The HIDDEN Cause of Lumbar Stenosis (& Exercises to Treat)
Key insights: 60-second read
- Lumbar stenosis involves a narrowing of the spaces where nerves exit the spine – this can lead to pain, numbness, and weakness, especially with activities that involve arching your back.
- A hidden cause of stenosis symptoms can be an anterior pelvic tilt – where the pelvis tilts forward, creating excessive extension in the lower back and narrowing the nerve spaces.
- Gentle flexion-based exercises – such as seated lumbar flexion – help open up the spinal spaces and can provide symptom relief by reducing nerve pressure.
- Freeing up tight hip flexors – is a crucial first step in correcting pelvic tilt, as sitting for long periods tends to shorten these muscles and pull the pelvis forward.
- Strengthening your core from a neutral spine position – using exercises like the Pallof press – helps retrain your body to maintain a healthy posture and reduce long-term stress on your lower back.
If you're struggling with lumbar stenosis, you're not alone. This condition affects countless people, often causing frustrating pain, numbness, and limits on everyday activities. The good news is that effective strategies exist to help relieve pressure, improve mobility, and restore quality of life.
Let's walk through an often-overlooked cause of stenosis and provide practical exercises you can do at home to find relief.
On this page
1. Why Your Pelvis Matters for Lumbar Stenosis
Let's start with the basics. When we talk about stenosis, we're referring to a narrowing of the spaces within your spine. More specifically, we're talking about the foramen – those small gaps created by your spinal bones and joints where the nerves exit the spine to travel down through your body.
When that space becomes reduced for any number of reasons, it can start to "short-circuit" the function of your back. You might find your back becomes more extension sensitive – where it doesn't like bending backwards. As the condition progresses, those nerve roots can become irritated and annoyed as they try to squeeze through a tighter space than they're used to.
"The position we're concerned with is an anterior pelvic tilt. This is where your pelvis tilts forwards, and it creates a natural extension moment in your lower back."
Here's what happens with extension: as your spine extends backwards, the joints in your back close down. This is normal, but can be challenging for a stenotic spine -potentially impacting those sensitive nerve roots.
So, if you're getting around in a position where your pelvis is constantly anteriorly tilted, you may be creating an unnecessary extension moment in your lower back. Over time, this can set these tissues up to become dysfunctional and contribute to those stenotic symptoms.
Quick Check: Stand up nice and tall with your feet straight. Squeeze your glutes – tense your butt cheeks – and see if it pulls your pelvis back into a more neutral position. If it does, it suggests you have some work to do to get out of that naturally extended position.
2. How to Correct Pelvic Tilt
Step 1: Free Your Hip Flexors
The first step in trying to correct an anterior pelvic tilt is to free up the tight tissues at the front of your hip. One of the biggest contributing factors to this tilt is tight hip flexors, most commonly from all the sitting we tend to do.
Seated Hip Flexor Stretch: Step-by-Step
- Sit on the edge of a chair, sitting up nice and tall. Have one butt cheek off the chair. Slide your knee behind you as far as feels comfortable.
- Important: Do not lean forwards or arch backwards. Maintain an upright, tall position. Squeeze your glutes to help you find and hold this good position.
- From that base, slowly take your foot further away until you find tightness at the front of your hip. Don't lose that good spinal position.
- Once you feel the stretch, squeeze your glutes again. Tense up everything around your hip – your thigh, your hips. Hold this contraction for 5 to 10 seconds.
- Relax. Those tight tissues should now give a little bit more, allowing you to sink further back into the stretch while maintaining your good position.
- Repeat: squeeze, hold 5-10 seconds, relax, and go further. Do this on both sides.
Step 2: Strengthen from a Good Position
Once you've started to free up any restrictions, it's time to incorporate strength. But the theme here is crucial: we want strength from a good pelvic and lower back position.
A really simple and effective strength exercise for this is called a Pallof press.
Pallof Press Instructions
- Set-up: Stand side-on to a thera-band or elastic band. Hold it with one hand.
- Position: Pull your pelvis into a good, neutral position. Draw your belly in to help support the position.
- Execution: Take a step out until you have tension on the band. Press your arms straight out in front of you. The band will try to pull you backwards – resist this.
- Focus: Engage your trunk muscles to maintain your good position. The further you straighten your arms, the harder it becomes.
- Reps and Sets: Do a set of 10 on each side, repeating 3 times at a resistance that comfortably fatigues you without losing your good spinal position.
3. Symptom Relief: Flexion-Based Exercises
While it's important to address those root causes, it's still important to have a lever you can pull to help your symptoms.
As mentioned, it's important to be cautious with extension-based movements as they may aggravate your symptoms. But focusing on flexion-based movements may help. They open up that foraminal space and take some of the pressure off those potentially sensitised structures.
Seated Lumbar Flexion
- Position: Sit comfortably in a chair.
- Movement: With your hands on your thighs, gently flex your neck, then your upper back, and then slide your hands down towards the ground as you flex your lower back.
- Finding the Stretch: You may feel a sense of stretch or relief through your lower back. The wider apart your feet, the further down you may be able to go.
- Returning Up: Don't just use your back muscles to straighten up. Instead, reach up and put your hands on your knees. Use your hands to push yourself back up.
- Repetitions: Lower yourself down as far as you feel comfortable, then use your hands to push back up. Do this 10 to 20 times.
"If symptomatic, the more you do this, the more relief you may start to get."
If sitting is uncomfortable, you can try the same movement lying on your back, pulling both knees up to your chest. This also opens the lumbar spine and can provide relief.
Your stenotic symptoms have come from somewhere. While fancy exercises and getting stronger are important, we want to pair those symptom-treating exercises with a broader understanding of why you might need to be doing them in the first place.
Start by looking at your pelvic position. Freeing up tight hip flexors and strengthening your trunk in a more neutral position can be a powerful combination. Address the potential underlying causes, and you'll be starting to make real progress toward a healthier, more comfortable back.
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- Grant
Frequently Asked Questions
What is the best sleeping position for lumbar stenosis?
Sleeping on your side with a pillow between your knees is often most comfortable. Alternatively, lying on your back with a pillow under your knees can help maintain a slight flexion in your spine, which can ease pressure on the nerves.
Can lumbar stenosis be reversed with exercise?
While exercise may not reverse the structural narrowing, it is highly effective at improving symptoms, increasing function, and preventing progression. A strong core and good posture can take pressure off the nerves and help you move better.
Are all exercises safe for lumbar stenosis?
No. Exercises that involve extension or arching your back (like standing backbends or prone presses) can often worsen symptoms. Focus on flexion-based exercises and core strengthening from a neutral spine position. Always consult with a physiotherapist for a personalised plan.
How long does it take to see results from stenosis exercises?
Many people find some relief immediately from flexion-based movements. However, for long-term postural and strength changes, expect to see noticeable improvements within 4 to 12 weeks of consistent effort.
One key insight from this video
"Your stenotic symptoms haven't come from nowhere. Start by looking at your pelvic position. Freeing up tight hip flexors and strengthening your trunk in a more neutral position can be a powerful combination to relieve pressure and improve mobility."
Living With Back or Hip Pain?
If you are struggling with back pain, hip pain, or movement issues, we can help. Learn more about our back pain physiotherapy services in Port Macquarie.
Want personalised guidance?
If you would like help making sense of your aches, pains, or ongoing symptoms, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
