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Can Physical Therapy Help Spinal Stenosis (And Maybe Help You Avoid Surgery)?

Tom Willemann |
Spine Physical Therapy

If you’ve been told you have lumbar spinal stenosis, it can sound a little scary and final. You might be thinking:

  • “Is this why my legs feel heavy when I walk?”
  • “Do I have to have surgery now?”
  • “Is there anything I can do before it gets worse?”

The good news: surgery is not the only option, and for many people it’s not the first step.

A large research project called the SPORT trial followed people with lumbar spinal stenosis all over the U.S. and looked at what happened when they tried conservative care (like physical therapy) first.

Big picture from that research and others:

  • People who started with physical therapy were less likely to end up having surgery in the first year.
  • They tended to move better and were more likely to say they felt “much improved.”

Let’s unpack this in normal language—and talk about how we approach this in our clinic.

First: What Is Lumbar Spinal Stenosis?

“Lumbar” just means lower back.
“Stenosis” meansnarrowing.

With age and wear-and-tear, the space around the nerves in your lower back can narrow because of:

  • Arthritis and joint changes
  • Bone spurs
  • Thickening of ligaments
  • Disc changes

When that space gets tight, nerves can get irritated. Common symptoms:

  • Pain or heaviness in the buttocks or legs when you stand or walk
  • Numbness, tingling, or burning down the legs
  • Needing to lean forward (like over a shopping cart) to get relief

If that sounds like you, you’re not alone. Spinal stenosis is one of the most common causes of back and leg pain as we age. You can read a nice overview from Mayo Clinic here:
Spinal stenosis – Symptoms and causes (Mayo Clinic)

Why an MRI or X ray Is Only Part of the Story

This is really important:

A finding of “stenosis” on MRI or X ray is only one pieceof the puzzle.

Plenty of people have “stenosis” on imaging and no symptoms at all, and others have significant pain and limitation with only mild changes on their scans.

That’s why a proper diagnosis can’t be made from the MRI report alone.

A good evaluation should include:

  • Detailed history – When does your pain come on? Walking? Standing? Sitting? How far can you walk before symptoms start?
  • Movement testing – What happens when you bend forward, backward, or to the side? Does repeated movement make things better, worse, or no different?
  • Strength testing – Are certain muscles weaker? Is one leg different from the other?
  • Nerve testing – Checking reflexes, sensation, and nerve tension to see how the nerves are actually behaving, not just how they look on a picture.

That’s where physical therapy really shines. We’re not just looking at images—we’re watching how you move and how your symptoms respond in real time.

For a nice, general explanation of how physical therapists approach spinal stenosis, you can also check out the American Physical Therapy Association’s consumer site:
Physical Therapy Guide to Spinal Stenosis (ChoosePT)

How the Big Study (SPORT) Looked at Physical Therapy

In the SPORT study, people with lumbar spinal stenosis were treated at 13 spine clinics across 11 states. Researchers focused on those who started with non-surgical care and then looked at:

  • Who chose physical therapy in the first 6 weeks
  • Who did not do physical therapy in that time

They followed everyone for one year and measured:

  • Who eventually went on to have surgery
  • How their pain and function changed
  • How satisfied they were and whether they felt “much improved”

What they found:

  • About 21% of people who did PT in the first 6 weeks had surgery within a year.
  • About 33% of people who did not do PT had surgery.

So people who started with PT were less likely to end up having surgery in that first year.

They also:

  • Improved more on a “physical functioning” score (how well they could do daily activities).
  • Were more likely to say they had “major improvement” in how they felt.

Other tools, like the American Physical Therapy Association, have highlighted similar patterns in more recent research: early PT for lumbar spinal stenosis can lower later use of surgery and opioids.
See:Study: Early Physical Therapy for Spinal Stenosis Lowers Later Utilization (APTA)

What We Actually Do in Our Evaluation (McKenzie Method)

In our clinic, we don’t just glance at the MRI report and send you to generic exercises. We use a structured system called the McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT).

