If you have spinal stenosis, rethink those back-bending stretches

If you followed a back-stretching video and your legs felt more numb that evening

Key points in 30 seconds

1. Spinal stenosis is a condition in which the passage the nerves run through has narrowed over the years.
2. This passage changes with posture. Bending your back backward makes it narrower, and bending forward opens it up a little.
3. So back-bending stretches based on the idea that "a bent back needs to be straightened" can work against you with stenosis.
4. Here's the direction to go: hugging your knees to your chest, walking aids you can lean on, an indoor bike on days when walking is hard, and building strength in your abs and glutes.
5. If leg numbness gets worse when you bend backward, stop that movement. Before choosing exercises, you need to know the name of your pain.

What we often hear

• "I did a stretch that's supposed to be good for the back, and my legs got more numb."
• "When I push a cart at the supermarket, I can walk for a long time. Walking on my own, I have to rest soon."
• "Riding a bike is fine, but walking is hard."
• "Everyone tells me to straighten my back, but I feel better bent forward."

You've probably followed a stretching video that's supposed to be good for the back.

Lying on your stomach and pushing your upper body up with your arms, or standing with both hands on your lower back and leaning backward. You were told a bent back needs to be straightened, so you followed along diligently, and that evening your legs felt more numb. The distance you can walk before you need to rest seems shorter, if anything.

If you've been diagnosed with spinal stenosis, or if your legs get heavy when you walk and feel better when you sit, please read this article. With stenosis, bending your back backward may be the wrong direction.

What is spinal stenosis?

In the exam room, we explain it like this.

When you use your back from a young age, it hurts every now and then. As that builds up, bone slowly grows extra, and the ligament connecting the back of the vertebrae thickens. That narrows the passage the nerves run through and squeezes the nerves. That's spinal stenosis.

It's a change built up over decades of bending and straightening your back thousands of times a day. How it differs from a herniated disc is summarized in My legs are numb. Is it a herniated disc or spinal stenosis?.

Why does bending back cause numbness, and bending forward bring relief?

The narrowed passage isn't always the same width. It widens and narrows depending on posture.

• When you bend your back backward, the back of the spine folds. The thickened ligament pushes into the passage like a wrinkle, and the space between the bones narrows too. The passage gets even narrower.
• When you bend your back forward, the back of the spine opens up and the passage widens a little. The nerves get some room to breathe.

Everything people with stenosis experience comes from this.

• Walking upright makes the legs heavy, but pushing a cart, you can walk for a long time.
• Walking is hard, but riding a bike is manageable.
• Going downhill is harder than going uphill, because your body leans back on the way down.

The more the body leans slightly forward, the wider the passage gets.

So should I not do back-straightening stretches?

If you have stenosis, you need to be careful. Bending your back far backward moves in the direction of narrowing a passage that's already narrow. This may be why your legs felt more numb that evening.

Yet the same movement can feel good to some people with a herniated disc. Both cause leg numbness, but the way the nerve gets pressed is different.

A stretch that helped someone else may do the opposite for you. That's why you need to know the name of your pain before choosing exercises.

Which exercises fit spinal stenosis?

We'll set how many and how at your visit. Here's the direction.

First, lie down and hug your knees to your chest. Lying flat on your back and slowly pulling both knees toward your chest gently opens the back of your spine and gives the passage some room. It's also a good position to rest in for a moment when your legs feel heavy.

Second, when walking, use something you can lean your upper body on. A cane, a walker, or a supermarket cart, anything you can lean on slightly, lets you walk with the passage opened up. These are tools for walking longer. Tips on resting before the numbness starts and then walking again are in Don't walk until your legs go numb.

Third, on days when walking is hard, switch to an indoor bike. An indoor bike puts your body in a slightly forward-leaning position, so you can move your legs relatively comfortably even with stenosis. Don't make it a day off from exercise. Just change the activity.

Fourth, build strength in your abs and glutes. Feeling better bent forward doesn't mean you should stay hunched all day. If the abdominal and buttock muscles that support your back are weak, your lower back tends to tip forward into an arched, bent-back posture. This strength becomes a support that protects the passage.

There's one thing to avoid. If leg numbness gets worse when you bend your back far backward, stop that movement. Typical examples are lifting your upper body while lying on your stomach, and bending your back backward while standing.

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, a surgical evaluation comes before any talk of exercise. If just stopping brings relief regardless of posture and your feet are cold, it may be a problem with the blood vessels in your legs. These signs are described in detail in the article on telling a herniated disc from spinal stenosis.

How we work

First, we get the name right. We ask when it hurts and what makes it feel better, and during the exam we have you bend forward and backward to see which direction changes your leg symptoms. We check leg strength, sensation and reflexes, and if needed, take an MRI in partnership with the radiology clinic on the 2nd floor of the same building to see which level has narrowed and by how much.

Second, we treat in the right direction. We manage leg pain and tension around the lower back with acupuncture and pharmacopuncture (herbal acupuncture), and work on the movement of a stiff pelvis and lower back with Chuna (Korean manual therapy). We set exercises and a way of walking in the direction that fits your back, and check them together at the next visit.

Third, we check with walking time. Before treatment, we write down how many minutes you can walk without stopping and how far down the numbness goes, and compare at set points. Because it's a change built up over decades, it won't turn around overnight, but whether your walking time is increasing can be seen in numbers. If it doesn't increase, we don't keep repeating the same treatment. We guide you to the next step.

What changes

A day when you finish your grocery shopping without a cart. A day when you make it around the park without stopping. Every day doing exercises you know fit your back, instead of the stretches other people swear by.

That's what we aim for.

How fast you recover differs from person to person, depending on how narrow the passage is, how many levels are affected, and how long you've had symptoms.

Today's takeaway

If you have spinal stenosis, rethink back-bending stretches first. Bending back narrows the passage, and bending forward widens it. Choose your exercise direction to match the name of your pain.

Check just two things today.

• Whether leg numbness gets worse when you stand and slowly, slightly bend your back backward (don't push it, and stop right away if numbness comes)
• Whether it feels better when you sit in a chair and lean your upper body forward

Write down the two answers and bring them, and we'll decide together on the exercise direction that fits your back. We're open until 8:30 p.m. on weekdays, and on weekends and public holidays too.

The course of spinal stenosis and the evidence for treatment are summarized in the director's column Spinal stenosis: is surgery the only option?.

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