Intermittent Claudication

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.

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.

Vascular

The most common cause of vascular claudication is peripheral artery disease, hence it being 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 walking distances. Typically, vascular claudication is associated with high cholesterol, high blood pressure and diabetes.

Neurogenic

Typically caused by nerve root compression in your lumbar spine which is often caused by lumbar spinal stenosis (narrowing) 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.

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 who will have the knowledge and experience to provide you with an accurate and timely diagnosis. They will then work with you to develop a set of personalised treatment goals so that we can work towards achieving recovery. With your goals in place, regular re-assessment will ensure progress is being made and will allow any adjustments to be made.

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 Physio will provide you with suggestions and guidance on how you can begin to incorporate more activity in to your life, helping to improve your overall health.

Your Physio may also liaise with your GP to discuss specific medication to help reduce your blood pressure and cholesterol should they be considered causal factors. They can also establish if medication will be suitable to help alleviate your neuropathic pain.

Exercise Therapy is best initial treatment for intermittent claudication.  Your specialist Physiotherapist will be able to provide you with a specific exercise protocol to improve and manage your symptoms. Your Physio will be able to treat your symptoms with hands on techniques including joint mobilisation and deep tissue massage. You will be given ongoing support and advice so that you can confidently manage your symptoms independently, ensuring that further complications can be avoided.