Spinal Canal Stenosis

Author: K. Zbinden

Definition 

What is spinal canal stenosis?

Spinal canal stenosis describes a narrowing of the spinal canal. The spinal canal is the bony vertebral canal within the spine through which the spinal cord and nerve roots run protected. If this canal becomes narrower, the spinal cord, nerves, or blood vessels can come under pressure. This can lead to pain, sensory disturbances, loss of strength, or load-dependent symptoms.

Spinal canal stenosis occurs most frequently in the lumbar spine. This is referred to as lumbar spinal canal stenosis or narrowing of the lumbar vertebral canal. A typical feature is that symptoms increase when walking or standing for long periods and improve when sitting or bending the upper body forward. The reason is that the spinal canal widens somewhat in a forward-bent posture, while it tends to narrow in an upright or backward-leaning posture.
Less commonly, the narrowing affects the cervical spine. In this case, it is called cervical spinal canal stenosis or spinal canal stenosis of the cervical spine. In addition to neck discomfort, cervical spinal canal stenosis can cause symptoms in the arms, tingling, numbness, gait unsteadiness, or impaired fine motor skills. Spinal stenosis in the thoracic spine is much rarer, but it can also lead to pain, sensory disturbances, or neurological deficits.

The definition of spinal canal stenosis therefore does not describe a single disease, but rather an anatomical narrowing in the spine. Depending on its location, severity, and the nerves affected, this narrowing can cause very different symptoms. Not every visible stenosis on imaging such as MRI or CT automatically leads to pain. What always matters is whether the anatomical narrowing matches the actual symptoms of spinal stenosis.

Causes of spinal canal stenosis 

Spinal stenosis is among the common causes of back pain, leg pain, and load-dependent limitations in older age. The main cause is usually age-related wear and tear of the spine. Over many years, the intervertebral discs, facet joints, ligaments, and bony structures change. These changes can progressively narrow the spinal canal, causing pressure on the spinal cord, nerve roots, or blood vessels. This is then referred to as spinal canal narrowing, vertebral canal narrowing, or spinal stenosis.
Spinal stenosis usually does not develop suddenly, but slowly over years. Often several factors interact. In addition to age-related wear processes, lack of exercise, a sedentary lifestyle, overweight, poor posture, muscular imbalances, foot misalignments, previous injuries, operations, or congenital anatomical peculiarities can play a role. Existing spinal instability, for example due to vertebral slippage, can also promote narrowing of the spinal canal.

Below are important factors that can contribute to the development or worsening of spinal stenosis.

• ◉ Age-related wear processes of the spine

  The most common cause of spinal canal stenosis is degenerative changes in the spine. With increasing age, the intervertebral discs lose fluid, elasticity, and height. As a result, the distance between the vertebral bodies decreases. At the same time, the load on the small vertebral joints, the so-called facet joints, increases. These can thicken, react with inflammation, or undergo arthritic changes. In response to the altered load, the body may form additional bony growths. These bony changes are also called osteophytes. Together with thickened joint capsules and altered ligaments, they can narrow the spinal canal. This leaves less room for the sensitive nerve structures.

• ◉ Vertebral slippage and instability

  Another possible trigger is vertebral slippage, medically called spondylolisthesis. In this condition, one vertebral body shifts slightly relative to the vertebra below it. This changes the shape of the spinal canal, and nerve structures can become additionally constricted. This instability can be congenital, wear-related, or occur after injuries or operations. Especially in the lumbar spine, vertebral slippage can worsen lumbar spinal canal stenosis and contribute to load-dependent pain, numbness, or weakness in the legs.

• ◉ Lack of exercise and sedentary lifestyle

  Lack of exercise does not cause vertebral canal narrowing on its own, but it can promote the development of symptoms and functional limitations. A sedentary lifestyle often leads to weakened trunk, gluteal, and leg muscles. As a result, the spine loses active stability. Loads are distributed less evenly, and individual sections of the spine can be stressed more heavily. Regular movement is important to activate the muscles, maintain joint mobility, and promote blood circulation in the surrounding tissue. If this movement is lacking, muscular imbalances, poor posture, and stiffness can develop. These factors can increase the load on the spine and worsen existing symptoms of spinal canal stenosis.

