Etiology — what causes it
Narrowing of the intervertebral foramen due to facet hypertrophy, uncovertebral osteophytes, disc bulging, or loss of disc height. Symptoms result from mechanical and inflammatory compression of the exiting nerve root.
Epidemiology — who gets it
More common in older adults; often coexists with degenerative changes and spinal stenosis.
Clinical signs
Positive Kemp's test (extension–rotation reproducing radicular symptoms), positive SLR or femoral nerve tension test depending on level, dermatomal findings. Imaging confirms foraminal narrowing.
Symptoms
Unilateral leg pain following a dermatomal pattern, often worse with extension, standing, walking, and ipsilateral side bending. Relieved by flexion.
Best evidence for chiropractic treatment
Flexion-biased exercises, neural mobilization, and graded loading are foundational. Manual therapy may provide short-term benefit. Epidural steroid injection has supportive evidence for short-term relief. Surgical decompression is reserved for refractory cases.
When to seek emergency care
Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.
Bottom line
Foraminal stenosis often responds to flexion-biased exercise and neural mobilization. Surgery is for refractory progressive cases.