Test library › Low back & pelvis
No pain when seated (lumbar spinal stenosis)
For: Lumbar spinal stenosis
Website-only page: no separate test card in the book, which discusses this in its ‘The low back and pelvis’ chapter.
Narrowing of the spaces in the lower spine that carry the nerves, usually from age-related change. Typically causes pain, heaviness or tingling in the buttocks or legs on walking or standing that eases with sitting or bending forward.
Treat with caution (see below)Likelihood ratios as published by the review.
Caution: Single small study (93 patients) in specialty clinics; the 95% confidence interval for LR+ is wide (1.9 to 30).
How it is done
Ask whether the pain goes away when the patient sits down. Positive: the patient reports no pain when seated.
What the studies found
Clinical syndrome of lumbar spinal stenosis. A history question, not a physical test. From a single study (Katz 1995: 93 patients in 3 specialty clinics), reported in the Suri 2010 JAMA review: sensitivity 47% (95% CI 32–61%), specificity 94% (85–100%), LR+ 7.4 (1.9–30), LR− 0.57 (0.43–0.76). The review judged this, with improvement of symptoms when bending forward, the most useful single finding. Related findings in the same review: symptoms improve when bending forward, LR+ 6.4 (4.1–9.9; Konno 2007); pain in both buttocks or legs, LR+ 6.3 (3.1–13; Ljunggren 1991).
What the numbers mean
- Positive result: see the caution above before relying on this result.
- Negative result: barely informative: a negative result changes little.
The ladder: what a result does to your estimate
| If you thought | After a positive | After a negative |
|---|---|---|
| 10% | 45% | 6% |
| 30% | 76% | 20% |
| 50% | 88% | 36% |
Calculated from the likelihood ratios above. Read the caution above before relying on these. For any other starting estimate, use the probability calculator.
Work out what a result means for your patient: probability calculator
Other tests in the library for lumbar spinal stenosis
- Lumbar spinal stenosis diagnostic support tool (Konno score)
- Lumbar spinal stenosis history cluster (Cook, 5 items)
- Wide-based gait (lumbar spinal stenosis)
Compare all the tests for lumbar spinal stenosis side by side
Source
Suri P, Rainville J, Kalichman L, Katz JN. Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis? JAMA. 2010;304(23):2628–2636. Journal article (DOI) · systematic review
Also cited: Katz JN, Dalgas M, Stucki G, et al. Degenerative lumbar spinal stenosis: diagnostic value of the history and physical examination. Arthritis Rheum. 1995;38(9):1236–1241. Journal article (DOI)
Website-only page, added to the library on 9 October 2026. Rule It In, Rule It Out discusses this but has no separate test card for it. Figures independently checked against the sources cited above; any note above says where only the abstract could be checked.
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The ‘The low back and pelvis’ chapter of Rule It In, Rule It Out discusses this, alongside how to do and read each test in the chapter.
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