• ◉ Poor posture and one-sided strain

  Long periods of sitting, frequent work in a forward-bent posture, one-sided strain, or unfavorable movement patterns can place uneven stress on the spine over many years. This can lead to muscular imbalances and altered posture. In existing vertebral canal narrowing, certain postures can additionally influence symptoms. An upright or backward-leaning posture often narrows the spinal canal, while a slight forward bend can create more space. That is why many affected people report that they can walk longer without symptoms when leaning slightly forward, for example on a shopping cart or while cycling.

• ◉ Shortened and tense structures

  Shortened muscles and tense fascia can restrict the mobility of the spine, pelvis, and hips. Particularly often affected are the hip flexors, back extensors, gluteal muscles, and the hamstrings. When these structures lose their elasticity, posture and movement quality change. Restricted hip mobility can cause the lumbar spine to compensate for movements that should actually come from the hip or pelvis. This increases the mechanical load on the facet joints and intervertebral discs. In the presence of stenosis, such functional limitations can worsen symptoms.

• ◉ Foot misalignments and altered body statics

  The feet form the basis of upright walking. Foot misalignments such as flat feet, splayed feet, knock-knees, or fallen arches can influence body statics and gait. Through the biomechanical chain, changes in the feet affect the knees, hips, pelvis, and spine. If foot function is restricted, impact forces may be absorbed less effectively and movements transmitted less harmoniously. This creates compensatory movement patterns that can additionally strain the spine. Foot misalignments are not the sole cause of spinal canal stenosis, but they can worsen existing symptoms and misloading in the musculoskeletal system.

• ◉ Hard, flat floors and rigid shoes

  Hard, flat floors and rigid, highly supportive shoes can reduce the natural movement of the feet. As a result, the foot muscles are activated less, the rolling motion is restricted, and natural shock absorption is reduced. The forces generated while walking are then less effectively cushioned through the foot, leg muscles, and fascia.
  This increased force transmission can travel via the knees and hips to the spine. In sensitive or already degeneratively changed structures, this can worsen symptoms. Especially in spinal stenosis, where nerve structures already have less space, an unfavorable load distribution can negatively affect the symptoms.

• ◉ Congenital or acquired narrowing

  Not every spinal canal stenosis is caused solely by age. Some people are born with a naturally narrower spinal canal. In such cases, even minor degenerative changes may be enough to trigger symptoms. Injuries, inflammation, scar tissue after surgery, or rare diseases can also narrow the spinal canal. In these cases, it is especially important to carefully clarify which structure is causing the narrowing and which treatment is appropriate.

Symptoms of spinal canal stenosis 

The symptoms of spinal canal stenosis depend on where the narrowing occurs, how severe the narrowing of the spinal canal is, and which nerve structures are affected. Individual pain perception, physical condition, accompanying illnesses, and everyday strain also play an important role. A typical feature of spinal stenosis is that symptoms often develop slowly and worsen over months or years. A clear diagnosis should always be made by a doctor, especially if numbness, loss of strength, gait unsteadiness, or bladder and bowel problems occur. Below are the most common symptoms of spinal canal stenosis:

