Non-Operative — Lumbar Spinal Stenosis (Non-Operative)

Massachusetts General Hospital · MGH Sports Medicine

Weight-Bearing

WBAT; lumbar spine unloading in 90-90 position; assistive device (cane, poles, rollator) as needed for spinal unloading

Key Restrictions

Avoid prolonged sitting, bending, lifting, and forced lumbar extension (flexion-biased approach); spinal unloading in 90-90 position; assistive device recommended for spinal unloading; aquatics with modified stroke to reduce extension; avoid lumbar extension with strength training Phase III

Timeline & Phases

4 phases: Phase I (0-6 wks, 6-8 visits — lumbar unloading 90-90, frequent position changes, STM, traction in hook-lying/90-90, aquatics with modified stroke, NuStep/recumbent bike/treadmill with incline, local TA/MF core, sit-to-stand), Phase II (6-12 wks, 6 visits — clamshell, squat/lunge with support, step-up, balance progression, reduce/D/C lumbar support), Phase III (12-16 wks, 2-4 visits — squat progression, plantigrade plank, avoid extension with strength training, return to gym), Phase IV (16+ wks, optional — sport/recreational specific with modified strokes for extension-sensitive activities)

Notes

March 2025; flexion-biased approach throughout (unlike disc herniation); neurogenic claudication management with 90-90 unloading and assistive devices; FABQ and STarT Back Tool for chronic cases; Oswestry Questionnaire; discharge: no pain increase with sport-specific exercise and proper mechanics. [Archived copy — original Massachusetts General Hospital URL retired in the Mass General Brigham site migration; Wayback snapshot 2025-11-22.]

Surgeon / Author

MGH Sports Medicine

Published

March 2025