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.
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: 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. doi.org/10.1016/j.ijsu.2017.07.032
Claudication is muscle pain that presents when the body is active and stops when the body is at rest, also known as intermittent claudication. Individuals typically report dull aching, cramping, tingling, and/or numbness. Vascular claudication is caused by circulatory problems like poor blood circulation and peripheral artery disease. Still, spinal conditions can also cause neurogenic claudication caused by problems with the spine and nervous system.
Neurogenic Claudication
Sciatica is the usual suspect when thigh, hip, buttock, calf, or total leg pain or other sensations are present; however, it could be spinal stenosis with neurogenic claudication. Spinal stenosis is sometimes called pseudo claudication, a narrowing of the space around the low back, which can put pressure on the spinal cord directly and compress the blood vessels around the spine, cutting off oxygen-carrying blood. Pain can start in the lower back and circulate down the legs and cause weakness, tingling, or numbness in the legs and feet. The most common areas of spinal compression include:
The foramen are the openings on the sides of the spine where nerves exit and connect to the peripheral nervous system.
The narrowing can occur in any of these areas, with the most common cause being lumbar spinal stenosis brought on by lumbar degenerative disease.
Symptoms
The most common symptoms of neurogenic claudication include:
Pain in the lower extremities, including the buttocks, thighs, and calf, only manifests with activities like walking or standing around.
Pain that shows up equally on both sides.
There is no pain when sitting or not walking around.
Radiculopathy or nerve pain that radiates down an affected limb. Sciatica is a typical example.
However, the symptoms of claudication and radiculopathy are different.
Claudication will be felt all along the length of the nerve.
Radiculopathy pain is more localized to the buttock, thighs, and calves and can get worse with activity and is generally present even when at rest.
Treatment
Non-surgical treatment of neurogenic claudication includes medication to help control pain, chiropractic manual therapy, non-surgical spinal decompression, physical rehabilitation therapy, and steroid shots to reduce inflammation. A doctor will recommend stretching, strengthening exercises, and types of activities to help improve the body’s ability to support itself. This could include swimming, walking, and stationary cycling. However, conservative treatment might not be an option for individuals with more severe cases. If conservative treatment options don’t work, surgery could be recommended. A healthcare provider can help explain treatment options. Successful outcomes have been seen in cases that are diagnosed and treated early.
Non-Surgical Spinal Decompression Chiropractor
References
Colak, Ahmet, et al. “A less invasive surgical approach in the lumbar lateral recess stenosis: a direct approach to the medial wall of the pedicle.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 17,12 (2008): 1745-51. doi:10.1007/s00586-008-0801-z
Munakomi S, Foris LA, Varacallo M. Spinal Stenosis And Neurogenic Claudication. [Updated 2022 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK430872/
Spinal disorders and injuries could cause a nerve injury through compression or damage causing Neurogenic Bladder Dysfunction also known as Bladder Dysfunction. Neurogenic bladder disorder means an individual is having problems with urination.
Neurogenic involves the nervous system and the nerve tissues that supply and stimulate the organs and muscles to function and operate correctly. Neurogenic bladder dysfunction causes the nerves that control the bladder and muscles in urination to be overactive or underactive. �
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Symptoms
Constant bathroom visits
Control in urination is limited
Complete involuntary urination
Sudden urge/s to urinate
The bladder is unable to hold urine
The bladder fails to empty completely
Overfilling of the bladder creates intense pressure causing accidental leakage
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Nerves of the Bladder
The brain and spinal cord function as the headquarters with the spine as the body’s highway that transmits and relays signals/messages to and from the bladder. In the low back, the spinal cord splits apart into a bundle of nerves called the cauda equina. �
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At the end of the lumbar spine is the sacrum this area is known as the sacral spine. The sacrum is the backside of the pelvis between the hip bones. The nerves in the sacral spine branch out and become part of the peripheral nervous system. �
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These nerves provide and stimulate bladder sensation and function. When these nerves become compressed, inflamed, injured, or damaged in some way, organ dysfunction can present. This is when any of the symptoms listed above can develop and progress. �
Potential Causes of Neurogenic Bladder Dysfunction
Spinal Cord Injury/s are a common cause of neurogenic bladder dysfunction. The spinal cord does not have to be severed to cause paralysis below the injured part of the spine. If the spinal cord gets bruised or there is improper blood flow, the spinal cord’s ability to send nerve signals can become inhibited. Cauda Equina Syndrome happens when the nerves spinal roots become pinched or compressed. It is rare, but it is a serious medical condition that requires immediate medical attention. Causes of cauda equina syndrome include:
Trauma like an auto accident, personal/work/sports injury
Spinal condition from injury or present from birth
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Treatment
The treatment depends on the cause or causes of neurogenic bladder dysfunction. A primary physician could call upon a bladder specialist like a urologist, nephrologist, or urogynecologist to collaborate and coordinate the treatment plan. If the dysfunction is caused by a nerve root compression, a spinal procedure (discectomy) is performed to decompress and relieve the pressure on the nerves.
