What positions can help improve symptoms of lumbar spinal stenosis?

From the Guidelines

Positions that help improve symptoms of lumbar spinal stenosis include forward flexion postures, such as leaning forward while walking, sitting in a reclined position, and bending forward slightly while standing, which can provide relief by opening up the spinal canal and relieving pressure on nerves. When considering the management of lumbar spinal stenosis, it's essential to focus on interventions that improve morbidity, mortality, and quality of life. While the provided evidence [ 1 ] discusses various noninvasive treatments for low back pain, including motor control exercise, Pilates, Tai Chi, and yoga, the question specifically asks about positions that can help improve symptoms of lumbar spinal stenosis. Some key positions to consider include:

• Leaning forward while walking, such as when pushing a shopping cart
• Sitting in a reclined position
• Bending forward slightly while standing
• The fetal position while lying on your side with knees pulled toward the chest It's also crucial to avoid positions that extend the spine backward, as extension narrows the spinal canal and can worsen symptoms [ 1 ]. Additionally, when sleeping, using a side-lying position with knees bent and a pillow between the legs can help maintain proper spinal alignment. For sitting, choosing chairs with good lumbar support and considering the use of a small lumbar roll can help maintain the natural curve of the lower back. These positions work by mechanically increasing the space in the spinal canal, reducing compression of nerve roots that causes the characteristic pain, numbness, and tingling of spinal stenosis [ 1 ]. Regular position changes are also important, as prolonged static postures of any kind can increase stiffness and discomfort.

From the Research

Positions to Improve Lumbar Spinal Stenosis Symptoms

• Lumbar spinal stenosis is a prevalent condition that affects millions of people worldwide, causing low back and leg pain 2.
• The diagnosis of lumbar spinal stenosis can be made based on a clinical history of back and lower extremity pain that is provoked by lumbar extension, relieved by lumbar flexion, and confirmed with cross-sectional imaging 2.
• Patients with lumbar spinal stenosis often adopt a flexed trunk posture or bend forward to improve tolerance for walking, which can help alleviate symptoms 3.
• Positions that involve flexion of the lumbar spine, such as bending forward or sitting, can help relieve symptoms of lumbar spinal stenosis 2, 4.
• Walking with a slightly flexed spine can also help reduce symptoms, but the effect of symptoms on normal gait kinematics is not marked 3.

Non-Surgical Interventions

• Non-surgical interventions, such as physical therapy, exercise programs, and lifestyle modifications, can be effective in managing symptoms of lumbar spinal stenosis 4, 5.
• Multimodal care, including education, advice, and lifestyle changes, behavioral change techniques, home exercise, manual therapy, and/or rehabilitation, can be beneficial for patients with lumbar spinal stenosis 5.
• Pharmacological therapies, such as serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants, may be considered for patients with lumbar spinal stenosis, but the evidence is limited 5.

Surgical Interventions

• Surgical interventions, such as decompressive laminectomy, may be effective in carefully selected patients with lumbar spinal stenosis who do not improve with conservative management 2.
• Lumbar fusion may be considered for patients with lumbar spinal stenosis and concomitant spondylolisthesis, but the indications for this procedure are unclear 2.