 METHODS: This will be a comparative effectiveness study utilizing the research design of a randomized controlled clinical trial RCT. It will be a 3-group RCT that allows for pragmatic treatment approaches in each of the three study arms. The study sample will consist of 240 older adults 60 years who have symptoms consistent with a diagnosis of LSS, which will be confirmed by clinical examination and diagnostic imaging. Eligible subjects will be randomized into one of three pragmatic treatment approaches: 1 usual medical care; 2 group exercise; or 3 manual therapy with rehabilitative exercise. 