SPINAL STENOSIS

The pattern is unmistakable once you recognise it. You set off walking and feel fine for a while. Then your legs start to ache, feel heavy or go numb. You stop, sit down or lean on something, and within a couple of minutes you can go again. Over months or years the distance you manage before it starts gets shorter.

This happens because the canal carrying your spinal nerves has gradually narrowed. Discs flatten with age, joints thicken and ligaments lose some elasticity and bulge inward. It is a normal part of how the spine ages. Worth knowing: narrowing shows up on scans in plenty of people who have no symptoms whatsoever, so the picture on an X-ray or MRI matters far less than what you can actually do.

It also explains why bending forward helps so much. Leaning forward opens the canal and takes the pressure off, which is why people find they can push a shopping trolley around a supermarket for far longer than they can walk down a street, and why cycling is often comfortable when walking is not. Standing still, in a queue for instance, is often the worst of all.

The evidence for treating this without surgery is genuinely good. Clinical guidelines recommend manual therapy combined with exercise as a first-line approach (Bussières et al., 2021). In a trial of 259 adults over 60, those who received manual therapy and individualised exercise from chiropractors and physiotherapists improved more in both symptoms and walking distance than those given standard medical care or general group exercise classes (Schneider et al., 2019). A 2024 multi-centre trial across 12 clinics found that adding spinal manipulation to conventional rehabilitation produced better pain and function outcomes than rehabilitation on its own (Young et al., 2024).

Comparisons with surgery are encouraging too. When patients who were already considered surgical candidates were randomly assigned to either decompression surgery or a structured non-surgical programme, both groups were doing equally well two years later (Delitto et al., 2015). A Cochrane review found no clear advantage for surgery and noted that complications affected 10 to 24% of surgical patients, with none reported for conservative care (Zaina et al., 2016).

Treatment focuses on what actually changes your day: how far you can walk and how comfortably you can stand. That means hands-on treatment to improve movement through the lower back and hips, targeted exercise to build strength and endurance and practical strategies to extend your walking tolerance. We cannot widen the canal itself, and we will not pretend otherwise, but how much that narrowing limits you is very much something we can change. If you ever develop sudden weakness in both legs, or any change in bladder or bowel control, treat that as an emergency and seek immediate medical care.