Spinal stenosis

What spinal stenosis is

Your spinal cord and nerves run down a tunnel inside the bones of your spine, called the spinal canal. In spinal stenosis, this tunnel, or the gaps where nerves leave it, gets narrower. The nerves have less room and can become irritated or squeezed.

It is usually caused by normal wear and tear as we get older. Over time the small joints of the spine can get bigger, ligaments can thicken and discs can bulge. Osteoarthritis can also form bony spurs that press on nerves. Some people are born with a narrower spinal canal, which makes them more likely to get symptoms.

Spinal stenosis is most common in people over 60. Many people have some narrowing on a scan without any symptoms at all.

Types of spinal stenosis

Doctors describe stenosis by where it is in the spine and what is being squeezed.

Lumbar spinal stenosis

Narrowing in the lower back. This is the most common type. It typically causes pain, tingling or weakness in the buttocks and legs when standing or walking.

Cervical spinal stenosis

Narrowing in the neck. It can cause neck pain and pain, numbness or weakness in the shoulders, arms and hands.

Central stenosis

The main spinal canal is narrowed. In the lower back this often affects both legs.

Foraminal or lateral stenosis

The small gaps where single nerves leave the spine are narrowed. This tends to cause pain down one leg or one arm, like sciatica.

Degenerative cervical myelopathy

When narrowing in the neck presses on the spinal cord itself. It can cause clumsy hands, poor balance and walking problems. It needs specialist assessment.

Congenital stenosis

Some people are born with a narrow spinal canal. They may get symptoms at a younger age, when everyday wear and tear narrows it further.

Symptoms and how it changes

Symptoms usually come on slowly. In the lower back, the classic pattern is called neurogenic claudication:

pain, aching, heaviness, tingling or numbness in the buttocks or legs
symptoms that build up when you stand or walk for a while
relief when you sit down or bend forward, for example leaning on a shopping trolley, because bending forward opens up the spinal canal
feeling unsteady on your feet, and lower back pain

Cycling is often easier than walking for the same reason. In the neck, symptoms affect the arms and hands instead.

What usually happens to lumbar spinal stenosis over many years
Out of every 10 people	Symptoms
About 6	Stay much the same
About 2	Get better
About 2	Get slowly worse

When it does get worse, it is usually gradual, for example being able to walk a shorter distance before you need to stop. Sudden changes need medical advice.

When to get urgent help

Rarely, nerves at the bottom of the spine are badly squeezed. This is called cauda equina syndrome. It is an emergency, because treatment within hours can prevent permanent damage.

Call 999 or go to A&E if you have

numbness around your genitals or bottom, or where you would sit on a saddle
new problems passing urine, or not being able to control your bladder or bowels
sciatica in both legs
weakness or numbness in both legs that is severe or getting worse
new problems getting an erection

Call NHS 111 or ask for an urgent GP appointment if

you have new weakness in a leg or foot, or your foot starts to drag
your hands become clumsy, or your balance gets worse
your pain is severe and painkillers aren't helping
you also have a high temperature or feel very unwell

See your GP if

you get leg pain or numbness when walking that eases when you sit
the distance you can walk is getting shorter
home treatments haven't helped after a few weeks
pain is stopping you working or doing daily tasks

Diagnosis and referral

Your GP or an NHS physiotherapist will ask about your symptoms and examine your back, legs and reflexes. They will also check that leg pain on walking isn't caused by poor blood flow, which can look similar.

An MRI scan shows the narrowing, but it is usually only arranged if injections or surgery are being considered, or if there are worrying signs. What a scan shows doesn't always match how much pain you feel. Many people have narrowing on a scan and no symptoms.

You may be referred to a community musculoskeletal (MSK) service, a pain clinic or a spinal surgeon. In many areas you can refer yourself to NHS MSK physiotherapy without seeing a GP first. Waiting times vary a lot between areas, so ask what the local wait is when you are referred.

Treatments and medicines

Most people are treated without surgery. NICE guidance on low back pain and sciatica puts exercise and staying active first, with medicines to help you keep moving.

Exercise and physiotherapy

NHS physio, often by self-referral

NICE recommends exercise, such as stretching, strengthening, aerobic exercise, yoga or tai chi, often in a group. Exercises that bend you forward and strengthen your core can help. Hands-on therapy such as manipulation or massage should only be used alongside exercise. Most programmes run for several weeks before you notice a clear change.

Anti-inflammatory painkillers (NSAIDs)

Ibuprofen from a pharmacy; stronger ones like naproxen on prescription

NICE suggests NSAIDs for back pain, at the lowest dose that works, for the shortest time. They usually start to work within hours. Your doctor may also prescribe a stomach-protecting medicine. They aren't suitable for everyone, especially people with stomach, kidney or heart problems.

Weak opioids

Codeine-based medicines, short term only

Codeine, or co-codamol, may be suggested for a short spell of bad pain if NSAIDs aren't suitable or haven't helped. They aren't meant for long-term use.

Nerve pain medicines

Prescription

Some doctors prescribe medicines such as amitriptyline for burning or shooting nerve pain. NICE says the evidence for these in sciatica is still uncertain. Ask your doctor about the likely benefit and side effects, and how long to try them before deciding whether they help.