Nutrition and Fitness During These Times
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If the sensory system becomes impacted by injury or disease, the nerves in that system can’t function in the transmitting of sensation to the brain. This can lead to a sensation of numbness, or lack of sensation. In some cases when the sensory system is injured, individuals can experience pain in the affected region. Neuropathic pain does not start quickly or ends quickly. It’s a chronic condition that leads to�symptoms of persistent pain. For many, the intensity of the symptoms can come and go throughout a day. Neuropathic pain is thought to be associated with peripheral nerve problems, i.e. neuropathy caused by diabetes, spinal stenosis, injury to the brain or spinal cord can also lead to chronic neuropathic pain.
NEUROPATHIC PAIN
Objectives:
What is it?
What is the pathophysiology behind it?
What are the causes
What are some of the pathways
How can we fix it?
NEUROPATHIC PAIN
Pain initiated or caused by a primary lesion or dysfunction in the somatosensory nervous system.
Neuropathic pain is usually chronic, difficult to treat and often resistant to standard analgesic management.
PATHOGENESIS OF NEUROPATHIC PAIN
PERIPHERAL MECHANISMS
After a peripheral nerve lesion, neurons become more sensitive and develop abnormal excitability and elevated sensitivity to stimulation
This is known as…Peripheral Sensitization!
CENTRAL MECHANISMS
As a consequence of ongoing spontaneous activity arising in the periphery, neurons develop an increased background activity, enlarged receptive fields and increased responses to afferent impulses, including normal tactile stimuli
This is known as…Central Sensitization!
COMMON CAUSES
Lesions or diseases of the somatosensory nervous system can lead to altered and disordered transmission of sensory signals into the spinal cord and the brain; common conditions associated with neuropathic pain include:
Postherpetic neuralgia
Trigeminal neuralgia
Painful radiculopathy
Diabetic neuropathy
HIV infection
Leprosy
Amputation
Peripheral nerve injury pain
Stroke (in the form of central post-stroke pain)
PHANTOM LIMB PAIN & AUGMENTED REALITY
Phantom Limb Pain and AR
NEUROGENIC INFLAMMATION
Objectives:
What is it?
What is the pathophysiology behind it?
What are the causes
How can we fix it?
NEUROGENIC INFLAMMATION
Neurogenic inflammation is a neurally elicited, local inflammatory response characterized by vasodilation, increased vascular permeability, mast cell degranulation, and the release of neuropeptides including SP and calcitonin gene-related peptide (CGRP)
It appears to play an important role in the pathogenesis of numerous disease including migraine, psoriasis, asthma, fibromyalgia, eczema, rosacea, dystonia and multiple chemical sensitivity
COMMON CAUSES
There are multiple pathways by which neurogenic inflammation may be initiated. It is well documented, using both animal models and isolated neurons in vitro, that capsaicin, heat, protons, bradykinin, and tryptase are upstream regulators of the intracellular calcium influx, which results in inflammatory neuropeptide release. In contrast, it is thought that prostaglandins E2 and I2, cytokines, interleukin-1, interleukin-6, and tumor necrosis factor do not cause neurotransmitter release themselves, but rather excite sensory neurons and thus lower the threshold for firing and cause augmented release of neuropeptides.
While neurogenic inflammation has been extensively studied and well documented in peripheral tissues, until recently the concept of neurogenic inflammation within the CNS has remained largely unexplored. Given the capacity for neurogenic inflammation to influence vascular permeability and lead to the genesis of edema, it has now been widely investigated for its potential to influence BBB permeability and vasogenic edema within the brain and spinal cord under varying pathological conditions.
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PATHOGENESIS OF NEUROPATHIC PAIN
COMMON CAUSES
PHANTOM LIMB PAIN & AUGMENTED REALITY
COMMON CAUSES
