Spinal Stenosis

That difference is almost diagnostic for lumbar spinal stenosis. Cycling keeps the spine in a forward-flexed position, which increases the diameter of the spinal canal and relieves pressure on the compressed nerve roots. Walking, especially with the slight backward lean many people unconsciously adopt, closes the canal down by 12 to 30% compared with flexion — enough to produce the leg heaviness and cramping known as neurogenic claudication. The stationary bike is actually one of our recommended low-impact aerobic tools during care for exactly this reason.

Stenosis doesn't follow an inevitable progression in everyone. Many patients remain stable for years or decades without meaningful change in symptoms or imaging findings, especially when they stay active, maintain healthy weight, and engage in flexion-biased exercise. Some do progress, particularly if underlying degenerative changes advance rapidly. The best predictor of long-term function isn't the severity of the narrowing on imaging — it's whether you stay engaged in care, keep moving, and address the modifiable factors. We monitor your walking tolerance and neurological function over time as a practical measure of how you're doing.

Both can cause leg pain and neurological symptoms, but the patterns differ in useful ways. Disc herniation typically produces acute symptoms that worsen with sitting and forward bending and improve with extension. Stenosis produces the opposite: walking and standing (extension) provoke symptoms, and sitting or bending forward relieves them. Disc herniation patients often can't sit comfortably; stenosis patients often can't stand comfortably. Stenosis also tends to produce bilateral leg symptoms more often, and the leg symptoms are more diffuse — described as heaviness, cramping, or fatigue rather than the sharp, electric shooting of disc herniation.

Not permanently — we can't structurally widen a narrowed canal with manual therapy. What we can do is optimize the position and movement of the surrounding tissues so that the available space is used as efficiently as possible, and reduce the secondary muscle guarding and joint stiffness that often amplifies symptoms beyond the structural narrowing alone. Flexion-distraction technique creates temporary distraction of the segment that reduces intradiscal pressure and opens the posterior elements during each cycle. Over multiple sessions, patients typically regain walking tolerance and reduce leg symptoms significantly — not because the anatomy changed, but because the mechanical and neurological environment improved.

They're complementary, not competing approaches. Epidural injections work by delivering anti-inflammatory medication directly to the inflamed nerve roots — they're excellent at calming acute inflammation and can provide a window of reduced pain that makes it easier to engage in the active rehabilitation that produces longer-term change. Chiropractic care addresses the mobility, muscle, and postural factors that injections don't touch. Patients who combine both often do better than those using either alone. We communicate openly with the pain management specialists managing those injections and time our manual care accordingly.