Understanding Neurogenic Claudication: Symptoms, Causes, Diagnosis, and Treatment

Oct 21

Neurogenic claudication is a medical term used to describe pain or discomfort in the legs that occurs when walking or standing and is relieved by sitting down or bending forward. For people experiencing it, daily activities like walking or standing for long periods can become challenging. The symptoms were so severe for one of my patients, he could not make it to his mailbox without having to stop and rest several times. This condition is often linked to spinal issues and affects many people, particularly as they age.

If you or someone you know is experiencing leg pain that improves with rest, here’s a guide to understanding neurogenic claudication.

What Causes Neurogenic Claudication?

The root cause of neurogenic claudication is **spinal stenosis**, which is the narrowing of the spinal canal. This narrowing puts pressure on the nerves that travel from the lower spine into the legs. The most common reason for spinal stenosis is age-related changes in the spine. Over time, the spine can undergo wear and tear, leading to the development of bone spurs, thickening of ligaments, or bulging discs, all of which can contribute to the narrowing of the spinal canal.

As the spinal canal narrows, the nerves that control the legs become pinched. This nerve compression causes the pain, tingling, or weakness that people with neurogenic claudication often feel.

Symptoms of Neurogenic Claudication

The key symptom of neurogenic claudication is **leg pain or discomfort** that happens when prolonged walking or standing. Other common symptoms include:

- Tingling or numbness in the legs or feet

- Weakness in the legs, making walking or standing difficult.

Some patients describe this sensation is “heaviness” in the legs

- **Cramping or burning sensation** in the thighs, calves, or buttocks (and sometimes the low back itself)

- Pain that gets worse with walking or prolonged standing but **relieves when sitting or bending forward**

Patients often times have to lean over a shopping cart or over a walker to make their symptoms go away
Patients have to frequently pause when walking and either stand still or sit down to make their symptoms go away

These symptoms often develop slowly over time and tend to get worse as the spinal stenosis progresses.

Diagnosing Neurogenic Claudication

If you are experiencing symptoms of neurogenic claudication, a healthcare provider can help confirm the diagnosis. A typical evaluation includes:

- Physical Exam: Your doctor will assess your range of motion, muscle strength, and reflexes in the lower body.

- Medical History: A detailed discussion about when your symptoms occur and what makes them better or worse can help pinpoint the condition.

- Imaging Tests: Tests such as an X-ray, MRI, or CT scan are used to look for spinal stenosis and determine if the spinal canal has narrowed, causing nerve compression. MRI is particularly useful because it can provide detailed images of the spinal nerves and soft tissues.

Treatment for Neurogenic Claudication

Fortunately, neurogenic claudication can often be managed with a combination of **conservative treatments** or, in some cases, surgery if the condition does not improve.

Conservative (Non-Surgical) Treatments

1. Physical Therapy (PT)

A physical therapist can design an exercise program tailored to your needs. PT focuses on strengthening the muscles of your core and lower body, improving flexibility, and increasing overall mobility. These exercises can help reduce pressure on the nerves and alleviate some of the discomfort caused by neurogenic claudication.

2. Medications

Over-the-counter anti-inflammatory medications like ibuprofen or naproxen may help relieve pain and inflammation. In some cases, doctors may prescribe muscle relaxants or stronger pain medications for short-term relief. It’s important to talk with your healthcare provider about what medications are right for you, especially if you have other health conditions.

3. Epidural Steroid Injections (ESI)

Injections of corticosteroids into the spine can reduce inflammation and provide pain relief by reducing swelling around the nerves. This treatment doesn’t cure the stenosis but can offer relief while you work on strengthening your body with physical therapy.

When Surgery is Needed

If conservative treatments don’t provide adequate relief and symptoms continue to worsen, surgery is an option. The primary goal of surgery for neurogenic claudication is to relieve pressure on the nerves and decompress the area of the spine where the stenosis (narrowing) is occurring.

The most common surgery for spinal stenosis is decompression surgery, such as a laminectomy or laminotomy. This procedure involves removing a small part of the bone or tissue that is pressing on the spinal nerves, creating more space for the nerves to function normally.

Minimally invasive surgical techniques are often used to treat spinal stenosis, which can lead to quicker recovery times and less post-operative discomfort compared to traditional open surgery. The good news is that many patients experience significant relief from symptoms after surgery and are able to return to a more active lifestyle.

Conclusion

Neurogenic claudication can significantly impact your mobility and quality of life, but it is a manageable condition. If you’re experiencing leg pain, weakness, or discomfort that improves with sitting or leaning forward, it’s essential to seek medical advice. A thorough diagnosis can help determine the cause of your symptoms, and a range of treatment options—both conservative and surgical—can help you regain comfort and mobility.

With the right treatment plan, you can find relief and return to the activities you enjoy.

Schedule a consultation and we’ll figure out how to get you better.