Very simply, the McKenzie Method:

  • Starts with a thorough history of your symptoms
  • Uses specific, repeated movements and positions to see how your pain responds
  • Helps us classify your problem based on how your body behaves (not just how it looks on a scan)
  • Leads to a very targeted exercise plan that you can often do yourself

From the McKenzie Institute USA:

“MDT begins with the clinician taking a detailed history about your symptoms and how they behave. You will be asked to perform certain movements and rest in certain positions… The main difference to most other assessments is the use of repeated movements.”

You can read more about the McKenzie Method here:

Our Evaluation Typically Includes

  • History: We talk through when and how your pain behaves, what makes it better or worse, and how it affects your daily life.

    • Movement evaluation (McKenzie-style):

    • Repeated bending forward, backward, and side-to-side
    • Positions like lying, sitting, or standing for short periods
    • We watch how your pain changes—does it move, centralize, spread, or calm down?

  • Strength and balance testing:

    • Checking key muscle groups in the hips, legs, and trunk
    • Looking for side-to-side differences

  • Nerve testing:

    • Reflexes, sensation (numbness/tingling), and special tests that gently tension the nerves to see how they respond.

    This full picture helps us answer a crucial question:

    “Is your pain really coming from what we see on the MRI, or is there something mechanical we can change with movement and exercise?”

    What Does Treatment Look Like?

    Once we’ve done a thorough evaluation, treatment for lumbar spinal stenosis may include:

    • Targeted exercises based on your McKenzie classification: Often, these are simple movements in specific directions that reduce or centralize your symptoms.

    • Flexion or unloading positions that open space around the nerves and make walking easier.
    • Strength training for the core, hips, and legs to improve support and endurance.
    • Manual therapy (hands-on work) to improve mobility in the spine and hips when appropriate.
    • Activity and posture coaching – how to pace your walking, stand, sit, and move in ways that calm your symptoms instead of aggravating them.
    • A progressive walking or cycling plan to safely build up your tolerance.

    And just as important: we teach you how to help yourself, so you’re not dependent on us long-term.

    Why Consider PT Before Jumping to Surgery?

    Based on both research and clinical experience:

    • Many people with lumbar spinal stenosis do quite well with a focused course of physical therapy.

    • Early PT is associated with lower surgery rates, better function, and less reliance on medication in many cases.
    • Even if you eventually need surgery, going into it stronger and better conditioned usually helps your recovery.

    The American Physical Therapy Association summarizes it well: physical therapists are movement experts who help people with spinal stenosis improve mobility, manage pain, and often avoid more invasive treatments when possible.
    You can read their overview here:
    Physical Therapy Guide to Spinal Stenosis (ChoosePT)

    The Bottom Line

    • An MRI or X ray that says “lumbar spinal stenosis” is not the whole story
    • A proper diagnosis has to include your history, movement evaluation, strength testing, and nerve testing.
    • We use the McKenzie Method (MDT) to guide that process and build a custom plan based on how your body responds—not just what your scan shows.
    • Research shows that starting with physical therapy can help many people move better, feel more improved, and lower their chances of needing surgery in the short term.

    If you’ve been told you have lumbar spinal stenosis—or you’re dealing with back and leg pain that limits your walking—we’d be happy to take a deeper look.

    Click the button below to schedule a McKenzie-based evaluation and see what physical therapy can do for you.

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    Tom Willemann

    Tom Willemann

    Tom Willemann is a premier physical therapist based out of Bergen County, New Jersey. He holds an MS in physical therapy from the University of Miami, is credentialed in the world-renowned McKenzie Method of Mechanical Diagnosis and Therapy (MDT), and holds an OCS (Orthopedic Clinical Specialist) certification. As of 2018, there are approximately 14,000 ABPTS certified specialists in the nation and less than 400 of them are located in the state of New Jersey. Tom is the owner and director of Apex Orthopedic Rehabilitation in Paramus. He opened the clinic, which specializes in spine and sports injury prevention, in 2004 after many years of experience in the field. Tom’s caring interest in others and his strong belief in continuity of care, combined with his clinic’s ability to find solutions for the most difficult orthopedic problems, have earned Apex Orthopedic Rehabilitation its excellent reputation with patients and medical professionals in northeastern New Jersey and beyond. A true “family man,” Tom takes pride in his clinic’s warm and welcoming environment.
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