal health and lower the chance of symptomatic stenosis.
How spinal stenosis is diagnosed
Clinical examination
When you see your GP or a specialist, they will:
- Discuss your symptoms: When it started, pattern, activities that make it better or worse.
- Review your medical history: Past back injuries, surgeries, or health conditions.
- Perform a physical exam: Test muscle strength, reflexes, sensation, and balance. In the lower back, your clinician may ask you to walk on your toes or heels, squat, or perform other movements to assess nerve function.
Diagnostic tests
If your symptoms are severe, persistent, or if there are “red flag” signs (see When to seek medical advice), you may need imaging:
- MRI scan: The best way to see soft tissues, discs, nerves, and any narrowing in detail.
- X-rays: Show bony changes, alignment issues, or fractures.
- Electromyography (EMG): Measures electrical signals in muscles to check for nerve damage.
These imaging tests provide detailed information on the location and extent of spinal narrowing, helping your healthcare team choose the most appropriate treatment approach.
Treatment options for spinal stenosis
Lifestyle changes
Simple self-care measures can help reduce pain and support recovery:
- Stay active: Gentle walking, swimming, or cycling helps keep your spine flexible and supports good blood flow.
- Posture and ergonomics: Use chairs with good back support, keep feet flat on the floor, and avoid slouching. When standing, distribute weight evenly on both feet.
- Flexion exercises: Activities that bend the spine forward (like cycling, leaning forward on a shopping trolley) can open the canal and ease leg symptoms.
- Heat and cold packs: Warmth can relax muscles; ice can reduce local inflammation.
- Over-the-counter pain relief: Paracetamol or ibuprofen (if suitable) may help in the short term.
Physiotherapy
A physiotherapist can design a personalised plan to:
- Strengthen core muscles: Better support for your spine reduces pressure on nerves.
- Improve flexibility: Gentle stretches for the hamstrings, lower back, and neck maintain range of motion.
- Teach safe movement patterns: Advice on lifting, bending, and posture to protect your spine.
- Manual therapy: Hands-on techniques to ease muscle tension and improve joint mobility.
Working with a physiotherapist not only relieves current discomfort but also equips you with the strength and flexibility needed to prevent future flare‑ups.
Medications and injections
If self-care and physiotherapy aren’t enough, your GP may consider various medical treatments:
- Prescription NSAIDs: Stronger anti-inflammatory drugs to reduce nerve irritation.
- Muscle relaxants: To ease painful muscle spasms.
- Neuropathic pain agents: Such as gabapentin or amitriptyline for nerve-related pain.
- Short-term opioids: For severe pain flares, used with caution and close monitoring.
- Epidural steroid injections: Corticosteroid medication delivered around the irritated nerve root can reduce inflammation and pain for weeks to months, helping you engage more fully in exercise and rehabilitation.
Your healthcare practitioner may recommend combining medications with targeted injections can effectively relieve nerve irritation and support your recovery plan.
Surgery (if applicable)
Most people improve with non-surgical care, but surgery may be needed if:
- Symptoms stop you walking or doing daily activities
- You develop significant leg weakness or numbness
- You lose bladder or bowel control (cauda equina syndrome – emergency)
Common operations include:
- Decompressive laminectomy: Removal of the back part of the vertebra to create more room for nerves.
- Foraminotomy: Widening the openings where nerves exit the spinal canal.
- Spinal fusion: In some cases, two vertebrae are fused to stabilise the spine after decompression.
Surgerycan offer significant, lasting relief when conservative treatments haven’t beenenough, with most patients noting reduced pain and improved mobility afterrecovery.
Can spinal stenosis be prevented?
Although you can’t stop age-related changes, adopting certain habits can significantly reduce your risk of symptom flare-ups by:
- Regular exercise: Engage in low-impact exercises such as walking, swimming or cycling for at least 30 minutes a day, five times a week. Strengthening your core, with exercises like planks, pelvic tilts and gentle yoga, helps stabilise your spine and ease pressure on your nerves.
- Maintain a healthy weight: Keeping your body mass index (BMI) within a healthy range reduces mechanical stress on spinal joints and discs. Even a little weight loss can lead to significant decreases in back strain.
- Use safe lifting techniques: When lifting heavy objects, bend at the hips and knees rather than your waist, hold the load close to your body, and avoid twisting motions. This protects your spine from sudden jolts or unnecessary pressure.
- Support good posture: Sit and stand with your back straight, shoulders relaxed, and abdominal muscles gently engaged. Use chairs with lumbar support and adjust your workstation to keep your spine in a neutral position.
- Quit smoking: Smoking impairs blood flow to spinal tissues, slows disc nutrition and repair, and accelerates degenerative changes. Quitting can improve healing and overall spinal health.
By putting these habits into practice, you’ll support your spinal health and minimise the chance of developing painful symptoms.
When to seek medical advice
Signs you shouldn't ignore
Contact your GP or emergency services if you experience:
- Sudden loss of bladder or bowel control may signal cauda equina syndrome.
- Severe or rapidly worsening leg weakness increases risk of permanent nerve damage.
- High fever or unexplained weight loss with back pain, could indicate infection or malignancy.
- Pain so severe it doesn’t improve with rest or pain relief.
Early assessment ensures serious causes are ruled out and that you receive the right treatment quickly.
Doctors who treat this condition
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References
- https://www.nhs.uk/conditions/spinal-stenosis/ [accessed 01.08.2025]
- https://en.wikipedia.org/wiki/Spinal_stenosis [accessed 01.08.2025]
- https://www.ncbi.nlm.nih.gov/books/NBK448103/ [accessed 01.08.2025]
- https://www.nice.org.uk/guidance/ng59 [accessed 01.08.2025]
- https://www.ninds.nih.gov/health-information/disorders/spinal-stenosis-information-page [accessed 01.08.2025]