• ◉ Back pain: Local pain in the area of the affected spine. In narrowing of the lumbar vertebral canal, symptoms usually occur in the lower back. In cervical spinal canal stenosis, neck and shoulder pain may be more prominent.
• ◉ Radiating pain in the legs or arms: In lumbar spinal canal stenosis, pain often radiates from the lower back through the buttocks into one or both legs. In cervical spinal canal stenosis, pain can radiate into the shoulder, arm, or hand.
• ◉ Load-dependent leg pain: Typical lumbar spinal canal stenosis symptoms are pain, a feeling of heaviness, or pulling sensations in the legs when walking or standing. Symptoms often improve when sitting or bending the upper body forward.
• ◉ Tingling and numbness: Pressure on nerve roots can cause abnormal sensations such as tingling, pins and needles, or numbness. Depending on the level of the stenosis, these spinal canal narrowing symptoms affect the legs, feet, arms, or hands.
• ◉ Muscle weakness: If nerves are more severely constricted, loss of strength can occur. Affected people may notice this, for example, when climbing stairs, lifting the foot, walking on tiptoes, or when grip strength decreases.
• ◉ Gait unsteadiness: Advanced spinal stenosis can impair coordination and stability while walking. Affected people feel unsteady, stumble more often, or need more frequent breaks.
• ◉ Improvement when bending forward: A very typical sign is that symptoms improve when bending forward, sitting, or cycling. In this posture, the spinal canal often becomes somewhat wider, temporarily relieving the nerves.
• ◉ Worsening when standing upright or leaning backward: When standing upright or leaning back, the spinal canal can narrow further. This can increase pain, tingling, or weakness.
• ◉ Reduced walking distance: Many affected people can only walk a certain distance before pain or weakness occurs in the legs. After a short break, symptoms often improve again.
• ◉ Symptoms of cervical spinal canal stenosis with spinal cord involvement: If the spinal cord is compressed in the cervical spine, gait unsteadiness, coordination problems, weakness in the arms or legs, and an insecure body feeling can occur. Such symptoms should be medically evaluated.
• ◉ Symptoms of thoracic spinal canal stenosis: These are rare, but can cause chest pain, belt-like radiating discomfort, sensory disturbances, or unsteadiness while walking.
• ◉ Cold or numb legs and feet: Disturbed nerve conduction can alter sensation in the legs and feet. Affected people sometimes describe a feeling of coldness, numbness, or limbs that have fallen asleep.
• ◉ Reflex changes: Pressure on nerve roots can weaken or alter reflexes. This is usually found during a neurological examination.
• ◉ Muscle tension: Pain and protective postures often lead to tension in the back, buttocks, neck, or legs. This can additionally worsen symptoms.
• ◉ Fatigue due to chronic symptoms: Persistent pain, limited walking ability, and insecurity in everyday life can lead to tiredness, sleep problems, and mental strain.
• ◉ Emergency symptoms: Sudden paralysis, severe sensory disturbances in the genital or buttock area, as well as bladder or bowel emptying problems are warning signs. In such cases, medical help should be sought immediately.

Important: Not every vertebral canal narrowing visible on MRI or CT automatically causes symptoms. What matters is whether the visible narrowing of the vertebral canal matches the actual symptoms and clinical findings. Therefore, diagnosis and treatment should always be assessed individually.

Conventional therapies - What helps with spinal canal stenosis 

There are various treatment approaches for spinal stenosis. Which treatment is appropriate depends, among other things, on the extent of the narrowing, the affected region of the spine, the symptoms, age, physical resilience, and possible neurological deficits. Medical evaluation is recommended to determine the appropriate therapy for vertebral canal narrowing.
The goal of conventional therapy is to reduce pain, improve walking ability, relieve pressure on the nerves, and increase quality of life. In many cases, conservative therapy is initially recommended for spinal canal stenosis. Surgery for spinal canal stenosis is usually considered only when severe symptoms are present, neurological deficits occur, or conservative measures do not help sufficiently. Common treatment options are listed below:

