Introduction
Intermittent claudication like most medical diagnoses is latin in origin. The ‘intermittent’ part refers to pain that comes and goes with the ‘claudication’ part meaning to limp. Intermittent claudication is a symptom that describes pain that is present most commonly in the calf muscle upon physical exertion. However, claudication can also involve other muscles in the lower limb including the thigh and buttocks.
Intermittent claudication falls into two categories:
- Vascular.
- Neurogenic.
Signs & Symptoms
Vascular claudication
The main symptom is pain which occurs intermittently and is associated with physical exertion. The symptoms are subsequently alleviated by rest until you are able to start walking again only to find the pain returns. The pain is often described as a dull ache or cramping sensation.
Neurogenic claudication
The main symptoms are tingling, numbness or weakness in certain areas of your lower limb according to the spinal level of nerve root compression. You may also experience lower back pain. In some patients, it is precipitated by walking and prolonged standing. The pain is classically relieved by a change in position or flexion of the waist. Although a flexed position may also potentially relieve symptoms, resting typically offers the greatest relief of pain. As such, activities involving leaning backwards typically cause exacerbation of symptoms.
Causes
Vascular
The most common cause of vascular claudication is due to peripheral artery disease. In this instance, intermittent claudication is often referred to as vascular claudication. It is an early symptom of peripheral artery disease which is caused by plaques that accumulate on the inner walls of the affected peripheral arteries. These plaques narrow the width of the artery, restricting the amount of blood that can flow through the affected artery this is known as atherosclerosis. Symptoms will occur in the muscle group immediately below where the obstruction is. As the process of artery restriction progresses, symptoms can occur more frequently and after short distances of walking. Typically, vascular claudication is associated with high cholesterol, high blood pressure and diabeties.
Neurogenic
Typically caused by nerve root compression in your lumbar spine which is often caused by lumbar spinal stenosis which can involve tingling and numbness, often sciatica is present. Typically, lumbar spinal stenosis is caused by additional common pathologies such as:
- Hypertrophied facet joints.
- Ligamentum flavum hypertrophy.
- Bone spurs.
- Scar tissue.
- Herniated discs.
Often you may have lower back pain associated with neuropathic pain in your legs which can be in one or both. This discomfort may present itself as some (or isolated) discomfort, numbness, tingling or weakness in the calves, buttocks, and/or thighs. A defining factor in differentiating between neurogenic and vascular claudication is that neural symptoms are not present with vascular claudication and discomfort will not typically resolve as soon as physical exertion stops with vascular claudication. Additionally, you may be able to reduce your symptoms by bending forwards (depending on the cause of your nerve root compression) whereas with vascular claudication; spinal movement will have no effect.
Treatment & Management
Vascular
Exercise Therapy is best initial treatment for intermittent claudication. Aerobic exercise will improve your symptoms by improving specific biomechanical and biochemical mechanisms. Additionally, exercise reduces cardiovascular risk by lowering cholesterol, blood pressure and glycaemic (blood sugar) control which are associated with this pathology. Your specialist Physiotherapist will be able to provide you an exercise protocol to alleviate and improve your symptoms. Your general practitioner will be able to provide specific medication to help reduce your blood pressure and cholesterol.
Neurogenic
Before management strategies can be initiated, the specific cause of your neurogenic claudication needs to be established which can be established by your specialist Physiotherapist. Once a formal diagnosis is made, a specific exercise protocol can be initiated to improve and resolve your symptoms. Typically, your general practitioner will be able to provide specific medication to help alleviate your neuropathic pain to treat your symptoms whilst your specialist Physiotherapist will be able to treat your symptoms and the underlying cause for your pain.
