If your legs hurt when walking but feel better when sitting, could it be spinal stenosis?

There are individuals who experience pain and numbness in their buttocks and legs when walking or standing for a long time, but feel relief when sitting or bending forward at the waist.

Such symptoms may occur in lumbar spinal stenosis, where the space through which the lumbar nerves pass has narrowed.

However, there are people who show a narrowed spinal canal on MRI but have no symptoms, and conversely, the cause of leg pain may be hip joint issues, knee problems, or circulation disorders.

Therefore, stenosis must be evaluated not only through imaging but also by assessing how far one can walk, which positions provide relief, and the status of muscle strength and sensation.

The spinal canal is a space within the lower back through which nerves pass.

As you age, changes in the discs, spinal joints, and ligaments may narrow the space through which nerves pass. At this time, standing or walking may stimulate the nerves, leading to leg pain, numbness, and a heavy sensation.

The imaging findings indicating stenosis do not always correspond to the actual severity of symptoms.

The more you walk, the more your legs hurt and feel numb.

Initially, you may feel fine, but after walking for a certain period or distance, pain and numbness may occur in the buttocks, thighs, and calves.

It becomes easier when sitting or bending the waist.

Sitting in a chair or bending forward may cause symptoms to subside relatively quickly. Some people say that leaning on a shopping cart allows them to walk for longer.

Walking distance gradually decreases.

Walking distance may decrease, for example from being able to walk for 30 minutes before needing a rest to needing one after only 5 minutes.

One or both legs feel heavy.

Numbness and changes in sensation may occur together with a feeling of weakness in the legs.

The lower back pain may not be severe.

In some cases, buttock and leg symptoms and difficulty walking are more prominent than lower back symptoms.

No.

Blood circulation problem

Pain in the calves when walking that improves with rest may also indicate a problem with leg blood vessels. If your feet feel cold, your skin color changes, or wounds heal poorly, you should check the condition of your blood vessels.

Hip and knee joint problems

Degenerative changes in the hip or knee can also reduce walking distance and cause leg pain.

Peripheral neuropathy

In diabetic neuropathy and other conditions, numbness or tingling may occur in both feet and legs.

Lumbar disc herniation

The disc may stimulate the nerve, causing leg pain and numbness. We must examine the process in which symptoms began and changes according to posture.

Walking distance and symptom changes

We check how many minutes or how far you need to walk for symptoms to appear, and how quickly symptoms improve when sitting down.

Lumbar movement

We examine how symptoms in the lower back and legs change when you straighten or bend your waist.

Muscle strength and sensation

We check leg muscle strength and sensation, as well as knee and ankle reflexes.

Balance and gait

We examine whether the leg drags, whether gait is unstable, or whether balance is disturbed when changing direction.

Hip and knee

We can perform a joint examination together to distinguish whether the gait limitation is due to lumbar nerve issues or joint problems.

Symptoms related to blood vessels

We check for signs of coldness in the feet, changes in skin color, and risk factors for vascular diseases.

Through such history taking and physical/neurological examinations, we assess the possibility of stenosis and other causes, and determine whether an MRI is necessary.

If stenosis is suspected based on symptoms and examination, MRI may be considered to assess the space through which nerves pass in order to determine the treatment direction.

Especially in the following cases, the need for imaging studies may increase.

• If walking distance continues to decrease
• When leg muscle strength decreases
• If sensory loss progresses
• When it is necessary to decide whether an injection or surgery is needed
• Cases requiring differentiation from other conditions

Severe stenosis seen on an MRI does not necessarily require surgery. Actual gait function and neurological symptoms must be evaluated together.

The activities are conducted in divided sessions.

Rather than walking for a long time at once until pain occurs, you can maintain your activity level by alternating between rest and walking.

Chuna manual therapy

It may be considered as part of a treatment plan when there are no progressing neurological abnormalities and when movement of the lower back, pelvis and hips and muscle function need to be managed together.

Chuna manual therapy is not a treatment that widens a narrowed spinal canal with hands. This is performed to help restore function so that the patient can walk and move more comfortably by managing the movement of the lower back and pelvis.

Treatment response is checked not only for pain but also for the following.

• The duration and distance you can walk without symptoms
• Time to recover after sitting
• Range of numbness in the leg
• Muscle strength and balance
• Changes in daily life

Acupuncture treatment and pharmacopuncture treatment

It may be selected according to the patient’s condition after assessing pain and muscle tension in the lower back, buttocks and legs.

Exercise and Rehabilitation

Exercise is performed considering movement of the lumbar spine and hip joint, lower limb muscle strength and balance, and gait ability. While some people find it comfortable to maintain a posture with the back slightly bent, like riding a bicycle, not all patients respond well to the same exercise.

Analgesics and neuropathic pain medications

Medications may help reduce pain and numbness and assist with activity.

For older patients, gastrointestinal, kidney and cardiovascular health, as well as fall risk from dizziness or drowsiness, should also be considered. Even if pain decreases, walking distance and leg strength must be checked separately.

Steroid injection and nerve block

If muscle strength is stable, walking discomfort and pain from spinal stenosis can be treated with the Chuna manual therapy, acupuncture, pharmacopuncture, and exercise described above. In periods when nerve pain is severe, injections are sometimes used alongside them, but in spinal stenosis, the effects are often temporary.

Because risks such as elevated blood sugar and reduced bone health accumulate the more they are repeated, and because this condition frequently affects older patients, greater caution is needed. If injections are repeated, walking function and muscle strength should be re-evaluated, and recovery continues with treatment to regain movement of the lower back, pelvis, and hip joints.

Surgical evaluation

Surgical evaluation is considered in cases such as the following:

• When restrictions on walking and daily life are very severe
• When symptoms continue to worsen despite non-surgical treatment
• When leg muscle weakness progresses
• When there are changes in bowel or bladder control and perineal sensation

While there are certainly cases where surgery is necessary, there are reports that particularly after spinal fusion surgery, strain can shift to adjacent segments above and below, causing new problems. If surgery has been recommended, it is best to weigh your walking distance and daily limitations, response to non-surgical treatment, surgical scope, and recovery plan together before deciding.

Even after surgery, once the surgical site stabilizes, Korean medicine treatments such as Chuna manual therapy can be helpful in the process of regaining function in surrounding joints and muscles. The starting time and intensity are determined in consultation with the surgical medical team.

• If leg strength drops rapidly
• If you experience dragging your leg or repeatedly falling
• Changes in bowel and bladder control
• Reduced sensation in the perineum
• If symptoms in both legs suddenly worsen
• If pain occurs along with a severe injury or high fever