Lumbar Spinal Stenosis: Leg Pain That Increases With Walking
Narrowing of the spinal canal compressing the nerve roots and shortening walking distance.
Lumbar spinal stenosis is a narrowing of the canal through which the nerve roots pass. Loss of disc height, thickening of the facet joints and buckling of the ligaments all reduce the space available. It is among the most common causes of leg pain that shortens walking distance after the age of sixty.
The Distinguishing Symptom
The most recognisable feature is leg pain that increases with walking and eases on sitting or bending forward:
- Pain, numbness and heaviness in the legs after a certain distance
- Relief within minutes of sitting or leaning forward
- Symptoms reduced when pushing a shopping trolley or walking uphill
- Symptoms aggravated by leaning backwards
- Walking distance shortening progressively over months
Distinguishing this from leg pain caused by arterial disease is important; the differentiation is made on examination and, when needed, vascular studies.
Diagnosis and Treatment
The history and examination strongly suggest the diagnosis; MRI demonstrates the degree and level of narrowing. Standing X-rays show spinal alignment and any slippage.
Non-surgical treatment includes a strengthening programme that uses forward-flexed positions, activities such as cycling, weight management, appropriate pain relief and, in selected patients, injections.
Surgery to decompress the canal is considered when walking distance limits daily life, when weakness is progressing, or when conservative treatment fails. If slippage is present, stabilisation may be added — see spine surgery.
If your walking distance has shortened over months and leg pain increases with walking but eases on sitting, arrange an assessment.
Frequently Asked Questions
Why do I feel better when I sit?
Bending forward and sitting slightly widen the spinal canal, reducing pressure on the nerve roots. This is characteristic of spinal stenosis.
Will surgery increase my walking distance?
In appropriately selected patients the aim of surgery is to reduce leg pain and increase walking distance. Results depend on the degree and duration of narrowing and on general health.
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