Pain management programmes

NHS pain services, usually by referral

NICE recommends a combined physical and psychological programme, using a cognitive behavioural approach, for persistent back pain or sciatica. These help you build activity, manage flare-ups and cope with pain day to day.

What NICE doesn't recommend for back pain and sciatica

NICE advises doctors not to offer: paracetamol on its own; opioids for long-term back pain or sciatica; gabapentin, pregabalin or other anti-epileptic medicines for sciatica; or benzodiazepines. It also advises against acupuncture, TENS machines, ultrasound, and belts or corsets for low back pain. If you already take any of these medicines, don't stop suddenly. Talk to your GP or pharmacist first.

Injections and surgery

Spinal injections

Relief, if it comes, often lasts weeks to months

Steroid and local anaesthetic can be injected near an irritated nerve. NICE suggests considering epidural injections for severe sciatica that started recently. It advises not to use epidural injections for the walking-related leg pain caused by central stenosis, because they don't help it.
Lumbar decompression surgery

Usually considered when other treatment hasn't helped

A surgeon removes some bone, ligament or disc to make more room for the nerves. The most common operation is a laminectomy. It is better at easing leg pain than back pain. About 17 in 20 people make a good recovery, and about 4 in 100 need another operation within 4 years.
Recovery

Home in 2 to 5 days, work in 4 to 6 weeks

You'll be helped to walk the day after surgery. Most people go home within 2 to 5 days and go back to work after about 4 to 6 weeks, depending on their job. It can take up to 12 weeks to get back to all your usual activities.
Spinal fusion

Only in specific cases

Fusion joins bones together. NICE does not recommend it for low back pain, except as part of a trial. A surgeon may suggest it with decompression if part of your spine is unstable. Ask why it is needed and what the risks are.

Self-help and living well

Moving and pacing

Keep active. Stiffness and weakness make symptoms worse
Walk in short spells and sit or lean forward to rest
Try cycling, an exercise bike or swimming
Break up long periods of standing
Do your physio exercises little and often

Sleep, mood and health

Lying on your side with knees bent can be more comfortable
Keep regular sleep times
Talk to your GP if pain is affecting your mood. NHS talking therapies can help
Stopping smoking and a healthy weight help your spine
A walking stick or trolley can let you go further

Tips for getting the best treatment

Before your appointment

Keep a simple diary for 2 to 4 weeks: how far you can walk, how long you can stand, what eases it, and which medicines help
Write down what you most want to be able to do again, such as walk to the shops or work a full day
Ask: "Could this be spinal stenosis?" and "What are my options if physio doesn't help?"
Check if you can refer yourself to NHS MSK physiotherapy in your area
Ask about a pain management programme if pain is long term
If surgery is offered, ask about the chance of success, the risks and the recovery time. You can ask for a second opinion

If you choose private physiotherapy, check the physio is registered with the Health and Care Professions Council (HCPC).

Spinal stenosis and work

Spinal stenosis can count as a disability under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland). This applies if it has a substantial, more than minor, effect on your daily life and has lasted, or is likely to last, at least 12 months. Conditions that get worse over time, or that come and go, can count.

If it does, your employer must make reasonable adjustments. Examples include:

A supportive, adjustable office chair
A perching stool for jobs done standing
A sit-stand desk so you can change position
Less walking or standing in your role
A parking space near the entrance
Regular short breaks
Flexible hours or working from home
Time off for appointments and surgery

Access to Work is a government grant that can pay for equipment, travel to work and support. See GOV.UK on reasonable adjustments, or contact Acas or Citizens Advice for advice on your rights.

Benefits

If you can't work for a while, you may get Statutory Sick Pay from your employer for up to 28 weeks. If stenosis affects daily tasks or getting around, you may be able to get Personal Independence Payment (Adult Disability Payment in Scotland), even if you are working. New Style ESA or Universal Credit may help if you can't work. Turn2us and Citizens Advice can help you check.

How The Beyond Pain Foundation can help

If NHS waits are too long, or the help you need isn't available to you on the NHS, we may be able to fund:

A course of private physiotherapy with an HCPC-registered physio
A private consultation with a spinal specialist or pain consultant
A private pain management programme
An ergonomic chair, a perching stool or a sit-stand desk for work or home
Mobility aids, such as a walking stick or rollator with a seat

We fund treatment, equipment and support, not general living costs. Prices vary, so always get a written quote to include with your application.

Apply for funding Check the requirements

Support and sources

Arthritis UK

Charity, formerly Versus Arthritis

Free helpline 0800 5200 520, Monday to Friday, 9am to 6pm. Information on back pain and spinal osteoarthritis.

arthritis-uk.org

BackCare

The national back pain charity

Phone 020 8977 5474, Monday to Thursday, 9am to 4pm. Information on back and neck conditions.

backcare.org.uk

Pain Concern

Charity for people living with pain

Helpline 0300 123 0789. Leave a message and they usually call back the next working day.

painconcern.org.uk

If you have symptoms of myelopathy in the neck, Myelopathy.org is a UK charity with information and support.

Sources for this guide

Last reviewed: October 2026.