Radiating Pain
Neurogenic Claudication
Neurogenic claudication is characterized by burning pain and dyesthesia that is found in the back and can radiate into the buttocks, thighs, calves, and feet. The pain is usually bilateral but can be unilateral in some cases. Spinal stenosis is the cause of neurogenic claudication. The narrowing of the spinal canal, nerve root canals, or intervertebral foramina puts pressure on nerves causing pain following nerve root distributions.
Locations of Pain:
Low back (lumbar), buttocks, thighs, calves, and feet
Common associated signs and symptoms:
Normal Pulse
Good skin condition
Decreased or absent Achilles reflex
Positive straight leg raise
Sciatica
Aggravating Factors:
Pain increases with back extension
Increased with walking
Relieving Factors: Pain is decreased with
Sitting
Lying down
Bending forward
Flexion exercises
The Bike Test: used for Differentiating between neurogenic and vascular claudication
The patient is seated on an exercise bike and asked to pedal against resistance. If pain in any of the locations listed above returns we must differentiate the cause. While pedaling, ask the patient to lean forward, if the pain is relieved the test is positive for neurogenic claudication. Leaning forward (flexion) opens the spinal canal (increases the diameter) which relieves the pressure on the nerves and thus relieves or decreases symptoms. The test is confirmed when the patient sits up and symptoms return. With vascular claudication a change in position will have no effect on or alleviate symptoms.
References
1. Goodman, C. C., Teresa E. Kelly snyder. (2007). Differential Diagnosis for Physical Therapists Screening for Referral: Saunders Elsevier.
Neurogenic claudication is characterized by burning pain and dyesthesia that is found in the back and can radiate into the buttocks, thighs, calves, and feet. The pain is usually bilateral but can be unilateral in some cases. Spinal stenosis is the cause of neurogenic claudication. The narrowing of the spinal canal, nerve root canals, or intervertebral foramina puts pressure on nerves causing pain following nerve root distributions.
Locations of Pain:
Low back (lumbar), buttocks, thighs, calves, and feet
Common associated signs and symptoms:
Normal Pulse
Good skin condition
Decreased or absent Achilles reflex
Positive straight leg raise
Sciatica
Aggravating Factors:
Pain increases with back extension
Increased with walking
Relieving Factors: Pain is decreased with
Sitting
Lying down
Bending forward
Flexion exercises
The Bike Test: used for Differentiating between neurogenic and vascular claudication
The patient is seated on an exercise bike and asked to pedal against resistance. If pain in any of the locations listed above returns we must differentiate the cause. While pedaling, ask the patient to lean forward, if the pain is relieved the test is positive for neurogenic claudication. Leaning forward (flexion) opens the spinal canal (increases the diameter) which relieves the pressure on the nerves and thus relieves or decreases symptoms. The test is confirmed when the patient sits up and symptoms return. With vascular claudication a change in position will have no effect on or alleviate symptoms.
References
1. Goodman, C. C., Teresa E. Kelly snyder. (2007). Differential Diagnosis for Physical Therapists Screening for Referral: Saunders Elsevier.