Relief from Neurogenic Claudication: Managing Leg Pain

Individuals experiencing shooting, aching pain in the lower extremities, and intermittent leg pain could be suffering from neurogenic claudication. Can knowing the symptoms help healthcare providers develop an effective treatment plan?

Neurogenic Claudication

Neurogenic claudication occurs when spinal nerves become compressed in the lumbar or lower spine, causing intermittent leg pain. Compressed nerves in the lumbar spine can cause leg pain and cramps. The pain usually worsens with specific movements or activities like sitting, standing, or bending backward.  It is also known as pseudo-claudication when the space within the lumbar spine narrows. A condition known as lumbar spinal stenosis. However, neurogenic claudication is a syndrome or group of symptoms caused by a pinched spinal nerve, while spinal stenosis describes the narrowing of the spinal passages.

Symptoms

Neurogenic claudication symptoms can include:

• Leg cramping.
• Numbness, tingling, or burning sensations.
• Leg fatigue and weakness.
• A sensation of heaviness in the leg/s.
• Sharp, shooting, or aching pain extending into the lower extremities, often in both legs.
• There may also be pain in the lower back or buttocks.

Neurogenic claudication is different from other types of leg pain, as the pain alternates – ceasing and beginning randomly and worsens with specific movements or activities. Standing, walking, descending stairs, or flexing backward can trigger pain, while sitting, climbing stairs, or leaning forward tends to relieve pain. However, every case is different. Over time, neurogenic claudication can affect mobility as individuals try to avoid activities that cause pain, including exercise, lifting objects, and prolonged walking. In severe cases, neurogenic claudication can make sleeping difficult.

Neurogenic claudication and sciatica are not the same. Neurogenic claudication involves nerve compression in the central canal of the lumbar spine, causing pain in both legs. Sciatica involves compression of nerve roots exiting from the sides of the lumbar spine, causing pain in one leg. (Carlo Ammendolia, 2014)

Causes

With neurogenic claudication, compressed spinal nerves are the underlying cause of the leg pain. In many cases, lumber spinal stenosis – LSS is the cause of pinched nerve. There are two types of lumbar spinal stenosis.

• Central stenosis is the main cause of neurogenic claudication. With this type, the central canal of the lumbar spine, which houses the spinal cord, narrows, causing pain in both legs.
• Lumbar spinal stenosis can be acquired and develop later in life due to spine deterioration.
• Congenital means the individual is born with the condition.
• Both can lead to neurogenic claudication in different ways.
• Foramen stenosis is another type of lumbar spinal stenosis that causes the narrowing of spaces on either side of the lumbar spine where nerve roots branch off the spinal cord. The associated pain is different in that it is either in the right or left leg.
• The pain corresponds to the side of the spinal cord where the nerves are being pinched.

Acquired Lumbar Spinal Stenosis

Lumbar spinal stenosis is usually acquired due to the degeneration of the lumbar spine and tends to affect older adults. The causes of the narrowing can include:

• Spinal trauma, such as from a vehicle collision, work, or sports injury.
• Disc herniation.
• Spinal osteoporosis – wear-and-tear arthritis.
• Ankylosing spondylitis – a type of inflammatory arthritis that affects the spine.
• Osteophytes – bone spurs.
• Spinal tumors – non-cancerous and cancerous tumors.

Congenital Lumbar Spinal Stenosis

Congenital lumbar spinal stenosis means an individual is born with abnormalities of the spine that may not be apparent at birth. Because the space within the spinal canal is already narrow, the spinal cord is vulnerable to any changes as the individual ages. Even individuals with mild arthritis can experience symptoms of neurogenic claudication early on and develop symptoms in their 30s and 40s instead of their 60s and 70s.

Diagnosis

Diagnosis of neurogenic claudication is largely based on the individual’s medical history, physical examination, and imaging. The physical examination and review identify where the pain is presenting and when. The healthcare provider may ask:

• Is there a history of lower back pain?
• Is the pain in one leg or both?
• Is the pain constant?
• Does the pain come and go?
• Does the pain get better or worse when standing or sitting?
• Do movements or activities cause pain symptoms and sensations?
• Are there any usual sensations while walking?

Treatment

Treatments can consist of physical therapy, spinal steroid injections, and pain meds. Surgery is a last resort when all other therapies are unable to provide effective relief.

Physical Therapy

A treatment plan will involve physical therapy that includes:

• Daily stretching
• Strengthening
• Aerobic exercises
• This will help improve and stabilize the lower back muscles and correct posture problems.
• Occupational therapy will recommend activity modifications that cause pain symptoms.
• This includes proper body mechanics, energy conservation, and recognizing pain signals.
• Back braces or belts may also be recommended.

Spinal Steroid Injections

Healthcare providers may recommend epidural steroid injections.

• This delivers a cortisone steroid to the outermost section of the spinal column or the epidural space.
• Injections can provide pain relief for three months to three years. (Sunil Munakomi et al., 2024)

Pain Meds

Pain medications are used to treat intermittent neurogenic claudication. These include:

• Over-the-counter analgesics like acetaminophen.
• Nonsteroidal anti-inflammatory drugs or NSAIDs like ibuprofen or naproxen.
• Prescription NSAIDs may be prescribed if needed.
• NSAIDs are used with chronic neurogenic pain and should only be used when required.
• The long-term use of NSAIDs can increase the risk of stomach ulcers, and the overuse of acetaminophen can lead to liver toxicity and liver failure.

Surgery

If conservative treatments are unable to provide effective relief and mobility and/or quality of life are affected, surgery known as a laminectomy may be recommended to decompress the lumbar spine. The procedure may be performed:

• Laparoscopically – with small incisions, scopes, and surgical instrumentation.
• Open surgery – with a scalpel and sutures.
• During the procedure, facets of the vertebra are partially or completely removed.
• To provide stability, the bones are sometimes fused with screws, plates, or rods.
• Success rates for both are more or less the same.
• Between 85% and 90% of individuals undergoing the surgery achieve long-lasting and/or permanent pain relief. (Xin-Long Ma et al., 2017)

Movement Medicine: Chiropractic Care

References

Ammendolia C. (2014). Degenerative lumbar spinal stenosis and its imposters: three case studies. The Journal of the Canadian Chiropractic Association, 58(3), 312–319.

Munakomi S, Foris LA, Varacallo M. (2024). Spinal Stenosis and Neurogenic Claudication. [Updated 2023 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430872/

Ma, X. L., Zhao, X. W., Ma, J. X., Li, F., Wang, Y., & Lu, B. (2017). Effectiveness of surgery versus conservative treatment for lumbar spinal stenosis: A system review and meta-analysis of randomized controlled trials. International journal of surgery (London, England), 44, 329–338. https://doi.org/10.1016/j.ijsu.2017.07.032