• ◉ Pain medication: Anti-inflammatory and pain-relieving medications can help reduce pain and irritation. For more severe symptoms, depending on the doctor’s assessment, additional painkillers, muscle-relaxing medications, or short-term cortisone may be used.
• ◉ Physiotherapy: Targeted physiotherapy is an important part of treatment. It focuses on mobility, trunk stability, muscle strength, and posture. In lumbar spinal canal stenosis, exercises are often aimed at relieving the lumbar spine and improving walking ability.
• ◉ Medical exercise therapy: Under professional guidance, strength, endurance, coordination, and mobility are built up. Better trunk, gluteal, and leg muscles can help stabilize the spine and reduce mechanical load on the spinal canal.
• ◉ Infiltrations and injections: In cases of severe pain, injections with anti-inflammatory or pain-relieving substances can be administered near the affected nerve root. Such injections for vertebral canal narrowing can temporarily relieve symptoms and make movement therapy easier again.
• ◉ Pain therapy: Targeted pain therapy for spinal canal stenosis can be useful if symptoms persist for a long time or severely limit everyday life. Medication, physiotherapy, and psychological measures can be combined.
• ◉ Manual therapy and mobilization: Gentle mobilization techniques can help improve the mobility of the spine, pelvis, and hips. This can reduce muscular tension and minimize unfavorable compensatory movements.
• ◉ Posture training and everyday training: Affected people learn which postures and movements worsen or relieve symptoms.
• ◉ Aids: Walking sticks, rollators, or other aids can improve walking distance. Individually adapted insoles or suitable footwear can also be supportive in cases of foot misalignment and altered body statics.
• ◉ Heat and cold therapy: Heat can relax tense muscles and promote circulation. Cold can have a pain-relieving effect in acute irritation states.
• ◉ Weight reduction: Overweight increases the load on the spine, intervertebral discs, facet joints, and muscles. Long-term weight reduction can lower mechanical stress and positively influence symptoms of spinal canal stenosis.
• ◉ Movement: Regular, adapted movement is important. Activities such as cycling, walking with breaks, water gymnastics, or joint-friendly strength training are often recommended.
• ◉ Occupational therapy and workplace adaptation: Occupational therapy measures can help adapt everyday movements, work processes, and physical strain. The goal is to reduce pain and maintain independence in daily life.
• ◉ Osteopathy: Osteopathy for spinal canal stenosis can also contribute to pain relief.
• ◉ Acupuncture for spinal canal stenosis: Acupuncture can be used as a complementary treatment to relieve pain and reduce muscle tension by activating the body’s own regulatory mechanisms.
• ◉ Operation: Surgery for spinal canal stenosis may become necessary if severe pain, increasing limitation of walking distance, muscle weakness, signs of paralysis, or bladder and bowel problems occur. The goal of back surgery on the spinal canal is to relieve the compressed nerve or spinal cord. Depending on the findings, bony growths, thickened ligaments, or other narrowing structures are removed. As with any procedure, possible risks, complications, and aftercare must be discussed individually.

Since many of these measures do not permanently eliminate the consequences of lack of exercise, muscular weakness, poor posture, restricted foot function, and hard, flat floors and rigid shoes, symptoms of spinal canal stenosis can regularly recur or persist. The goal of any treatment should therefore be not only to relieve pain, but also to improve mobility, muscle activity, body statics, and natural shock absorption in the long term. This is where the kybun mode of action provides additional support, helping to use the musculoskeletal system more actively in everyday life and functionally relieve the spine.

kybun mode of action - What helps with spinal canal stenosis 

The kybun products aim to reduce the harmful effects of hard, flat floors and rigid, supportive shoes, and to actively address lack of exercise and a sedentary lifestyle. Thanks to the elastic-springy properties of kybun products, the musculoskeletal system is relieved on the one hand and activated on the other. This combination can be supportive in spinal canal narrowing, because the spine is less misloaded in everyday life while being moved more functionally at the same time.

The goal is to reduce the force acting on the spine, activate the muscles, improve body statics, and promote a gait pattern that is as natural and joint-friendly as possible. The kybun mode of action addresses exactly these functional factors and can therefore help positively influence symptoms of spinal canal stenosis in everyday life. The kybun products do not replace medical treatment, but can be used as a complementary conservative therapy for spinal canal stenosis. The elastic-springy kybun products provide support thanks to the following mode of action:

• ◉ Promotion of movement and reduction of sedentary behavior

  Regular movement plays a central role in spinal canal stenosis. Lack of exercise, prolonged sitting, and monotonous strain can weaken the muscles, reduce mobility, and worsen existing spinal canal stenosis symptoms. Many affected people move less because of pain, which can create a cycle of protection, muscle loss, stiffness, and increasing symptoms. The elastic-springy kybun products encourage enjoyment of movement, as walking and standing on the soft, yielding material are perceived as more pleasant. Reduced impact load and constant gentle activation invite the body to move more in everyday life. This can reduce sitting time and lessen the negative effects of a low-activity lifestyle. Especially in lumbar spinal canal stenosis, regular, adapted activity is important to maintain walking ability for as long as possible. Short, frequent movement sessions are often better tolerated than long periods of strain without a break.

