Spinal Stenosis Exercises for Adults With Scoliosis: What the Trials Show and What to Avoid

By Dr. Justin Dick, DC · Clear Life Scoliosis and Chiropractic Center, Charlotte, NC · Published October 14, 2026

Exercise and physical therapy are reasonable first-line care for lumbar spinal stenosis, and one randomized trial found a structured physical therapy program produced physical function similar to surgery at two years. The overall quality of evidence for any specific nonsurgical treatment is low, and surgery outperforms continued conservative care once that care has failed for several months. Adults with scoliosis add a layer: the curve itself can narrow the canal and nerve openings unevenly.

I am Dr. Justin Dick, and at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC, I see older adults whose scoliosis was quiet for decades and now produces leg pain when they walk. This post covers what the evidence supports and how I approach exercise in that setting.

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Stenosis and Neurogenic Claudication

Lumbar spinal stenosis is narrowing of the spinal canal or the openings where nerves exit. The classic symptom is neurogenic claudication: leg pain, heaviness, or numbness that comes on with standing or walking and eases with sitting or bending forward. That pattern reflects position. Extension of the lumbar spine reduces canal and foraminal space, and flexion increases it, which is why many patients lean on a shopping cart.

In adults with scoliosis, rotation and lateral translation at the lower end of a lumbar or thoracolumbar curve can narrow the openings on one side more than the other. My posts on thoracolumbar scoliosis and adult scoliosis treatment cover how those curves behave over time.

What the Trials Show

Delitto and colleagues randomized 169 surgical candidates aged 50 or older with lumbar spinal stenosis to decompression surgery or physical therapy. At two years, physical function improved by 22.4 points with surgery and 19.2 with physical therapy, with no difference between groups in the intention-to-treat analysis. Fifty-seven percent of the physical therapy group crossed over to surgery, and the authors noted that without an untreated control, neither result can be attributed with certainty to the intervention.

The 2013 Cochrane review by Ammendolia and colleagues covered 21 trials and 1,851 participants. It found low-quality evidence from a single trial that exercise gives short-term benefit for leg pain and function compared with no treatment, and concluded that moderate and high-quality evidence for nonoperative treatment is lacking.

Kovacs and colleagues reviewed five randomized trials of 918 patients in whom conservative care had already failed for 3 to 6 months. Surgery produced better pain, disability, and quality of life than continued conservative care, though not better walking ability, with the advantage narrowing over 2 to 4 years.

Read together: a structured, supervised program is a sound first step, and its results in one good trial were comparable to surgery. If it has not helped after several months, the case for surgical consultation is strong.

Exercise Principles I Use

These are my clinical approach, built on the positional physiology above and the trial evidence, not a protocol tested in a scoliosis-specific trial.

• Positions that open the lumbar canal, such as flexion-biased stretching and supported forward lean, are usually tolerated better than sustained extension.
• Cycling or walking with a forward-leaning support often allows conditioning when upright walking provokes symptoms.
• Hip mobility and trunk endurance work reduce the demand on the lumbar segments.
• In scoliosis, exercises are chosen with the curve in mind. A movement that opens one side can close the other, so side-specific loading is checked against the curve pattern.
• Progress is tracked with a walking measure. A 2019 systematic review of walking outcome measures recommended the self-paced walking test and the Oswestry Disability Index walking item until better evidence is available.

What to Avoid

Exercises that hold the lumbar spine in sustained extension, heavy loaded spinal extension, and programs that ignore the curve's direction are the ones I modify first. Worsening weakness, loss of bladder or bowel control, saddle numbness, or rapidly progressive symptoms are not exercise problems. They need urgent medical evaluation.

How Dr. Justin Dick Approaches Stenosis With Scoliosis at Clear Life

At our Charlotte office, the evaluation starts with a neurological exam, standing PA and lateral radiographs that show the curve, rotation, lateral translation, and sagittal balance, and review of any MRI. Care combines curve-aware exercise, structural rehabilitation, and, where appropriate, shockwave and PEMF as adjuncts. Walking capacity and function are re-measured at set intervals, and patients who are not improving are referred for surgical consultation.

Comparison

Research and Evidence

Evidence tiering: Delitto 2015 is the strongest single trial, limited by crossover and the absence of a no-treatment arm. The Cochrane review grades most nonoperative evidence as low or very low quality. None of these trials focused on patients with scoliosis, so applying them to degenerative or adult idiopathic curves involves extrapolation.

My own published work includes two adult cases relevant here. The refractory lumbar pain case, Refractory Lumbar Pain Following Motor Vehicle Collision in a Geriatric Patient With Prior Lumbar Surgery (Cureus, 2026, PMID 41694169), describes a 66-year-old with prior lumbar fusion and mild thoracic scoliosis whose radicular symptoms resolved after a 10-week multimodal program. The geriatric case series, Radiographic Sagittal Alignment and Kinetic Chain Alterations in Geriatric Patients With Scoliosis: A Case Series (Cureus, 2026, PMID 42037873), describes two older adults with scoliosis whose pain related to kinetic chain compensation and sagittal alignment. Both are case-level evidence.

References

1. Delitto A, Piva SR, Moore CG, et al. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 2015;162(7):465-73. doi:10.7326/M14-1420
2. Ammendolia C, Stuber KJ, Rok E, et al. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database Syst Rev. 2013;(8):CD010712. doi:10.1002/14651858.CD010712
3. Kovacs FM, Urrútia G, Alarcón JD. Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine. 2011;36(20):E1335-51. doi:10.1097/BRS.0b013e31820c97b1
4. Anderson DB, Mathieson S, Eyles J, et al. Measurement properties of walking outcome measures for neurogenic claudication: a systematic review and meta analysis. Spine J. 2019;19(8):1378-1396. doi:10.1016/j.spinee.2019.04.004
5. Whelan JP, Dick JM. Radiographic sagittal alignment and kinetic chain alterations in geriatric patients with scoliosis: a case series. Cureus. 2026;18(3):e105827. doi:10.7759/cureus.105827
6. Dick JM. Refractory lumbar pain following motor vehicle collision in a geriatric patient with prior lumbar surgery: clinical resolution after multimodal conservative spinal structural rehabilitation. Cureus. 2026;18(2):e103540. doi:10.7759/cureus.103540

Frequently Asked Questions

Service Area

Clear Life Scoliosis and Chiropractic Center sees patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, Fort Mill SC. Families from across the Charlotte region and the South Carolina border communities come to the Rachel Freeman Way office for radiographic scoliosis evaluation with Dr. Justin Dick.

Related Pages

• Scoliosis Treatment for Adults
• Thoracolumbar Scoliosis
• Adult De Novo Scoliosis Case
• Kinetic Chain Dysfunction in Geriatric Scoliosis
• Adult Scoliosis
• Adult Scoliosis Treatment
• Can Scoliosis Cause Pelvic Tilt?
• Shockwave Therapy
• Spinal Emergencies
• Dr. Justin Dick Research

Schedule an Evaluation in Charlotte

If walking now brings on leg pain and you have a known curve, the evaluation should cover both the curve and the canal. Dr. Justin Dick does that at our Charlotte office and refers for surgical consultation when the evidence points there.

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