Spinal Stenosis Without Surgery: A Walnut Creek Doctor Explains What Actually Works

From the podcast “Back At It with Dr. Decompression” with Dr. JD Dudum.

Listen, if you have been told you have spinal stenosis and the next conversation on the table is a spinal fusion, slow down before you schedule anything. Stenosis is one of the most common diagnoses I see in our Walnut Creek office, and it is also one of the most misunderstood. There is usually a lot that can be done before surgery becomes the only option.

Let me break down the three signs of lumbar spinal stenosis, the three different types, and exactly how non-surgical spinal decompression works on a problem most people assume only a surgeon can touch.

What are the three signs of lumbar spinal stenosis?

The three classic signs are leaning forward to get relief, pain that gets worse standing and better sitting, and nerve pain running down one leg or both legs. If all three sound like your day, stenosis is very likely part of your picture.

Sign 1: You lean forward on the shopping cart to feel better

We call it shopping cart syndrome. You are at Costco or Safeway or Trader Joe’s and you catch yourself hunched over the cart, forearms down, pushing along. It feels good, so you keep doing it.

That is not a posture habit. That is your spine solving a problem. Leaning forward flexes the lumbar spine, and flexion opens up the space where your nerves and spinal cord live. You are unloading the nerves, and your body figured that out before you did.

Sign 2: Standing makes it worse, sitting makes it better

With most low back problems, sitting is the enemy. With stenosis it flips. Standing in line, standing at the sink, walking any real distance, that is when the low back pain or the leg pain shows up. You sit down for a minute and it eases off.

Sitting is good, standing is bad. When a patient tells me that in the consult room, I am already thinking stenosis.

Sign 3: Nerve pain down one leg or both legs

This is the sciatica piece. Burning, numbness, tingling, heaviness, or that dead leg feeling that shows up after a few minutes of walking. Which leg it hits actually tells us something about the type of stenosis you have.

What is spinal stenosis, exactly?

Stenosis simply means a closing of a hole. In your spine there are two holes that matter. The central canal is where the spinal cord and nerve bundle run down the middle. The foramen is the side opening where each individual nerve exits. When either one narrows, the nerves get crowded and irritated.

Central canal stenosis affects the whole bundle running down the middle, so it tends to give you symptoms in both legs. Foraminal stenosis affects one nerve on its way out the side door, so it gives you sciatica or numbness down one leg only.

One note so the terminology does not trip you up when you read your report. Around the L1 level the spinal cord ends and becomes a bundle of nerve roots called the cauda equina, which means horse tail. So at L4-L5 we are talking about nerve roots, not spinal cord. People use the terms interchangeably. Technically they are not the same thing, but the practical problem is identical. Something is crowding tissue that does not like being crowded.

What causes spinal stenosis in the first place?

Stenosis is a slow degenerative process that usually takes 10, 20, or 30 years to develop. Long-term compression and stress on the spine causes your body to lay down extra bone and calcium deposits, and when that extra bone builds up inside the canal, the canal narrows.

Wolff’s law says that when a bone is placed under stress, the body responds by building more bone in that area. That is a smart adaptation almost everywhere in your body. Inside the spinal canal it backfires, because there is no spare room in there.

Where does the stress come from? Years of manual labor. Years of sitting at a desk. Long commutes. Old injuries. Certain training habits. It is rarely one event. It is a couple of decades of load, and then one day you cannot get through the grocery store without leaning on the cart.

Then the mechanical crowding triggers an inflammatory response, and inflammation around a nerve is what produces the radiating pain, numbness, and weakness. That last part matters, because inflammation is something we can influence.

Can non-surgical spinal decompression help spinal stenosis?

For many people it can, and here is the honest version of how. I cannot remove bone. I cannot reverse 30 years of degeneration. What I can do is create space and reduce the inflammatory response around the nerve, and for a lot of stenosis patients that is enough to change everything.

Think of your spine as a five lane freeway at rush hour. Every lane is jammed. Decompression is not going to remove the cars and clear that freeway. That is not what it does, and any doctor telling you otherwise is selling you something.

But if I can open up one lane, traffic starts moving. Then maybe a second lane opens. The jam slowly clears itself. That is what decompression does for stenosis. We are not fixing the anatomy, we are restoring flow.

Mechanically, we are doing the same thing your body already discovered at the shopping cart. On the table your legs are elevated so the lumbar spine is flexed, and we pull and oscillate at that flexed angle. Flexion creates space. Space plus gentle traction takes pressure off the disc and the canal, brings oxygen and nutrients back into the joints and disc, and calms the inflammation sitting on that irritated nerve. One lane opens.

I have to be straight with you. This does not work for everyone with stenosis. I say that to every stenosis patient who walks in, which is exactly why the testing we do before you start a program is the most important appointment you will have with us. You can read more about how non-surgical spinal decompression works and what a full program involves.

How do I know if decompression will work for me before I start?

We test it before you commit. During the exam I put you on the table and pull at different angles while you tell me what your leg is doing. If we find an angle where the nerve pain or numbness measurably drops, there is a strong chance you will respond to a full program.

The angle is everything with stenosis. Legs at 10 degrees is a completely different treatment than legs at 20 degrees, and the difference between the two can be the difference between a patient who gets their life back and a patient who wastes eight weeks. Most clinics pull everyone the same way. That is guessing.

