SPINAL STENOSIS most often affects men in their late fifties and is associated with recurrent low back microtrauma. Stenosis may occur anywhere in the central or lateral canals and may be of bony or soft-tissue origin. Because of its varied pathogenesis, patient presentation often varies. A hypothetical case presentation, specific reference to red flags, and the Agency for Health Care Policy and Research low back pain guidelines are offered as an aid to differentially diagnosing spinal stenosis. The epidemiology, natural history, and special studies of spinal stenosis are discussed. Finally, a progressive rehabilitation and management plan are provided and include prevention, passive modalities, and active care for the low back using a rehabilitation phase approach.