Natural Relief for Lumbar Stenosis

So you’ve just got your MRI results back and the radiologist says that your back has stenosis. 

If you’re like most, this diagnosis comes as a shock and it sounds really bad. For many, just the name stenosis  calls to mind a steady progression from bad to worse without much that can be done about it. 

But…there is hope. A lot of hope actually. 

It is a medical reality that "your scan is not your story." Lumbar spinal stenosis (LSS) is incredibly common in people who have no back pain or leg symptoms at all. As we age, the spinal canal naturally narrows due to wear and tear, and for many, this happens without ever triggering a symptom.

According to major meta-analyses (such as Brinjikji et al. and Jensen et al.), the rates of asymptomatic lumbar stenosis break down as follows:

Rates of Stenosis by Age

The likelihood of finding stenosis on an MRI increases significantly with every decade of life. While it is rare in young adults, it becomes a "normal" finding in the elderly.

Age Group	Estimated Rate of Asymptomatic(pain free) Stenosis
Under 40	Very Rare (<5%)
Age 40–50	~10% to 15%
Age 60	~20% to 25%
Age 70+	20% to 30% (some studies suggest up to 50% for "mild" narrowing)
Age 80+	Nearly 50% or higher show some form of canal narrowing

Types of Stenosis

"Stenosis" is a general term for narrowing, but it happens in different "rooms" of the spine. The rates vary depending on where the narrowing is located:

• Central Canal Stenosis: This is the narrowing of the main "hallway" where the spinal cord/nerves travel. In people over 60, roughly 20–25% will show moderate central stenosis without symptoms.

• Foraminal Stenosis: This is narrowing of the "exit doors" where individual nerves leave the spine. This is actually more common than central stenosis. One study found that 75% of people aged 80+ have at least moderate foraminal stenosis, yet most remain symptom-free.

3. Severity Matters

Most asymptomatic findings are "mild" or "moderate." The more severe the narrowing, the more likely it is to eventually cause symptoms, but even "severe" stenosis isn't a guarantee of pain.

• Mild/Moderate: Highly common in the asymptomatic population (up to 30% of older adults).

• Severe: Significantly less common in people without symptoms. However, even among those with severe radiological narrowing, only about 17.5% to 20% actually report symptoms like neurogenic claudication (leg pain/heaviness when walking).

Why are so many people asymptomatic?

The spine is remarkably adaptable. As long as the narrowing happens slowly over decades, the nerves often have enough "room to breathe" or the body adapts to the decreased space. Symptoms usually only appear if:

1. The narrowing reaches a critical threshold where blood flow to the nerves is restricted.

2. An acute event (like a minor disc bulge) is added to an already narrow canal.

3. Inflammation occurs in the area, irritating the nerves.

Key Takeaway: If you have an MRI that shows "stenosis" but you don't have leg pain, numbness, or weakness, it is often considered an incidental finding (a "wrinkle on the inside") rather than a disease requiring treatment. Doctors generally treat the patient’s symptoms, not the image on the screen.

As it turns out, these changes are part of the aging process and are more like our wrinkles on the inside. 

But, you’re in pain, so what does this mean for you? 

Now, for the hope. Because stenosis happens in a lot of people who are not in pain, it means that it's actually pretty safe to start to try gentle exercise to start relieving the pain.  

How to do this, first, understand(and write down) how long you can do something like standing, sitting, or working before your symptoms start to flare. If you know how long you are able to sit before your back pain or sciatica starts or spreads down your leg, then you want to get out ahead of it...literally. If you are able, take a 5 minute posture break by getting out of the car or walking around  the office. 

More often than not, you are not actually damaging anything by sitting there but it can continue getting worse. Whether that is pain going down the leg or just not being able to straighten your back, taking the 5 minutes sooner rather than later can make it so you can get out in front of debilitating  back pain.

Next, if you have back pain that is worse when bending over, things like washing dishes, picking up laundry, or if your sciatica goes down your leg when bending, try some gentle stretches about every hour to ease back stiffness and give your body a break. 

Try to avoid the same position over and over, especially if bending over at the sink causes back pain. One way to ease this is by switching your stance. 

How to do this? Start with how you normally wash the dishes. Every few minutes then switch so you have 1 leg in front(not quite a lunge stance but just enough so one leg takes more of the load). Then switch every few minutes so your muscles take the load and not your spine.

What and when should I stretch? There are two or three stretches that are  probably my first go to moves when it comes to low back pain. More often than not, there will be 1 stretch that does the most to relieve the pain, calm the sciatica, and help you start to be more active and comfortable. 