• ◉ Activation and strengthening of the muscles through elastic-springy properties

  When walking and standing on an elastic-springy surface, the body must constantly perform small compensatory movements. This activates the foot, leg, and gluteal muscles as well as the deep trunk and back muscles. These muscles are important for stabilizing the spine and distributing loads more evenly. In spinal canal stenosis, weakened muscles can mean that the spine is less well guided. This can place more strain on individual sections, which may worsen spinal canal narrowing symptoms such as back and leg pain, heaviness, or gait unsteadiness. Better muscular stability can help functionally relieve the spine and make movements more controlled. Foot muscles also play an important role here. The feet form the basis of body statics. Active foot muscles support the arch of the foot, improve the rolling motion, and can positively influence force transmission through the knees, hips, pelvis, and spine. This makes the biomechanical chain more stable, which is particularly relevant for complaints in the lumbar spine.

Balance and EMG

Balance ability was measured with a force plate by tracking the movement of the body’s centre of mass from front to back (ant-post) and side to side (med-lat) while standing. An electromyography (EMG) simultaneously recorded muscle activity.

• ◉ Reduction of force transmission through cushioning effect

  Hard, flat floors transmit impact forces with every step through the feet, knees, hips, and pelvis to the spine. In existing spinal canal narrowing, such repeated load peaks can worsen symptoms, as degeneratively changed structures, irritated nerves, and tense muscles can react sensitively to mechanical strain. When the heel strikes the ground in kybun shoes, the elastic-springy material is compressed. This absorbs part of the force generated. Peak loads on joints, the spine, and surrounding soft tissues can be reduced. At the same time, the slower sinking of the heel gives the body more time to activate the stabilizing muscles. This improved muscular preparation can help stabilize the spine earlier. As a result, abrupt load peaks are reduced and the force acting on the spinal canal and surrounding structures is distributed more evenly.

• ◉ Natural foot rolling thanks to muscle activation and rolling function

  A natural rolling motion is important so that forces while walking are not transmitted upward in an uncontrolled way. Rigid shoes and hard floors can restrict foot movement and reduce the activity of the foot muscles. As a result, the foot’s shock-absorbing function may decrease. The kybun sole supports more active foot work through its elastic-springy properties. When the heel strikes, the foot sinks in a controlled way into the material. This allows the muscles to be activated in time to guide the foot stably and initiate a natural rolling motion over the forefoot. Functional rolling promotes movement in the foot, knee, hip, pelvis, and spine. This distributes the load more evenly across the entire musculoskeletal system. This can be especially helpful in spinal canal stenosis, because more harmonious movement can reduce point-specific strain on individual spinal segments.

• ◉ Improvement of posture and body statics

  In spinal canal stenosis, poor posture, muscular imbalances, and restricted mobility can worsen symptoms. Especially in the lumbar spine, many affected people react sensitively to long periods of upright standing or backward bending of the spine, as this can further narrow the spinal canal. The kybun products promote active postural control through the unstable, elastic-springy surface. The body must constantly make fine adjustments to maintain balance. This activates stabilizing muscle groups that are important for an upright but not rigid posture. The goal is not a forced posture, but dynamic, mobile stability. Better body awareness can help affected people recognize unfavorable postures more quickly and dose their load better in everyday life. This can support symptoms such as back pain, leg pain, or muscular tension in spinal canal stenosis.

• ◉ Care and protection of fascia

  Fascia are connective tissue structures that envelop, connect, and stabilize muscles, joints, and other tissues. Lack of exercise, one-sided strain, and prolonged sitting can cause fascia to lose elasticity and gliding ability. This can restrict movement, promote tension, and increase the load on the spine. Walking on an elastic-springy surface creates gentle, rhythmic movement impulses. These can promote fluid exchange in the fascial tissue and support gliding ability. More mobile fascia can help movements run more smoothly and reduce compensatory tension. In spinal stenosis, this can be especially helpful when tense back, pelvic, or leg muscles additionally worsen symptoms. Better fascial mobility can support functional relief of the spine.

