Lumbar spinal stenosis is a condition that may cause significant pain and associated disability, especially in older patients. It is being recognized with increasing frequency as the population continues to age, and is the most common diagnosis associated with lumbar spine surgery in patients older than 65 years of age. The natural history of lumbar spinal stenosis is not necessarily one of progressive deterioration. Conservative treatment is advocated in patients with mild to moderate symptoms of lumbar spinal stenosis, and may include therapeutic exercise. The therapeutic exercise program must be prescribed with a thorough understanding of the contributing pathoanatomic and pathophysiologic factors, and should be tailored to each patient based on his or her history and physical examination. Components of the program are described in detail and include specific stretching and strengthening exercises, general conditioning exercises, and education in proper posture and body mechanics. Randomized controlled studies are needed to help clarify the indications for conservative versus surgical treatment, to determine which components of the therapeutic exercise program are the most beneficial, and to compare outcomes after conservative or surgical measures.