10 Steps to Managing Spinal Stenosis

back pain education spinal stenosis

 

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I’ve spent over a decade treating patients with spinal stenosis, and I’ve seen what works and what doesn’t. If I were faced with the condition myself, this is the treatment path I’d follow — step by step.


1. Get an MRI to Confirm Spinal Cord Health

The first thing I’d do is get an MRI. Not every case of spinal stenosis requires one, but I’d want to know if my spinal cord is safe. In rare but serious situations, the canal can narrow so much that it threatens nerve function in the legs. If that’s the case, surgery may be necessary to prevent permanent problems.


2. Rule Out Red Flags

Before moving forward, it’s critical to make sure nothing more serious is causing symptoms. Some red flags for back pain include:

  • History of trauma

  • Changes in bowel or bladder control

  • History of cancer

  • Unexplained weight loss

  • Fever

  • Pain that wakes you up at night

  • Saddle anesthesia (numbness/tingling in the groin)

  • Pain that doesn’t change with posture, movement, or activity

If any of these are present, I’d seek immediate medical attention.


3. Modify Daily Activities

Spinal stenosis is often aggravated by specific triggers. For me, that might mean avoiding long walks that bring on leg pain. Instead, I’d sit and rest before symptoms fully kicked in. By recognizing and managing these triggers, I could stay active without constantly hitting setbacks.


4. Adjust Lifestyle Factors

No single lifestyle habit causes spinal stenosis, but improving them can help long-term outcomes. I’d focus on:

  • Losing excess weight

  • Quitting smoking

  • Cutting back on alcohol

  • Managing stress

  • Eating a balanced diet

  • Ensuring I have proper support from my mattress and shoes

Small changes in these areas add up over time.


5. Commit to Exercise or Physical Therapy

Movement is medicine. I’d start with low-impact options like walking or a stationary bike, plus some strength training. If symptoms made that difficult, I’d work with a physical therapist experienced in spinal stenosis.

If land-based therapy didn’t help, I’d switch to water therapy. Pool exercises are excellent for strengthening muscles while reducing pressure on the spine.


6. Consider Traction or Decompression Therapy (with Exercise)

In some clinics, traction or decompression devices can temporarily relieve nerve pressure. I’d only use these alongside exercise, because traction by itself doesn’t last. The long-term gains come from building strength and learning better movement patterns.


7. Use Epidural Steroid Injections (with Exercise)

If symptoms flared badly, I’d consider an epidural steroid injection. The relief is usually temporary, but it can buy valuable time to focus on exercise and rehab — which is what creates lasting improvement.


8. Use Pain Medication Sparingly (with Exercise)

If needed, I’d use a low dose of pain medication to manage symptoms. I’d avoid opioids and high doses. For me, medication would only be a short-term helper while I continued exercising.


9. Consider Surgery as a Last Resort

If all else failed and symptoms were severe, I’d consult a neurosurgeon or orthopedic spine surgeon at a large medical center. Surgery would be a last resort and something I’d only do once. A repeat surgery would only be on the table if there was a correctable issue with the first one.


10. Advanced Options: Pump or Stimulator (with Exercise)

As a final option, I’d look into an intrathecal pump (delivering pain medication directly to the spinal cord) or a spinal cord stimulator (interrupting pain signals). Even with these, exercise would remain essential for the best results.


Final Thoughts

If I developed spinal stenosis, this is the exact path I’d follow. Every case is different, and adjustments would be needed, but the overall approach is clear: rule out serious issues, manage symptoms wisely, and make exercise the backbone of treatment.

Spinal stenosis can be challenging, but it’s worth fighting for quality of life. For me, I’d exhaust every reasonable option before considering surgery.

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About the Author

Dr. Matt Harris, DPT, MS, is a Doctor of Physical Therapy with 18+ years of experience helping people with spinal conditions. He provides straight-to-the-point back pain solutions — from recovery to lifelong lifting. No fluff. Just spine-safe training you can trust.

Having lived through his own back injuries and guided thousands of patients, Matt knows what it takes to go from pain and setbacks back to safe, confident training.

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