• ◉ Promotion of circulation through increased movement activity

  Walking and standing on an elastic-springy surface naturally promotes movement activity. More movement supports blood circulation in the muscles, the supply of the surrounding tissue, and metabolism in the musculoskeletal system. Even if the spinal canal itself is not directly widened by movement, the surrounding structures can be positively influenced. Better-perfused muscles are more resilient, recover faster, and are less prone to painful tension. This can help reduce symptoms of spinal canal stenosis and improve tolerance in everyday life.

• ◉ Optimized pressure distribution

  The entire sole of the foot is surrounded by the elastic-springy material of kybun products. This allows pressure under the foot to be distributed more evenly. Point-specific peak loads are reduced, and the forces acting on the body can be transmitted more effectively through the foot, leg, pelvis, and spine. Improved pressure distribution can be especially helpful when foot misalignments, hard floors, or rigid shoes negatively affect body statics. More even loading of the feet can relieve the entire biomechanical chain and thus also support the spine.

Application tips for spinal canal stenosis 

Before wearing the kybun shoes for the first time, you should consider a few application tips. Correct use can help relieve symptoms of spinal canal stenosis and gradually accustom the musculoskeletal system to the elastic-springy properties. Especially with spinal canal narrowing, it is important to dose the load individually and pay attention to your own spinal canal stenosis symptoms.

• ◉ At the beginning, wear the kybun shoes only as long as your body allows. Take regular breaks from wearing them if pain, fatigue, muscle soreness, or an increase in spinal canal narrowing symptoms occurs. In spinal canal stenosis, symptoms often increase during prolonged walking or standing. Therefore, build up walking time slowly and take breaks in good time. Short, frequent movement sessions are often better tolerated than long periods of strain without interruption. Due to the activating properties of kybun products, the muscles are used more intensely than in conventional shoes. Especially at the beginning, so-called initial reactions can occur.
• ◉ Do not stand still for too long. Alternate regularly between standing, walking, and sitting. Small weight shifts, gentle rocking on the kybun sole, or slow walking in place can help keep the muscles active and avoid rigid strain on the spine.
• ◉ When the heel strikes, consciously press the heel into the elastic-springy material. Feel the cushioning of the kybun shoes. This can reduce impact loads and better absorb the force acting on the feet, knees, hips, pelvis, and spine.
• ◉ Try to roll off as actively and controlled as possible over the forefoot. A natural rolling motion promotes the activity of the foot and leg muscles and supports a more harmonious movement chain up to the spine. If active rolling is not yet possible because of back pain, reduce the rolling motion over the forefoot.
• ◉ At the beginning, take smaller steps and walk deliberately slowly. This allows the muscles to adapt better to the elastic-springy sole. Once you feel secure, you can vary your walking speed slightly without provoking symptoms.
• ◉ Try to support the effect of the kybun shoes with the following spinal canal stenosis exercises. The exercises are intended as a complementary measure and are meant to help improve mobility, muscle activity, posture control, and tolerance in everyday life.

Helpful exercises for spinal canal stenosis 

To support the effectiveness of the kybun shoes, we recommend performing targeted exercises for spinal canal stenosis. The selection of exercises is not exhaustive and can be supplemented by further measures. As a general rule for all exercises, the symptoms of spinal canal stenosis must not worsen. If increasing pain, numbness, tingling, muscle weakness, or gait unsteadiness occur during an exercise, the exercise should be stopped. Activating muscle stimuli or tension-relieving effects are desired, but strong pain is not.
The spinal canal stenosis exercises are divided into the following areas: correct walking in kybun shoes, muscle length training, fascia roller, and strengthening. Ideally, the different areas are used in combination to improve mobility, muscle activity, posture, and walking ability in the presence of spinal canal stenosis symptoms.

Correct walking in kybun shoes
The quality of each individual step is crucial in spinal canal stenosis in order to distribute the load on the spine, pelvis, hips, knees, and feet as evenly as possible. The kybun shoes can be supportive in spinal canal narrowing by reducing impact load while simultaneously activating the muscles.

Active heel strike

• ◉ Press the heel controlled into the elastic-springy material to consciously feel the cushioning property of the kybun sole.
• ◉ Keep the foot stable so that it does not tilt inward or outward.
• ◉ Place the midfoot and forefoot down in a controlled manner so that the force acting on the body is reduced.
• ◉ Choose small, slow steps if spinal canal stenosis symptoms increase while walking.

