You used to walk right round the park. Then you had to stop once. Now it is twice, and you sit on a bench until your legs ease — which, fortunately, usually happens quickly.
If you recognise this, it is probably not a lack of fitness. It is a pattern with a name, with an explanation, and with a good deal to do before surgery is considered.
If you ticked three or more, the rest of this page is worth reading carefully.
Inside the spine there is a canal the nerves pass through. Over time that canal can become narrower — through thickening of ligaments, changes in the joints, or the disc itself taking up space.
That cycle — walking, the legs growing heavy, stopping, sitting, easing, walking again — is called neurogenic claudication. It is the most recognisable sign of this condition, and it sets it apart from a circulation problem, which behaves differently.
Notice that the list of what eases it is almost the reverse of other spinal pain. That is what makes this condition identifiable.
The most characteristic sign. You manage a certain distance, your legs start to feel heavy or tingly, and you have to stop. After resting, you start again — and the cycle repeats.
In a queue, cooking, at an event. Standing without moving is usually as bad as walking, sometimes worse.
Extending the trunk closes the canal. It is the movement most people with this condition have been avoiding for a long time, without having noticed.
Going down is usually worse than going up — because going up you naturally lean further forwards, and that opens up space.
In this position the spine is in extension. It is often uncomfortable or impossible to hold.
Chairs that force you to keep your back very straight can be uncomfortable, unlike a chair that lets you lean back or tilt.
Relief is often almost immediate. Sitting and relaxed, it is common to have no pain at all — which confuses a lot of people, professionals included.
Leaning on the worktop, holding the handrail, or simply bending the trunk. It opens the canal and eases it.
It is not the trolley that helps, nor the support: it is the leaning over it. That forward lean opens the canal. That is why you can go round the whole supermarket and cannot manage the same distance in the street.
For the same reason: the posture is one of flexion. Many people who cannot walk 200 metres cycle for half an hour without trouble.
With your knees drawn up towards your chest. It is the sleeping position most people end up adopting on their own.
It may seem counterintuitive, but going up is usually easier than going down — the body's natural forward lean opens up space.
In this condition, measuring progress by how intense the pain is misleads. What matters is how many metres you can walk before having to stop — and that is what gets measured, at the start and along the way.
We start by recording how far you can walk before having to stop. Without that starting point, there is no honest way to know whether what we are doing is working.
It is the first thing we try, and the order matters: while the nerve is compressed, training walking is pushing against a closed door. Movements and positions that open the canal, progressing from lying down to sitting to standing — until you can use them in the middle of the street, when you need to.
Only when the symptoms have calmed: overall strength and walking broken into stages, gaining metres little by little. It is slow, unspectacular work — and it is what keeps you independent in the long run.
The narrowing of the canal is a structural change. We are not going to undo it with exercise, and promising you otherwise would be a lie.
What can often be achieved is something else — and it is no small thing: increasing the distance you walk without stopping, reducing how often the symptoms appear, keeping your strength and balance, and postponing or avoiding surgery. For many people that is the difference between carrying on with an independent life and stopping going out at all.
And there are cases where surgery is the right decision. If yours is one of them, I tell you — I do not carry on treating out of stubbornness while you lose months of your life.
If yours is not here, ask me directly.
Maybe, and maybe not. There are clear indications for surgery in this condition, and there are many people who gain enough distance without going through it. I cannot predict which is your case before assessing you and seeing how you respond over a few weeks. What I can promise is that I do not hide the surgical option if it is the best one for you.
You should not stop. You should adjust. If walking 500 metres in one go leaves you suffering for the rest of the day, walking five lots of 100 metres with breaks is usually far better tolerated and keeps your capacity. Stopping altogether is the fastest route to losing strength and distance.
Because on a bicycle you are leaning forwards, and that position opens the canal the nerves pass through. Walking upright closes it. It is not a lack of fitness or of willpower — it is geometry, and it is one of the signs that helps confirm the condition.
Not always, and not in a straight line. The narrowing tends to progress slowly, but the symptoms do not follow that progression directly — there are better and worse spells. Much of what determines how independent you are in a few years' time is the strength and capacity you keep, and that is largely in your hands.
Nothing on this page replaces an assessment by a healthcare professional. And there are situations that are not a matter for physiotherapy at all:
this calls for urgent medical care, the same day.
A medical appointment the same day, as soon as possible, with neurosurgery or spinal orthopaedics.
This is not a matter for physiotherapy, nor for any other healthcare professional.
And it is not a matter of waiting to see whether it improves. Here, time is what weighs most on the outcome: the sooner you are seen by a doctor, the better.
See every sign, by area, and what to do in each caseThat is often the most useful piece of information you can give me. From it I can work out a good deal, and tell you frankly what I think.
Initial conversation free of charge. I always reply — and, most of the time, the same day.
Cashin AG et al. Review on non-specific low back pain. JAMA, 2026. — the proportion of non-specific low back pain and of radiculopathy/stenosis among those seeking care; degenerative changes on MRI in people without low back pain (74.4%) and with pain (77.8%); recommendations on the use of imaging; the effectiveness of exercise in chronic low back pain and of invasive treatments.
Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR American Journal of Neuroradiology. 2015;36(4):811-816. — the prevalence of degenerative findings in people without symptoms, by age group.
Anything on this page that does not point to these references is my own clinical reading, marked as such throughout the text. No information here replaces an individual assessment.