The key is to understand what needs stretching and often it isn’t the low back muscles or hamstrings(i.e. You don’t need to keep bending forward to force more flexibility). To figure out what needs stretching, you need to first look at what positions make your back pain worse. Is it worse after sitting, worse lying down, worse trying to stand but eases off after a few steps. 

This is your back saying that it really wants to go into a gentle back bend(aka lean backwards against your counter). The key is not to push too far into pain on your first rep. To do this, we’re going to try about 10 repetitions trying to go deeper into the stretch with each rep and then once you’re done, walk around for about 30 seconds. Then answer the question, am I better, worse, or the same. 

Test this for several rounds. If you notice that you’re gradually getting better, you’ve found your stretch. Now, try 10 reps every hour and see if you are able to get on top of your pain. 

Why stretching your hamstrings isn’t fixing your back pain

The hamstrings are probably the most targeted area that people want to stretch, they try all sorts of positions to get them to loosen up but in the workshop, we’re going to look at why those poor hammies may be the victim and not the culprit for sciatica and back pain. 

Ok, for starters, what are the hamstrings and what do they do. The hamstrings are part of 3 separate muscles one having 2 heads, the biceps femoris as well as two others, the semitendinosus and semimembranosus, They mainly do 2 things which is bend your knee and bring your leg back. They are all provided power by the sciatic nerve. 

When this nerve is giving a little too much juice to the hamstrings, they are going to hold themselves tighter making them feel both stiff and tight to you. This is called tone and all muscles have it to some degree. If you’ve ever had those sore spots and knots between your shoulder blades, that is those muscles with a bit of higher tone and it forms painful knots.  

Those sore spots are called trigger points and are areas of higher tone and every muscle can get them. The hamstrings are no exception. So-why are they the victim? When we go back to your sciatic nerve, if it is being irritated by the spine, it is going to tell the muscles that it connects to to become stiffer to “protect”.  Often when we are stretching the muscle, we are often trying to get that tone to turn down.

 Unfortunately, if we are doing things like toe touches, pulling on them with a strap, or laying down with our legs on a wall, we are more often than not, irritating the very same nerves that are causing the tightness in the first place.

Should I strengthen?

The short answer is yes but the muscles you need to be focusing aren’t your abs.

Why doing crunches will never fix your back pain(the core strength myth)

We’ve all been told that to avoid or fix back pain, all we need is a stronger core. Many turn to machines for their abs, we’ve all seen the ab coaster, ab roller, the shake weight and people even electrocute themselves in pursuit of a stronger core but many of these training methods don’t actually stabilize the spine or use your core muscles in the way that they actually work when you’re running, lifting, or golfing. This is especially true with crunches which can actually irritate your back and flare your sciatica.  

What to do instead. Start by training your back with a couple of types of holds(called an isometric).  Load the side of your spine with a 5-10 pound weight and walk 100’ with it(this turns on the spinal protectors). Next, use your counter to hold yourself straight(modified plank on counter) making sure to not be provoking your spine while doing it. Last, focus on cardio. If you can do a 10 minute walk without provoking your pain, then make sure you are trying to get 3 of these in per day. 

You’ll start to notice that by doing these movements and exercises you are starting to get a measure of control over your back pain. 

But what happens when your back pain isn’t so cooperative? More often than not, it is either a mobility problem(like tight tender muscles)  or your stretches need more personalization in order to make them work. 

Confused about where to start? Book a call from the comfort of your home or office and  on your schedule with one of our Chronic Pain Specialists. You can schedule your call here.  Need help now? Come by and talk with one of our Doctors of Physical Therapy at no charge. We offer FREE consultations, which give you the opportunity to come in and meet us and see for yourself how we can help you.

Here are just a few of the things you will learn in one of our free consultation:

• What is the underlying cause of your pain? (hopefully nothing too serious!)

• Roughly, how long will it take to fix the problem?

• What to do to help – which doesn’t include painkillers, resting or surgery etc.

• What other, natural, drug free methods are there to speed up recovery alongside treatment?

Our consultations are great for anyone that may be “unsure” if physio is right for them, and they give you the opportunity to ask questions and see for yourself if we can help you.

If you’d like one of our limited free consultation sessions, please click here to schedule your free consultation or CALL us on 850-765-2779 to make a no-obligation enquiry.

Dr. Brandon is the owner and a Physio at Body Mechanix Physiotherapy and Fitness. Four of his favorite people call him daddy while he's been married to his other favorite person for 24 years. He enjoys teaching martial arts and is a Mestrando in Capoeira while in the mornings, he can be found working out with the guys in F3 around town.  He's the author of 4 pain relief guides for sciatica, low back, shoulder, and knees and the lead contributor to the Active Tallahassee Blog.