 OBJECTIVES: This study will perform a comparison of three common approaches to the non-surgical management and treatment of patients with LSS. The specific research questions associated with this study are: 1 How do group exercise and manual therapy with rehabilitative exercise compare with usual medical care? 2 How do group exercise and manual therapy with rehabilitative exercise compare with each other? 3 Are there any baseline predictors associated with clinical improvement in any of these non-surgical treatment approaches? The long term objective of this study is to produce research evidence relevant to community stakeholders and to inform better decision making about non-surgical treatment options available to LSS patients. 