Vascular or Neurogenic Claudication
Do Your Legs Hurt When You Walk but Feel Better When You Rest?
It Could Be Claudication.
If you experience leg pain when walking that improves with rest or sitting, you might be dealing with a condition called claudication. But here’s the key question: is it neurogenic claudication from your spine or vascular claudication from your blood vessels?
In this blog (and in the video below), we’ll break down the key signs and clinical tests used to tell the difference.
What Is Claudication?
The term claudication refers to pain, cramping, or weakness in the legs that is brought on by activity. There are two main types:
Vascular Claudication: Caused by poor blood flow to the legs, often due to peripheral artery disease (PAD).
Neurogenic Claudication: Caused by narrowing in the lumbar spine (spinal stenosis), which compresses the spinal nerves.
Although the symptoms of both types can feel similar, the underlying causes—and treatments—are very different.
Key Differences Between Vascular and Neurogenic Claudication
Triggering Activity
Neurogenic Claudication is typically triggered by walking **upright**.
Vascular Claudication is triggered by walking **regardless of posture**.
Relieving the Pain
Neurogenic Claudication improves when bending forward or sitting.
Vascular Claudication improves simply by stopping activity—**even if standing still**.
Note: Neurogenic claudication is posture-sensitive, vascular claudication is not.
Location of the Pain
Neurogenic Claudication: Pain often radiates through the buttocks, thighs, and calves, usually both legs.
Vascular Claudication: Pain is typically isolated to the **calves**, also in **both legs**.
Pulses
Neurogenic Claudication: The posterior tibial pulses (in the ankle) are usually normal.
Vascular Claudication: These pulses are often diminished, indicating poor blood flow.
Patient Profile
Neurogenic Claudication: More common in people over 60 with a history of spinal stenosis.
Vascular Claudication: Also seen in older adults, especially those with vascular risk factors like smoking, diabetes, or high cholesterol.
Diagnostic Tests You Can Try
The Standing Exertion Test
- Stand tall with your lower back arched.
- Hold this position for 30 seconds.
If this brings on leg symptoms it suggests neurogenic claudication.
If it doesn't more likely vascular claudication.
The Two-Stage Treadmill Test
Walk on a flat treadmill and then on an incline.
Neurogenic: Pain comes on sooner when walking flat; may improve uphill due to the slight spinal flexion.
Vascular: Pain worsens faster walking uphill due to increased muscle demand.
The Bicycle Test (Van Gelderen's Test)
Start cycling in an upright position until symptoms begin.
Then lean forward (flex your spine).
If symptoms ease with leaning forward this indicates neurogenic claudication.
If symptoms persist more likely vascular claudication.
Final Thoughts
It's worth noting that not everyone with spinal stenosis (seen on MRI or CT scans) will have symptoms. That’s why a good clinical examination and understanding of symptom patterns are crucial to getting the right diagnosis.
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