What Is Spinal Stenosis?
Spinal stenosis is a narrowing of the spinal canal or nerve exit foramina that compresses the spinal cord or nerve roots. It is one of the most common spinal conditions in adults over 50 and the most common reason Americans over 65 undergo spine surgery. At Pittsburgh Physical Medicine, we treat stenosis extensively — including many patients from Squirrel Hill, Shadyside, Oakland, and Bloomfield who have been told surgery is their only option. In many cases, it is not.
The Hallmark Symptom: Neurogenic Claudication
The defining symptom of lumbar stenosis is neurogenic claudication — leg pain, heaviness, cramping, and weakness that develops after walking a predictable distance, then relieves with sitting or bending forward. The "shopping cart sign" — patients lean forward on the cart handle to relieve symptoms — is essentially diagnostic. Why does forward bending help? Because spinal flexion opens the stenotic canal. Extension closes it.
What Causes Stenosis?
- Disc degeneration with bulging — degenerative discs bulge posteriorly into the canal
- Facet joint hypertrophy — arthritic facets enlarge, encroaching on the canal and foramina
- Ligamentum flavum thickening — this posterior canal ligament thickens with age
- Spondylolisthesis — vertebral slippage narrows the canal at the affected level
Red flags requiring urgent evaluation: Progressive weakness, loss of bladder or bowel control, or inability to walk. These require immediate medical evaluation and should not be managed conservatively.
What the Evidence Shows About Conservative Care
Multiple high-quality studies — including the landmark SPORT trial — have shown that conservative care and surgical outcomes for lumbar stenosis are comparable at 2 and 4-year follow-up for patients without severe neurological deficit. Many stenosis patients improve with conservative management and never need surgery.
Cox Flexion-Distraction
The most effective chiropractic technique for lumbar stenosis. The segmented table creates spinal flexion-distraction that opens the canal, decompresses nerve roots, and restores segmental mobility. Research shows consistent, clinically significant improvement in walking distance and pain levels.
Physical Therapy
Flexion-based exercise programs, core stabilization, and stationary cycling (which naturally puts the spine in flexion) are highly effective. Dr. Crockatt designs programs that keep stenosis patients active and functional.
Chiropractic Mobilization
Low-force mobilization restores facet joint mobility and reduces paraspinal muscle spasm without compressive high-velocity forces.
If you've been told you need spinal surgery for stenosis and want an expert conservative evaluation first, we serve patients from Shadyside, Lawrenceville, Bloomfield, Squirrel Hill, Oakland, Highland Park, Point Breeze, and Regent Square. Call (412) 404-8337.
Treating Patients from Across Pittsburgh's East End
Pittsburgh Physical Medicine is at 5916 Penn Ave in East Liberty — minutes from Shadyside, Bloomfield, Lawrenceville, Squirrel Hill, Oakland, Highland Park, and Point Breeze. We're in-network with UPMC Health Plan, Highmark BCBS, Aetna, and United Healthcare.
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