The Role of Exercise in Treatment of Lumbar Spinal Stenosis Symptoms
Purpose of Review
Lumbar spinal stenosis is a common condition that can cause significant disability due to low back or leg pain and walking limitations. Initial non-surgical management usually involves exercise. This review examines available evidence for various forms of exercise in managing symptoms of lumbar spinal stenosis (LSS).
Evidence for exercise in treating lumbar spinal stenosis symptoms is limited with a lack of robust, randomized-controlled trials. Generally, combinations of stretching, core strengthening with emphasis on lumbar flexion, and well-tolerated cardiovascular exercises are recommended.
Based on current evidence, various forms of exercise seem reasonable to consider for LSS symptoms as no one exercise has been shown to be superior. Engaging patients to exercise and addressing barriers is important to improve the adherence to and effectiveness of treatment. Future research is needed to study exercises specifically for LSS and compare the efficacy of different exercises in managing LSS.
KeywordsLumbar spinal stenosis Exercise Low back pain Spine Rehabilitation
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ (Clinical research ed). 2016;352:h6234. d.Google Scholar
- 5.• Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J. 2013;13(7):734–43. This article includes guidelines by the North American Spine Society regarding treatment of lumbar spinal stenosis including recommendations on exercise. https://doi.org/10.1016/j.spinee.2012.11.059.PubMedCrossRefGoogle Scholar
- 9.Malmivaara A, Slatis P, Heliovaara M, Sainio P, Kinnunen H, Kankare J, et al. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine (Phila Pa 1976). 2007;32(1):1–8. https://doi.org/10.1097/01.brs.0000251014.81875.6d.CrossRefGoogle Scholar
- 11.Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the Maine Lumbar Spine Study. Spine (Phila Pa 1976). 2005;30(8):936–43. https://doi.org/10.1097/01.brs.0000158953.57966.c0.CrossRefGoogle Scholar
- 14.Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;1:CD010264. https://doi.org/10.1002/14651858.CD010264.pub2.
- 15.Balakatounis KC, Panagiotopoulou KA, Mitsiokapa EA, Mavrogenis AF, Angoules AG, Papathanasiou J, et al. Evidence-based evaluation and current practice of non-operative treatment strategies for lumbar stenosis. Folia Med. 2011;53(3):5–14.Google Scholar
- 19.Jarrett MS, Orlando JF, Grimmer-Somers K. The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review. BMC Musculoskelet Disord. 2012;13(30). https://doi.org/10.1186/1471-2474-13-30.
- 20.• Ammendolia C, Stuber KJ, Rok E, Rampersaud R, Kennedy CA, Pennick V et al. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database Syst Rev. 2013(8):Cd010712. This Cochrane review examines non-operative management strategies for lumbar spinal stenosis, including exercise, and could not make recommendations based on available evidence. https://doi.org/10.1002/14651858.CD010712.
- 25.Whitman JM, Flynn TW, Fritz JM. Nonsurgical management of patients with lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy. Phys Med Rehabil Clin N Am. 2003;14(1):77–101, vi-vii. https://doi.org/10.1016/S1047-9651(02)00076-1.PubMedCrossRefGoogle Scholar
- 26.• Slater J, Kolber MJ, Schellhase KC, Patel CK, Rothschild CE, Liu X, et al. The influence of exercise on perceived pain and disability in patients with lumbar spinal stenosis: a systematic review of randomized controlled trials. Am J Lifestyle Med. 2016;10(2):136–47. This is an excellent review article looking at many studies that use exercise to address symptoms of lumbar spinal stenosis. https://doi.org/10.1177/1559827615571510.CrossRefGoogle Scholar
- 29.O'Sullivan PB, Phyty GDM, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine (Phila Pa 1976). 1997;22(24):2959–67. https://doi.org/10.1097/00007632-199712150-00020.CrossRefGoogle Scholar
- 30.Machado LA, de Souza M, Ferreira PH, Ferreira ML. The McKenzie method for low back pain: a systematic review of the literature with a meta-analysis approach. Spine (Phila Pa 1976). 2006;31(9):E254–62. https://doi.org/10.1097/01.brs.0000214884.18502.93.CrossRefGoogle Scholar
- 32.Paolucci T, Zangrando F, Iosa M, De Angelis S, Marzoli C, Piccinini G, et al. Improved interoceptive awareness in chronic low back pain: a comparison of Back school versus Feldenkrais method. Disabil Rehabil. 2017;39(10):994–1001. https://doi.org/10.1080/09638288.2016.1175035.PubMedCrossRefGoogle Scholar
- 34.Karayannis NV, Jull GA, Hodges PW. Physiotherapy movement based classification approaches to low back pain: comparison of subgroups through review and developer/expert survey. BMC Musculoskelet Disord. 2012;13(24). https://doi.org/10.1186/1471-2474-13-24.
- 35.Liebenson C. Active care: it’s place in the management of spinal disorders. In: Liebenson C, editor. Rehabilitation of the spine: a practitioner's manual. Baltimore: Lippincott Williams & Wilkins; 2007. p. 3–29.Google Scholar
- 36.Whitman JM, Flynn TW, Childs JD, Wainner RS, Gill HE, Ryder MG, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine (Phila Pa 1976). 2006;31(22):2541–9. https://doi.org/10.1097/01.brs.0000241136.98159.8c.CrossRefGoogle Scholar
- 40.Williams PC Lesions of the lumbosacral spine: Part II. Chronic traumatic (postural) destruction of the lumbosacral intervertebral disc. J Bone Joint Surg Am. 1937;19(3):690–703.Google Scholar
- 44.Areeudomwong P, Wongrat W, Neammesri N, Thongsakul T. A randomized controlled trial on the long-term effects of proprioceptive neuromuscular facilitation training, on pain-related outcomes and back muscle activity, in patients with chronic low back pain. Musculoskeletal Care. 2017;15(3):218–29. https://doi.org/10.1002/msc.1165.PubMedCrossRefGoogle Scholar
- 57.• Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Ann Int Med. 2017;166(7):493–505. This review article discusses non-pharmacologic treatments for low back pain (acute, chronic, radicular, non-radicular) including exercise, yoga, and tai chi. PubMedCrossRefGoogle Scholar
- 59.Yamato TP, Maher CG, Saragiotto BT, Hancock MJ, Ostelo RW, Cabral CM et al. Pilates for low back pain. Cochrane Database Syst Rev. 2015(7):Cd010265. https://doi.org/10.1002/14651858.CD010265.pub2.
- 64.• Bove AM, Lynch AD, Ammendolia C, Schneider M. Patients’ experience with non-surgical treatment for lumbar spinal stenosis: a qualitative study. Spine J. 2017. This qualitative study discusses barriers and facilitators of exercise performance in patients with LSS. https://doi.org/10.1016/j.spinee.2017.08.254
- 65.Nied RJ, Franklin B. Promoting and Prescribing exercise for the elderly. Am Fam Physician. 2002;65:3.Google Scholar
- 67.Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, et al .Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009;9(7):545–550. https://doi.org/10.1016/j.spinee.2009.03.005.