Spinal Stenosis: What It Is, What It Feels Like and What You Can Do About It

Spinal stenosis happens when the spinal canal narrows, putting pressure on the nerves that run through it. It is one of the leading causes of pain and loss of independence in older adults, and it is something we see and treat regularly at Health First Chiropractic in Modbury North, with patients from across Adelaide’s north-eastern suburbs.

It is most common in the lower back, where it is called lumbar spinal stenosis, and it tends to develop gradually as part of the normal ageing process. The discs lose height, the joints thicken, and over time there is simply less space for the nerves.

What does spinal stenosis feel like?

The most recognisable pattern is pain, heaviness, or numbness in the buttocks and legs when you stand or walk, which eases when you sit down or lean forward.

This is called neurogenic claudication, and it is the hallmark symptom of lumbar spinal stenosis.

You might notice:

• Leg pain or heaviness that builds the longer you walk
• Relief when you sit, lean on a shopping trolley, or stoop slightly forward
• Tingling or numbness down one or both legs
• A feeling of weakness in the legs
• Back pain, though often less prominent than the leg symptoms

The shopping trolley effect is a real and well-recognised sign. People often find they can walk further when leaning forward slightly, such as pushing a trolley at the supermarket, than when walking upright.

Is spinal stenosis serious?

For most people, spinal stenosis is a manageable condition, not an emergency.

The natural history is more variable than many people expect. Research shows that roughly one third of people with mild to moderate stenosis will gradually worsen over time, one third will stay stable, and one third will improve. That last statistic surprises many patients, but it is important.

Does spinal stenosis show up on scans?

Often, yes, but the scan findings frequently do not match how you feel.

Many people have significant stenosis visible on MRI and very mild symptoms. Others have moderate findings and significant disability. This disconnect between imaging and symptoms is well established in the research, and it is one reason we do not rely on imaging alone to guide your care.

Imaging becomes most useful if conservative treatment is not progressing as expected, or if surgery is being seriously considered.

What are the best non-surgical treatments for spinal stenosis?

Current clinical practice guidelines recommend a multimodal conservative approach as the first-line treatment for spinal stenosis. That means combining manual therapy, supervised exercise, and education, not relying on medication or injections.

What about medication?

Medications commonly prescribed for stenosis, including pregabalin, gabapentin, anti-inflammatories, and opioids, are not supported by the current evidence. Research shows no clinically meaningful improvement in symptoms, alongside a real risk of side effects such as dizziness and drowsiness. This is particularly relevant for older adults who are already managing other health conditions.

What about injections?

Epidural steroid injections are frequently offered for spinal stenosis, accounting for roughly a quarter of all epidural procedures. Yet clinical trials consistently show no meaningful improvement, in the short term or long term. They are not something we recommend as a first step.

How do we treat spinal stenosis in Modbury?

Our approach is conservative, evidence-informed, and focused on what genuinely helps.

Flexion distraction therapy is a gentle, hands-on technique that is well suited to spinal stenosis. It involves a specialised table that creates a rhythmic traction movement, gently opening the spinal joints and reducing pressure on the nerves. Most patients find it very comfortable, even when their symptoms are significant.

Spinal adjusting helps restore movement to stiff spinal segments. In stenosis, the surrounding joints often become restricted and painful in their own right. Restoring mobility to those areas can meaningfully reduce discomfort and improve function.

Exercise rehabilitation is one of the most effective tools available for managing stenosis, and the evidence for supervised exercise is clear. Where it suits you, we focus on movements and postures that work with your stenosis, not against it, typically favouring flexion-based and low-load exercises that are comfortable and sustainable for your lifestyle.

Home care advice means you are not just improving when you are in our practice. We will work with you on practical strategies for managing your symptoms day to day, including how to position yourself when walking, sleeping and sitting, and which activities to build gradually versus what to modify in the short term.

What about the emotional side of stenosis?

This is something we take seriously and do not overlook.

Living with spinal stenosis, particularly when it limits how far you can walk, how independent you feel, or how well you sleep, can affect your mood, your confidence, and your sense of self. Research acknowledges that fear of movement, low self-efficacy, and feelings of hopelessness are common in people managing stenosis, and that these factors directly influence how well people recover.

Our care takes this into account. We use positive, realistic language. We take your concerns seriously. And we focus on building your confidence alongside your physical capacity, because both matter.

Can spinal stenosis affect other areas of health?

Emerging research suggests that lumbar spinal stenosis can affect more than just your back and legs.

Because stenosis can compromise nerve supply to the pelvic region, it has been linked to urinary and sexual dysfunction in some patients, an area that is still being studied but one that clinicians are increasingly aware of. If you are experiencing these symptoms alongside your back or leg pain, it is worth raising with your treating practitioner.

Many patients with stenosis also experience nerve-related symptoms. You may find our article on what nerve pain feels like helpful reading alongside this one.

References

1. Ammendolia C. Effective non-operative treatments and practical management strategies for older adults with lumbar spinal stenosis. Chiropractic & Manual Therapies, 2025;33(1):27.

Written by

Dr Naomi Swan

Chiropractor and co-director of Health First Chiropractic in Modbury North, with over 20 years in practice and a Master of Chiropractic. Naomi is also a supervisor and examiner at the Australian Chiropractic College in Adelaide.

Meet Naomi →