Active foot rolling

• ◉ Actively roll over the forefoot and use the maximum range of motion.
• ◉ Using the maximum range of motion is important so that there is a physiological twist through the pelvis to the back.
• ◉ If spinal canal stenosis symptoms reappear due to rotation of the spine, the rolling motion must be reduced.

Muscle length training
Muscle length training can be helpful in spinal canal stenosis because shortened and tense structures in the hip, pelvis, buttocks, and legs can increase the load on the spine. The goal is to improve mobility without additionally irritating the spinal canal.

Hip opener

• ◉ Start position on all fours.
• ◉ Place the left foot forward next to the arms.
• ◉ Stretch the right leg backward and place the foot flat on the floor. Make sure that the hips and spine are in one line.
• ◉ To intensify the stretch, press the hips forward and downward. Depending on individual mobility.
• ◉ Perform 1–2 times daily.
• ◉ Hold the exercise for 3 x 30 seconds.

Buttocks

• ◉ Start position lying on your back.
• ◉ Stretch both arms out to the sides at a 90-degree angle and place the left leg bent over to the right side.
• ◉ Use the right hand to press the bent knee downward.
• ◉ Make sure that both shoulder blades remain on the floor.
• ◉ Perform 1–2 times daily.
• ◉ Hold the exercise for 3 x 30 seconds.

Fascia roller
Fascia training with the fascia roller or a fascia ball can help loosen tense myofascial structures. In spinal canal stenosis, you should not roll directly on the spine. It is more sensible to treat the buttocks, thighs, and calves, as these areas can influence the statics of the pelvis and spine.

Front thigh muscles

• ◉ Start position lying on your stomach.
• ◉ Place a large roller under the thigh of the extended leg. Place the other leg bent down to control movement.
• ◉ Roll out the front thigh actively from the hip to above the knee joint.
• ◉ Perform the exercise slowly and in a controlled manner. Adjust pressure to your personal perception, but go to a tolerable pain threshold.
• ◉ Roll out localized adhesions more intensively or hold the position at that point.
• ◉ 3 minutes per side.
• ◉ Perform 1–2 times daily.

Gluteal muscles

• ◉ Bend both legs and use the fascia ball to roll out the corresponding half of the buttock. Increase pressure by placing one leg to the side. If wrist pain occurs, the exercise can also be performed on the forearms.
• ◉ Perform the exercise slowly and in a controlled manner.
• ◉ Adjust pressure to your personal perception, but go to a tolerable pain threshold. Important: If the pain increases massively at the pressure point, avoid this area or reduce pressure significantly.
• ◉ Roll out localized adhesions more intensively or hold the position at that point.
• ◉ 3 minutes per side.
• ◉ Perform 1–2 times daily.

Strengthening

Targeted strength training for spinal canal stenosis can help stabilize the spine, improve walking ability, and better control everyday strain. The trunk, buttocks, hips, and legs are especially important. The spinal canal stenosis exercises should be performed calmly, in a controlled manner, and without strong backward bending of the spine.

All fours

• ◉ Start position on all fours.
• ◉ Place the hands shoulder-width apart below the shoulders, the knees hip-width apart below the pelvis.
• ◉ Stretch the right leg backward and the left arm forward.
• ◉ Keep the back straight and stable.
• ◉ Then bring the right leg and left arm together and extend them again.
• ◉ 3 sets of 8–12 repetitions.
• ◉ Perform 2–3 times per week.

Bridge

• ◉ Start position: lying on your back with bent legs (hip-width apart). Arms are stretched toward the feet at shoulder width.
• ◉ Actively lift the hips off the floor and move them toward the ceiling (the hips should be fully extended at the highest point of the exercise).
• ◉ Hold the position at the highest point for 4 seconds.
• ◉ Make sure that the force comes from the buttocks (not from the heels or the back of the thighs).
• ◉ Lower the hips slowly again without the buttocks touching the floor.
• ◉ 3 sets of 8–12 repetitions.
• ◉ Perform 2–3 times per week.