So we do not guess, and we do not just read your MRI and assume. We reproduce the relief in the room first, with you telling me what you feel, and then we build the program around the angle that worked. If nothing we try changes your symptoms, I will tell you that, and I will tell you before you have spent a dollar on a treatment plan.

That approach comes from volume. We run 13 decompression tables in our Walnut Creek center and we have performed more than 50,000 decompression treatments. When you have pulled that many spines, you stop believing one protocol fits everybody.

What does stenosis recovery without surgery actually look like?

Here is a real case. A patient came to us with anterolisthesis, a disc bulge, disc degeneration, and both central canal and foraminal stenosis. Severe left leg sciatica. He could not walk more than three minutes without pain into his calf, and he had already been told he needed a spinal fusion.

He had done the injections. The first one gave him a month or two. The second one did less than the first, which is common. Fusion was the next item on the list, and he did not want it.

We tested him. When I pulled him with his legs high in the air, his leg felt better right there in the room. Less numbness, less sciatic pain. I told him what I tell everybody. I am not going to fix the stenosis, but if we can calm the inflammatory response around that nerve, you have a real shot.

Eight weeks later he was more than 90 percent better. Barely any sciatic pain. Walking normally. He went to Canada and hiked. Same anatomy, same MRI, completely different life, because we opened one lane of the freeway and let traffic move.

I have patients who came in that way years ago, still have no sciatica, and come see us once every few weeks to a month to keep the pressure off. No fusion. That is a reasonable outcome to aim for.

Can a herniated disc cause spinal stenosis?

Yes, and this is the third type most people have never heard of. If a disc herniation, protrusion, or extrusion pushes out sideways into the foramen, it physically occupies the hole where your nerve exits. Your MRI report will call that foraminal stenosis, but the cause is a disc injury, not bone.

This distinction matters enormously, because a disc can change. Bone spurs cannot. When stenosis is caused by disc material sitting in the foramen, we are not just managing symptoms, we are going after the thing causing the blockage.

The technique is different too. If your sciatica is on the left, we laterally translate the table at your waist to the right, away from the disc, so we open that side. Then we pull and oscillate in that position. Flex, bend away, decompress.

I used that exact strategy with a patient who had a disc occupying the foramen. We pulled him at the right angle with lateral bending away from the injured side, and his post-treatment MRI showed the disc had reduced by at least 30 percent compared to his pre-treatment MRI. He is 100 percent pain free.

That is not a testimonial, that is imaging, and it is the same standard we hold ourselves to in our published research on disc reduction with non-surgical decompression. Independent radiologists confirmed post-treatment reductions of 9, 27, 30, and 78 percent in four lumbar patients, and our 2026 cervical paper in the Journal of Contemporary Chiropractic documented a 52 percent reduction in a disc extrusion with cord compression. Both papers were co-authored with Dr. Bryan Gatterman, a board-certified chiropractic radiologist.

What if I have already been told I need a spinal fusion?

Get a second opinion before you schedule it. A fusion is permanent. Non-surgical decompression is not, and if it does not work for you, you have lost some weeks, not a segment of your spine.

Three types of stenosis. Central canal, foraminal, and stenosis caused by a disc injury. I have treated hundreds of stenosis cases across all three, and I have watched a lot of people cancel a surgery date and get back to hiking, golfing, standing through a workday, and sleeping through the night. You can see how we approach it on our spinal stenosis care page.

If you are going to try this, ask the right questions of whoever you see. What angle are you going to pull me at, and why that angle? How much force? How many stenosis cases have you personally treated? If a clinic cannot answer those, keep looking. And if you are not local to us, message me and I will do my best to point you toward someone in your area who actually has experience with stenosis, cervical or lumbar.

Frequently asked questions about spinal stenosis

Can spinal stenosis be reversed without surgery?

The bony narrowing itself cannot be reversed without surgery. What can change is the inflammation, the nerve irritation, and the amount of space available at that level, and those are what produce your symptoms. When stenosis is caused by a disc pressing into the foramen rather than by bone, the disc itself can reduce in size, which we have documented on before and after MRI.

Is walking good or bad for spinal stenosis?

Walking is good for you, but with stenosis it is often the activity that provokes symptoms, because you are upright and extended. Many patients can walk much farther on an incline or pushing a cart, since both put you into slight flexion. Do not stop walking. Modify it, and get the underlying compression addressed.

How long does a spinal decompression program for stenosis take?

Most of our stenosis patients follow an eight week program, and many notice meaningful change well before the end of it. Your response during the initial testing gives us a strong indication of what to expect before you begin.

Do you treat spinal stenosis patients outside of Walnut Creek?

Yes. Our center is in Walnut Creek and we see patients from throughout the East Bay, including Concord, Lafayette, Danville, and Pleasanton, along with patients who travel in from outside the Bay Area for concentrated care. Bring your MRI to your first visit.

Is spinal decompression painful?

No. Most patients find it relaxing, and a fair number fall asleep on the table. If a position or angle increases your symptoms, that is information we use to adjust, not something you have to push through.

Do not lose hope

If you have been diagnosed with stenosis, cervical or lumbar, you can get past it, and in a lot of cases you can get past it without more injections and without surgery. The testing tells us whether you are one of those people, and it takes one appointment to find out.

Contact us to book your appointment.

I am Dr. JD Dudum. This is Back At It with Dr. Decompression. Thanks for listening.