Dry Needling and Spinal Manipulation vs. Conventional PT for Lumbar Spinal Stenosis

Inclusion Criteria: 1. Adult over the age of 50 years old that is able to read, write and speak English 2. Symptoms of neurogenic claudication (pain in the buttock, thigh, or leg during ambulation that improves with rest) or radicular leg symptoms with associated neurological deficits on the physical examination for at least 12 weeks. 3. Confirmatory imaging (i.e. magnetic resonance imaging (MRI), computed tomography (CT), myelography, ultrasound or X-ray of either central or lateral (foraminal) lumbar spinal stenosis at one or more levels in the lumbar spine. Exclusion Criteria: 1. Report of red flags to manual physical therapy to include: severe hypertension, infection, ankylosing spondylitis, neoplasm, uncontrolled diabetes, peripheral neuropathy, heart disease, stroke, chronic, ischemia, edema, severe varicosities, tumor, metabolic disease, prolonged steroid use, fracture, RA, osteoporosis, severe vascular disease, malignancy, etc. 2. Severe vascular, pulmonary, or coronary artery disease limiting participation in exercise, to include a walking program (including presence of absolute contraindications to submaximal exercise testing) 3. Severe degenerative stenosis with intractable pain and progressive neurological dysfunction 4. Lumbar spinal stenosis not caused by degeneration 5. Radiographic evidence of instability, degenerative spondylolisthesis, fracture or scoliosis of more than 15° 6. Lumbar herniated disc diagnosis during the last 12 months. 7. Previous lumbar surgery for lumbar spinal stenosis or instability (i.e. previous lumbar fusion, lumbar microdiscectomy, lumbar foraminotomy, lumbar laminectomy, etc.) 8. Psychiatric disorder or cognitively impaired. 9. Pregnancy