Sciatica Exercise for Stenosis Related Back Pain

Spinal stenosis occurs when one or more of the spaces in your spine (for example, your spinal canal, or your intervertebral foramen) narrows, usually because of arthritis. While neurogenic claudication is the classic symptom of spinal stenosis, sciatica is also possible. If your stenosis is affecting a spinal nerve root (called radiculopathy)  in your low back, you may experience related pain that radiates down your leg, which is known as sciatica.

Although research has yet to come up with a definitive set of back exercises for relieving sciatica symptoms that are due to stenosis, many people - including traditional health professionals - take this route anyway. If you're considering an exercise approach, the first thing to keep in mind is that symptoms tend to get worse when you arch your back.  Conversely, they tend to improve when you flex your spine. This is known as flexion bias.

Man with back pain
Peter Dazeley / Getty Images

Select Positions Based On Comfort and Avoid Positions That Cause Pain

Even in light of this useful bit of information, it's generally a good idea to select positions (and therefore exercises) based on comfort. Avoid positions that cause pain - even if they are known to relieve symptoms for your particular diagnosis. And of course, consult with your physical therapist or doctor to be sure you've selected the right exercises - and are doing them correctly.

I spoke with Dr. Naomi Betesh, a physiatrist and acupuncturist who specializes in pain management at Union County Orthopedic Group in New Jersey about sciatica exercise programs in general and also about exercise selection when sciatica symptoms are a result of spinal stenosis. She informed me that in the past, much of the education doctors and physical therapists received centered around this idea of flexion vs extension bias. 

Betish says with such an approach, the type of exercises in your program largely depends on your injury. I would add that spinal motion which tends to aggravate your symptoms also informs exercise selection. But things may be changing. "More recently, it has been suggested that each patient should be treated based on which position does not cause pain," Betesh says. 

Still, one of the main objectives for using exercise to manage stenosis related sciatica symptoms is to improve spinal extension (i.e. arching your back), says Jill Murphy, who is the director of MotionWorks Physical Therapy in Neenah, WI. Working on your flexibility is also a must, Murphy continues.   "Developing flexibility in your lower extremities may make up for the gradual loss of spinal extension that is generally due to stenotic changes," she informs me.  (Generally speaking, the term "lower extremity" refers to (hip, knee and ankle joints, and your feet.)

Dr. Judith Glaser, physiatrist and medical acupuncturist at Restorative Medicine in New Hyde Park, New York adds that strengthening muscles, as well as developing dynamic control of your body (i.e. control over your body while you are moving it) are key goals for exercise programs that target stenosis related sciatica symptoms.

Exercises for Stenosis-based Sciatica

So which exercises should you do? Is there a common set that doctors and physical therapists give to their patients with stenosis related sciatica? The short answer is likely -- no. "If you ask 20 physical therapists what they do for low back pain, you will probably hear about 20 different programs," Betesh comments. But in my experience, there is some crossover between therapists' recommendations.  Below are a few that Glaser, Murphy, and others suggest. Keep in mind that these are not the only exercises that may help with symptoms.

Strengthening Exercises

  • Abdominal bracing.
  • Pelvic tilts, which may help develop back and hip extender muscles.  Glaser says pelvic tilts also help support upright body posture. 
  • Bird dog, which may help counteract weakness in your back muscles due to the tendency toward spinal flexion common in people with stenosis.

Flexibility Exercises

Betesh suggests certain yoga poses for stenosis related sciatica, including pelvic tilts, downward facing dog, and others. She says that for a home program, sticking with simple movements may increase the likelihood of performing them without injury. 

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  • Email Interview. Betesh, N., MD, Pain Management and Physical Medicine/Rehabilitation specialist, Acupuncturist. Union County Orthopedic Group, New Jersey.  Feb. 2014.

  • Email Interview. Glaser, J., DO, Director Restorative Medicine, New Hyde Park, New York. February 2014.

  • Email Interview. Murphy, J. DPT, Director, MotionWorks Physical Therapy. Neenah, WI.

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