How to treat a narrow lumbar canal: physiotherapy, exercises?

You’ve been diagnosed with a narrow lumbar spinal canal (lumbar stenosis) and are looking for a simple, yet comprehensive guide?

Here it is! Based as usual on my experience as a physiotherapist and my research into internationally published medical studies.

♻️ Last update: July 1, 2024.
👩‍⚖️ Declaration of financial interests: none directly related to the subject. My complete declaration of financial interests is available in the legal notice section.
Written by Nelly Darbois, physiotherapist and scientific editor

What exactly is a narrow lumbar canal?

All along our back, our spinal cord passes between our vertebrae, in a kind of canal.

This canal can become narrower, especially in the lumbar region of the lower back. And this narrowing can have an impact on the nerves that run from the spinal cord to control the sensitivity and motor skills of our legs.

In this case, we speak of a narrow lumbar canal, synonymous with lumbar stenosis.

There are a number of causes for this:

1. ageing, the natural wear and tear of the discs between the vertebrae, which modifies the anatomy of this area;
2. congenital : for genetic reasons, some people are born with lumbar spinal stenosis;
3. spondylolisthesis : a slippage of one vertebra in relation to another;
4. rheumaticdiseases such as ankylosing spondylitis and other rarer conditions.

It’s a relatively common occurrence: 2 out of 10 people over 60 whose X-rays are observed have lumbar spinal stenosis (without necessarily having pain or other associated symptoms!).

And for all ages,1 in 10 people whose X-rays are observed have a stenosis, according to the radiological definition given. Again, without necessarily having symptoms!

Source : Wu 2024

How can I be sure if I have a narrow lumbar canal?

Here are some fairly typical signs of a narrow lumbar canal:

• lower back pain;
• numbness or tingling in the legs, often on both sides, but quite asymmetrical (not necessarily in the same place depending on the side);
• symptoms aggravated by walking or lumbar extension (moving the upper body backwards);
• loss of leg strength in 4 out of 10 people;
• It’s easier to climb the stairs than to go down them (because the back is flexed on the way up, which “opens” the lumbar canal and decompresses the nerve roots). Or pushing your shopping cart in the supermarket;
• gait with knees bent and trunk slightly bent forward.

Other pathologies may cause similar symptoms. A doctor or physiotherapist accustomed to seeing this type of pathology will find it easier to make what is known as a differential diagnosis: eliminating other pathologies that would require different treatment, in order to retain the diagnosis of narrow lumbar canal.

Depending on the extent of your symptoms and the uncertainty of the diagnosis, your doctor may prescribe additional imaging tests to observe the shrinkage (but not necessarily to provide more clues for treatment): X-ray, MRI, CT scan.

Cauda equina syndrome is a possible complication of lumbar spinal stenosis.

What conservative (non-operative) treatments are available?

The management of a narrow lumbar canal causing pain or discomfort is generally based on 3 pillars:

1. inform you about the pathology to reassure you;
2. alleviate your pain with medicated approaches (drugs such as AINSI or myorelaxans – among others, steroid injections) or non-medicated approaches ( physiotherapy, TENS, corset or soft lumbar belt, neuromodulation, etc.);
3. help you adapt your daily life to your symptoms, in particular through physiotherapy sessions.

There aren’t really any studies comparing the efficacy of one type of treatment against another, or against the natural course (doing nothing).

The care you are offered will therefore depend very much on the professionals you come across.

Exercise and physiotherapy: is it worth it?

Rehabilitation, as practiced by physiotherapists, aims to relieve your symptoms : pain, difficulty walking, sensory or motor problems. It does not, however, directly enlarge your lumbar canal.

There are no high-quality studies to suggest that regular physical exercise (muscle strengthening, brisk walking, cycling, etc.) leads to less pain or better movement, although it does seem consistent from a theoretical point of view.

There is even less evidence available to show that regular stretching of the lumbar spine can also reduce symptoms, although the relief provided during exercise may be a good thing in itself.

Other types of exercise frequently suggested by physiotherapists are muscle-strengthening exercises for the back or lower limbs. The theory behind this is to make the muscles stronger to compensate for the deficiencies of the more rigid structures.

Here are some examples of lumbar extension stretches and postures. Your physiotherapist can help you identify which ones are most helpful in your case:

Should I have a lumbar canal operation?

A research team has carried out a synthesis of studies comparing the evolution of 643 people with an average age of 59:

• some of them had undergone lumbar canal surgery;
• the others underwent conservative treatment, without surgery: medication, physiotherapy, orthoses, etc.

Here are the team’s 3 conclusions.

1. We have very little confidence in concluding whether surgical treatment or a conservative approach is preferable for lumbar stenosis.
2. 1 in 10 to 2 in 10 people who underwent surgery had at least one side effect (fracture, coronary ischemia, respiratory distress, hematoma, stroke, risk of reoperation and death due to pulmonary edema). No side effects were reported for any conservative treatment.
3. No clear benefit was observed with surgery compared to non-surgical treatment.

Source: Zaina 2016

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That’s all I wanted to say on the subject! Any questions or comments? See you in comments!