"How many visits until it's better?" How to think about the length of spinal stenosis treatment

If you started treatment for spinal stenosis and felt lost about when it would end

Key points in 30 seconds

1. We can't promise a number like "it'll be better after so many visits." How narrow the passage is, how many levels are affected, how long you've had it and your leg strength all differ from person to person.
2. In a study that followed spinal stenosis for more than 11 years, the people who got better, stayed the same and got worse were in similar proportions. It's not a condition to just sit back and wait out, nor one to give up on.
3. So instead of counting visits, we look at the trajectory. At the start, we set a baseline, a first check date and the criteria for each fork in the road together.
4. On the check date, if your walking time has increased, we continue. If it's unchanged, we change the approach. If it's getting worse, we refer you for a surgical consultation.
5. At home, please write down how long you can walk the same route without stopping, once or twice a week.

What we often hear

• "So how many visits until I'm better?"
• "Nobody tells me how long I'll have to keep coming."
• "I keep coming, but I'm not sure if it's getting better."
• "Am I going to end up having surgery anyway?"

This is the question we hear most from people starting treatment after a spinal stenosis diagnosis.

It's a natural question. It takes time and money, and anyone would feel uneasy walking a road without knowing when it ends.

To be honest, we can't promise a number of visits it'll take to get better. But we can promise something more useful: when, and based on what, we'll decide whether to continue.

Why can't you promise a number?

There's something we always say in the exam room.

"Something that formed quickly can get better quickly. But something that built up over a very long time takes time to get better, too."

Spinal stenosis is usually the second kind. It's a condition in which decades of bending and straightening your back thousands of times a day slowly make bone grow extra and ligaments thicken, narrowing the passage the nerves run through.

On top of that, how narrow it is, how many levels have narrowed, how long you've had symptoms, and how strong your legs are all differ from person to person. That's why the same spinal stenosis takes different amounts of time. Ignoring this and giving you a number first wouldn't be honest.

So do I just have to wait without knowing?

No. There are two studies worth knowing first.

One: spinal stenosis doesn't move in only one direction. In a study that followed people with spinal stenosis who didn't have surgery for an average of more than 11 years, the people who got better, stayed the same and got worse were in similar proportions. This means it's not a condition that only keeps getting worse once diagnosed, and at the same time, some people clearly do get worse. It's a condition to watch, but to watch while measuring.

Two: with steady care, a longer walking time can be maintained. In a study that followed 378 people with spinal stenosis who received integrative treatment at four Korean medicine hospitals for about three years, their pain-free walking time, which averaged 19 minutes at the start, was still about 29 minutes longer three years later. More than half of them had been advised to have surgery, and over three years only about 1 in 10 actually had it.

That said, this study didn't compare them with people who received no treatment, so we can't tell how much of the improvement was due to the treatment. The detailed numbers and limitations of both studies are summarized in the director's column Spinal stenosis: is surgery the only option?.

What do we look at instead of time?

What matters more than how many visits you've made is which direction you're heading now. So on your first visit, we set three things together.

First, a baseline. At the start, we write down how many minutes you can walk without stopping, how far down your leg the numbness goes, and how bad your back and leg pain is on a scale of 0 to 10. Without this, later we can only judge by feel whether you've gotten better or worse.

Second, a first check date. We decide from the start when we'll measure again in the same way. When that day comes, we put the results side by side with the baseline.

Third, the criteria for each fork in the road. On the check date, the trajectory comes out as one of three.

• If your walking time is increasing, we continue the current treatment. Even if it's slow, if the direction is right, we keep going.
• If it's unchanged, we don't repeat the same treatment. We review the diagnosis and change the approach.
• If it's getting worse or leg weakness is progressing, we refer you for a consultation at a place that can do a surgical evaluation. At that point, we don't hesitate.

When things are set up like this, the vague question "when will it end?" turns into a concrete one: "what needs to be different by the next check date?" That's what we mean when we promise not to keep you coming with no end in sight.

What should I do at home?

Please time your walks.

Walk the same route at the same pace, and once or twice a week write down how many minutes it took until your legs got heavy and you needed to rest. A lap of your neighborhood park or around your apartment complex is fine. As these records build up, you'll see the trajectory in much finer detail than from measurements in the exam room alone.

Tips on resting before the numbness starts and then walking again are in Don't walk until your legs go numb. Used together, walking itself becomes treatment.

If your bladder or bowel habits have changed, the area where a bike saddle touches has gone numb, or your ankles or toes are getting weaker and weaker, there's no need to look at the trajectory: a surgical evaluation comes first, right away. If you come to us, we'll tell you the same thing and refer you right away.

How we work

First, we measure. We use an examination to confirm whether it really is spinal stenosis and not a herniated disc or a blood vessel problem in the legs, and if needed, look at an MRI in partnership with the radiology clinic on the 2nd floor of the same building. Together we set the baseline for walking time, the extent of numbness and the pain score, along with the first check date and the criteria for each fork in the road.

Second, we treat. We manage leg pain and inflammation with acupuncture and pharmacopuncture (herbal acupuncture), and work on the movement of a stiff lower back and pelvis with Chuna (Korean manual therapy). We also use herbal medicine based on blood tests and body composition (InBody) tests, and set exercises in the direction that fits your back and a way of walking with rest breaks. The exercise direction is described in If you have spinal stenosis, rethink those back-bending stretches.

Third, we measure again on the set date. We put the results side by side with the baseline to check the trajectory, and decide together whether to continue, change course or get a surgical consultation. We don't treat without evidence.

What changes

A day when, instead of asking "when will it end?", you smile as you see you walked a few more minutes than last month. Treatment with the next check date written on the calendar.

That's what we want to give you.

How fast and how much things improve differs from person to person, depending on how narrow the passage is, how many levels are affected, how long you've had symptoms and your muscle strength.

Today's takeaway

Spinal stenosis treatment is judged by which direction you're heading, not by how many visits you've made. Write down a baseline, set a check date, and see on that day whether things have improved.

There's just one thing to do today. Pick one route you usually walk, and time how many minutes it takes until you need to rest. That number is the first baseline for your spinal stenosis. Bring it with you, and we'll decide together where to start and how far to aim. We're open until 8:30 p.m. on weekdays, and on weekends and public holidays too.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.