Understanding Claudication & Lumbar Spinal Stenosis: Exercises, Tests, and Clinical Guidance for Health Professionals

Do your patients complain of leg or buttock pain when walking—but feel relief when they sit or lean forward?

This classic presentation points toward neurogenic claudication, often caused by lumbar spinal stenosis (LSS), a degenerative condition common in adults over 60. As a physiotherapist, identifying the cause of claudication is critical for guiding effective, non-surgical management strategies and avoiding unnecessary referrals or interventions.

Let’s break down what you need to know about spinal stenosis, how to differentiate claudication types, and which exercises and clinical tests can guide your practice.

What Is Lumbar Spinal Stenosis?

Lumbar spinal stenosis refers to a narrowing of the spinal canal in the lower back, often due to age-related degenerative changes. This narrowing compresses the spinal nerves, impairing blood flow and leading to symptoms like:

• Buttock or leg pain with walking

• Heaviness, cramping, or pins and needles

• Pain relief when sitting or leaning forward

• Night cramps

Prevalence rises significantly in older adults.

Neurogenic vs Vascular Claudication: Know the Difference

Both conditions cause exercise-induced leg pain—but their mechanisms and treatments are distinct.

Key Tests to Differentiate:

• Standing Extension Test: Symptom provocation in extension suggests neurogenic origin.

• Two-Stage Treadmill Test: Neurogenic symptoms improve with incline walking; vascular worsens.

• Bicycle Test of van Gelderen: If leaning forward while cycling reduces symptoms, think neurogenic.

Exercise & Stretching for LSS (Non-Surgical Options)

Flexion-based exercises help open the spinal canal, improve blood flow to compressed nerves, and reduce neurogenic symptoms. These can often be safely done at home.

🔹 Stretching Routine (Flexion-Based):

1. Single-knee to chest – Supine, 3 seconds per leg

2. Double-knee hug – Supine, hips open, 10 seconds

3. Pillow hug in kneeling – Support spine flexion, 10+ seconds

4. Side-lying knees to chest – Especially helpful in bed at night

🔹 Pelvic Tilt Progression (Spine-Friendly Core Activation):

1. Supine pelvic tilts – Flatten lower back gently

2. Quadruped (cat curl) – Controlled spinal flexion

3. Seated tilts – Maintain mobility during daily activity

4. Standing tilts – For symptom relief when walking or shopping

These exercises help engage core musculature, promote spinal flexion, and alleviate nerve compression—ideal for conservative treatment protocols.

Functional Strategies for Activity Modification

Simple biomechanical adjustments can prolong mobility and independence:

• Planned walk breaks before pain begins

• Walking uphill or using treadmills with incline

• Using walking poles or shopping trolleys to encourage forward posture

• Rowing machines and recumbent bikes to support spinal flexion during cardio

Encourage patients to stay active within their symptom threshold and to avoid prolonged upright static standing.

References

• Buser Z, Ortega B, D'Oro A, et al. (2018). Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America. Global Spine J, 8(1):57–67.

• Walter KL, O’Toole JE. (2022). Lumbar Spinal Stenosis. JAMA, 328(3):310.

Clinical Note

Always rule out vascular causes before initiating spinal rehabilitation. A careful history, physical exam, and use of the van Gelderen test or treadmill protocols can clarify diagnosis when imaging is inconclusive.

Watch the Videos on ThePhysioChannel

➡️ “Lumbar Spinal Stenosis Exercises & Stretches”
➡️ “Neurogenic or Vascular Claudication? How to Tell the Difference”

Like, comment, or share with colleagues—these tools are made for busy clinicians looking to improve outcomes with evidence-based, patient-friendly strategies.

Want to create your own videos and YouTube Channel? Click Here

Daniel Lawrence | The Physio Channel
Helping people move better — one video at a time.