QUICK ANSWER (TL;DR)
Lumbar spinal stenosis is a narrowing of the spaces around the spinal cord and nerves, most commonly caused by age-related changes. Forward bending (flexion) increases canal volume and relieves symptoms, which is why sufferers lean on shopping trolleys. Flexion-based exercise programs, including clinical Pilates, have moderate-quality evidence for reducing pain and improving walking tolerance.
There’s a reason the older client in your life leans forward on the shopping trolley. There’s a reason they can ride a stationary bike for an hour but barely make it to the corner shop on foot.
Read more: Lumbar Spinal Stenosis: Why Flexion Provides Relief (and What to Do About It)It’s not random. It’s not bad posture. It’s biomechanics and once you understand it, the right kind of exercise becomes obvious.
What Is Lumbar Spinal Stenosis?
Lumbar spinal stenosis is a narrowing of the spaces within the spine – either the central canal (where the spinal cord and cauda equina sit) or the neural foramina (the side openings where nerve roots exit the spine). The narrowing can compress neural tissue, which is what produces symptoms.
It’s most commonly degenerative, caused by a combination of:
• Hypertrophy of the ligamentum flavum (the elastic ligament inside the canal becoming thicker with age)
• Facet joint osteoarthritis (small joints at the back of each vertebra developing bony overgrowth)
• Disc height loss (which reduces foraminal volume from above and below)
All extremely common in people over 60. Not all symptomatic.
What Does Spinal Stenosis Feel Like?
The classic presentation is called neurogenic claudication: leg pain, heaviness, or cramping that comes on with walking or standing, and is relieved by sitting or leaning forward. People describe “having to stop and lean on the trolley at the supermarket” or “feeling fine on the bike but terrible on a walk”.
That posture isn’t avoidance. It’s relief and there’s a beautiful biomechanical reason for it.
Why Does Bending Forward Help Spinal Stenosis?
When the lumbar spine moves into flexion, the canal cross-sectional area increases. Schönström and colleagues demonstrated this in cadaveric and live imaging studies decades ago, and it’s been replicated since: flexion stretches the ligamentum flavum thinner and opens the foramina.
Extension does the opposite though. The ligamentum buckles inward, the foramina close down, and symptoms worsen. So when someone with stenosis leans forward on a trolley, they’re literally creating more room for their neural tissue.
What Exercises Help Spinal Stenosis?
A 2019 Cochrane review by Ammendolia and colleagues found moderate-quality evidence supporting flexion-based exercise programs for symptomatic relief and functional improvement in lumbar stenosis. Pilates wasn’t isolated in the review, but the principles apply directly.
Helpful exercise approaches typically include:
• Flexion-biased work in supported positions
• Hip and thoracic mobility (so the lumbar spine has to do less)
• Walking tolerance training, often built up gradually
• Strength work for the lower limbs and core
• Aerobic conditioning that’s tolerated like stationary cycling, recumbent options
Can You Do Pilates With Spinal Stenosis?
Yes and it’s particularly well-suited. Clinical Pilates allows precise positioning, supported flexion-biased work, progressive loading, and the one-on-one attention that helps each session match what your body needs that week.
What works well:
• Supine work, footwork on the reformer with a slight posterior pelvic tilt option
• Supported C-curve work, hundred preparations with the head up
• Hip and thoracic mobility series
• Standing work that builds load-bearing tolerance
What to be careful with: end-range extension (swan, prone arabesque, aggressive thoracic extension into the lumbar spine). Not necessarily off-limits forever, but be smart how you do it and how much.
Frequently Asked Questions
Is walking good or bad for spinal stenosis?
Walking is often the most disabling activity for stenosis sufferers because the lumbar spine tends toward extension during gait. But total avoidance makes things worse. The goal is to gradually build walking tolerance, often supported by cycling, supported strength work, and flexion-based exercise.
Can spinal stenosis be cured without surgery?
Stenosis itself is a structural change that doesn’t reverse, but symptoms can be substantially managed without surgery in many cases. Conservative care including exercise, education, and sometimes medication or injections is the first line for most people.
Is cycling good for spinal stenosis?
Yes, cycling positions the lumbar spine in slight flexion, which keeps the canal more open. Many stenosis sufferers can cycle comfortably for long periods even when walking is painful. Stationary or recumbent bikes are excellent options.
What is neurogenic claudication?
Neurogenic claudication is leg pain, heaviness, or cramping caused by compression of the spinal nerves typically from spinal stenosis. It usually comes on with walking or standing and is relieved by sitting or leaning forward. It’s different from vascular claudication, which is caused by reduced blood flow.
Where can I find Pilates for stenosis in Sydney CBD?
Our studio at Pilates on George (Level 9, Dymocks Building, 428 George Street, Sydney CBD) specialises in personalised Pilates for clients with complex movement needs, including spinal stenosis. We start every client with an initial consultation to design a program that fits their body.
The Bottom Line
Sometimes the body’s preferred posture isn’t a postural fault. It’s a pain coping mechanism. The trick is to recognise it, understand the mechanism, and program accordingly.
“Stand up tall” is the worst possible cue for a stenosis client. “Let’s build the strength to walk further” is exactly what they need.
References
• Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ, 352, h6234.