Spinal Stenosis Treatment Without Surgery

By the GSMC pain management team, medically reviewed by Dharam P. Mann, MD

Spinal stenosis can turn a walk around the block or a trip through the grocery store into a struggle. Your back may ache, and your legs may feel heavy, tingly or weak after a few minutes of standing, then ease when you sit or lean forward on a shopping cart. Many people with spinal stenosis never need an operation. This guide walks through the non-surgical options our team offers.

This is Day 3 of our spine and sciatica series. Day 1 covered sciatica treatment options, and Day 2 covered how to sleep with sciatica.

What is spinal stenosis?

Spinal stenosis means the spaces inside the spine have narrowed, which can crowd the spinal cord or nerve roots. In the low back (lumbar stenosis), it often comes from age-related changes such as a thickened ligament, arthritis in the facet joints, or a bulging disc. Learn more about symptoms and diagnosis on our spinal stenosis condition page.

Step 1: Activity, exercise and physical therapy

For many people, care starts with movement. A physical therapy program can build core and hip strength, improve flexibility and teach positions that give the nerves more room.

• Try forward-flexed activities such as a stationary bike or walking with a cart or walker, which many people with stenosis find easier.
• Water exercise lets you stay active with less load on the spine.
• Break long walks into shorter ones with sitting breaks, and slowly build up your distance.
• Heat, gentle stretching and over-the-counter pain relievers, as advised by your doctor, may help day to day.

Step 2: Epidural steroid injections

When leg pain or heaviness continues despite therapy, an epidural steroid injection may help. A small amount of anti-inflammatory steroid and numbing medicine is placed near the irritated nerves using X-ray guidance. Relief can last weeks to months for some people, and that window can make it easier to keep up with exercise. Our Day 4 post, epidural steroid injection: what to expect, explains the visit step by step.

Step 3: The mild® procedure

For lumbar spinal stenosis caused mainly by a thickened ligament, the mild® procedure may be an option. Through a very small opening, small pieces of the thickened ligament are removed to make more room for the nerves. No implant is left behind, and it is done as an outpatient procedure with numbing medicine and light sedation. Your imaging helps us decide whether your type of stenosis fits.

Other options our team may discuss

• Spinal nerve root blocks, which target one specific nerve and can also help confirm where pain is coming from.
• Facet joint injections or radiofrequency ablation when arthritic facet joints add to back pain.
• Spinal cord stimulation for some people with ongoing back and leg pain when other care has not helped enough. A short trial comes first.

If symptoms are severe or getting worse, we may also suggest an opinion from a spine surgeon and are glad to coordinate with your other doctors.

When to see a doctor

Make an appointment if leg pain, numbness or heaviness limits how far you can walk or stand, or if it keeps getting worse. Go to the emergency room or call 911 if you have new loss of bladder or bowel control, numbness in the groin or saddle area, or leg weakness that is getting worse quickly.

Non-surgical spinal stenosis care at GSMC

Our team sees patients with spinal stenosis at all 7 GSMC offices in Ocean and Monmouth County: Whiting, Toms River, Brick, Barnegat, Manahawkin, Freehold and West Long Branch. We review your history and imaging and build a plan around your goals, whether that is walking the boardwalk or getting through a round of golf. Many plans, including Medicare, cover these treatments when criteria are met.

Call 732-202-3000 or request a consultation.

Frequently Asked Questions

Can spinal stenosis be treated without surgery?

Yes, for many people. Physical therapy, activity changes, medicines, epidural steroid injections and minimally invasive options such as the mild® procedure may ease symptoms. Surgery is usually considered when symptoms are severe or getting worse.

What exercises help spinal stenosis?

Forward-flexed activities such as a stationary bike, walking with a cart or walker, and water exercise are often easier. A physical therapist can show you which exercises are safe for you.

Is the mild® procedure surgery?

It is a minimally invasive outpatient procedure done through a very small opening with numbing medicine and light sedation. It leaves no implant, and many people go home the same day.

How long do epidural injections help spinal stenosis?

It varies. Some people have relief for weeks to months, and others have little benefit. We review your response before suggesting another injection.

Medical disclaimer: This article is for general education only and is not medical advice. Please talk with your own doctor about your symptoms and treatment. Individual results vary.