Is There Evidence That Acupuncture Works for Spinal Stenosis?

Key points in 30 seconds

1. There's no conclusive evidence yet that acupuncture works for spinal stenosis.
2. Having no evidence is not the same as having no effect.
3. Widening the narrowed space isn't the goal.
4. Instead, the goal is to increase how far you can walk and lengthen the time between rests.
5. If your legs feel weak or you have trouble controlling your bladder or bowels, talk to a surgeon first.

What we often hear

• "Is it really true that acupuncture works for spinal stenosis?"
• "I've had it several times, but it only helped for a while."
• "I want to know if this treatment is backed by evidence."

Is there evidence that acupuncture works for spinal stenosis?

There's no conclusive evidence yet. There is a study that pooled and analyzed 6 trials with 582 patients, and the researchers stated that they could not reach a conclusion about effectiveness and safety.

That's the reason we're writing this. Some places tell people with spinal stenosis that "acupuncture will make it better," but the evidence we have now doesn't support saying that. You need to know that first to make a decision about treatment.

What did that study look at?

It pooled and analyzed 6 trials on spinal stenosis patients (582 people) together with 6 non-randomized studies. The aim was to see whether acupuncture is effective and whether it's safe.

Here's the researchers' conclusion: the included studies had a high or unclear risk of their results being skewed, and were hard to apply directly to other patients, so they couldn't give a conclusive answer.

If there's no evidence, should I not get the treatment?

Saying there's no evidence is different from saying there's no effect. It means well-designed studies are still lacking, not that it has been shown not to work.

But the way we talk about it has to change. The accurate way to put it isn't "it will get better," but "it's something you can try, and how much it will help hasn't been confirmed by research yet." Starting with that understanding is different from starting without it.

So what is the goal?

Widening the narrowed space isn't the goal. Spinal stenosis is a condition where bone and ligaments have thickened, narrowing the passage that nerves run through. Hands-on treatment or exercise doesn't widen that passage. We want to be clear about that.

What can change is the conditions under which the nerves pass through that narrow space. Standing up straight for a long time narrows it further; bending slightly forward widens it. So the way you walk, the positions you rest in, and the muscles supporting your trunk actually change how far you can walk.

Here's what we do for you

We time your walking. At the first visit, we check how long you can walk without pain, and compare each time we see you. This is our first measure of whether stenosis treatment is going well. We check it by the time gained, not by whether you feel better.

We start by looking at the images. In partnership with the radiology clinic on the 2nd floor of the same building, we use MRI to see where and how much the space has narrowed, and at the first visit we check for any signs that surgery should come first.

We give you a walking plan too. We decide and tell you whether to use a back brace, how much to walk each day, and when to rest before numbness sets in and then walk again. Our aim is treatment that gets you walking, not treatment that keeps you from walking.

We don't stop at acupuncture. While treating pain and leg numbness with acupuncture and pharmacopuncture, we also use Chuna to work on the alignment of the lower back and loosen stiff areas.

If nothing changes, we recommend a surgical consultation. If walking time doesn't increase after a set period of treatment, we don't keep repeating the same treatment.

When should I consider surgery?

If your legs are losing strength, you have trouble controlling your bladder or bowels, or the distance you can walk is quickly getting shorter, a surgical consultation comes first. In these cases, waiting works against you.

If there are no such signs and your walking distance is holding steady, you can take a period of monitoring and management. Which way to go is decided in the clinic by checking your walking distance and leg strength.

We measure your walking distance before starting acupuncture. Even with a treatment that has evidence behind it, whether it works for you needs to be checked on its own.

If you keep having to stop and rest while walking, come in and get measured. Knowing how many minutes you can walk now gives you something to compare against later.

Because the degree of narrowing and walking ability differ, the results of management differ from person to person.

Sources for this article

Kim KH, et al. Acupuncture for lumbar spinal stenosis: a systematic review and meta-analysis. Complementary Therapies in Medicine. 2013;21(5):535-556. PMID: 24050593