Spine

Spinal stenosis.

When walking a few hundred yards forces you to sit down, and leaning on a shopping cart makes it better, that pattern is telling you something specific.

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The pattern that identifies it

Spinal stenosis is narrowing of the canal the spinal cord and nerves run through, usually from age-related thickening of ligament, bone and joint. The classic presentation — neurogenic claudication — is distinctive: leg pain, heaviness or weakness that comes on with walking or standing and eases within minutes of sitting or bending forward.

That bending-forward relief is the tell. It opens the canal slightly. It is why people with stenosis can push a shopping cart around a supermarket comfortably but cannot walk the same distance upright, and why they often find a stationary bike easier than a treadmill.

What we see

Symptoms that fit stenosis

  • Leg pain or heaviness on walking, relieved by sitting
  • Better leaning forward — on a cart, a counter, a bicycle
  • Symptoms in both legs more often than one
  • A steadily shrinking walking distance over months or years
  • Numbness or weakness in the legs with activity
  • Back pain that is often milder than the leg symptoms

How it works

How it is managed

  1. 01

    Confirm the diagnosis

    The history is highly suggestive; MRI confirms where and how severely the canal is narrowed. Vascular claudication can mimic it, so we consider that too.

  2. 02

    Target the inflamed level

    Epidural steroid injection at the level involved can reduce inflammation around the compressed nerves and extend walking distance.

  3. 03

    Address contributing facet pain

    Facet arthritis usually accompanies stenosis and adds its own pain, which responds to blocks and ablation.

  4. 04

    Preserve function

    Flexion-based exercise and conditioning keep walking distance up. Stenosis is a condition to be managed well over years, and doing that properly can defer surgery considerably.

Treatment options

Epidural steroid injection

Placed at the narrowed level under live X-ray to reduce inflammation around the compressed nerves.

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Medial branch block & radiofrequency ablation

For the facet arthritis component that typically accompanies stenosis.

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Spinal cord stimulation

For leg pain that has not responded to injections, including after decompression surgery.

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In their words

Patients treated for this

5.0 from 217 Google reviews
★★★★★
Over too many years I have seen too pain management guys. This one is different. First, he caught something on an MRI that only one other health professional had caught, including those reading the MRI, a cyst at the base of my spine pushing again the nerve. Second, his (their) treatment of it was first class. He took his time, was gentle. Concerned about my pain level throughout the process. Talked. Was funny, or at least amused by my jokes, a nervous habit and caring. Great experience!
Jim McCarthy
★★★★★
My first visit with the "Ponte Vedra Spine & Pain Center" was "exceptional". The staff were very friendly & welcoming as well as professional. My meeting with Dr Loch was equally "exceptional." He carefully reviewed the MRIs & and evaluations of previous physicians, listened attentively while I reported the origins of my back problem through my current condition. He then fully explained the available procedures to treat my back pain & was very frank about how effective each procedure could be in alleviating my pain. Our visit concluded with a thorough plan to address my condition until our next meeting; Dr Loch prescribed medication to manage my pain, and set up a follow up appointment. I could not be more impressed with the Spine & Pain Center and happier with my decision to seek treatment with Dr. Loch & staff. J. B. Egan CAPT. USCR Ret.
Joseph Egan
★★★★★
The Team at PV Spine and Pain have been great. From initial reach out through completion of procedure and communication has been top notch. Dr. Loch took time to discuss my needs, answered my questions and is unquestionably is an expert in his field. It is a friendly environment with the staff that clearly is concerned with the patient’s well-being.
Jeremiah White
Read all reviews on Google → Synced from Google on 24 July 2026

Questions we get asked

Will I eventually need surgery?
Some people do, particularly when walking distance becomes severely limited or there is progressive weakness. Many manage for years with injections and conditioning. Stenosis usually progresses slowly, so a considered approach over time is reasonable.
How long does an epidural help in stenosis?
It varies widely — weeks to many months. Where it helps meaningfully it can be repeated. Where it does not help at all, that tells us to reconsider the diagnosis or the plan rather than to try again.
Is walking bad for stenosis?
No — staying active is important. The trick is finding a way to do it that does not provoke the symptoms: a bike, a pool, interval walking with sitting breaks. We will work out what fits you.

Eliminate pain and reclaim your life.

Request an appointment with Dr. Loch, or call the office at (904) 750-3787. Most patients are seen within a week.

Request an appointment