Intermittent claudication is leg pain brought on by exercise, relieved by rest, only to start up again when you begin walking or cycling once more.
It is only one of the many possible causes of leg
pain, but it should ALWAYS be considered in every patient who complains
of pain in the leg associated with exercise, BUT has a negative
Straight Leg Raise test of Lasegue, and a negative
SLUMP test for sciatica
and a negative
FEMORAL NERVE test. Could the leg pain be caused by a blocked artery in the groin or pelvis?
Which of us is not forever a stranger and alone?
- Thomas Wolfe, novelist (1900-1938)
More difficult is when the patient has two diseases. A lower back condition, say a Piriformis Syndrome that may cause pain to radiate down the leg, AND a blocked artery.
Which is the real spoke in the wheel? Is one more life threatening that the other? Can both be treated simultaneously?
It's been said, "if you hear hoof beats, don't look up and expect to see zebras." Very occasionally every doctor will find they are zebra. In this instance a herd of horses and zebra running together...
CHAPTER 7: STONES IN MY CLOG
Anyone who has travelled will have experienced that sense of delight - click here for the free short story from Bernard Preston's third book of Chiropractic yarns. Sometimes fact is stranger than fiction: Something predictable Something surprising ...
This is the arteriogram of his patient's blood flow through the pelvis prior to surgery. Patients with intermittent claudication consult chiropractors occasionally.
Intermittent Claudication is leg pain that mimics a sciatica but is caused by a blocked groin artery. Smokers move on as this story's not for you; there are none so blind as those who will not see.
Pathophysiology of Atherosclerosis
It's a blood vessel disease in which the blood flow to the leg is restricted due to a partial blockage of the artery running down to the leg, somewhere along its course.
Sufficient blood gets through when you are sitting quietly, but as soon as you start to walk, the artery just can't supply sufficient oxygen for the calf muscles, which then start to complain.
Sit for a moment and the pain goes away as the demand for oxygen lessens. Precisely the same may occur in the quadriceps muscle in the upper leg, making cycling very difficult.
And of course can happen in any part of the body. Do you have chest pain when only when walking? Angina pectoris is
also precisely the same: a heart muscle starved of the extra oxygen needed during exercise by a partial blockage of one of the coronary arteries. It's medical name is atherosclerosis = arteriosclerosis.
The little understood fact that smokers suffer from far much more lower back pain is now well researched. Smoking is the biggest factor in both chiropractic and surgical treatment of lower back pain.
Chiropractor Bernie Preston tells all in his third book of chiropractic anecdotes, this one set in Holland where he practised for seven years. Take a walk through the polders with him.
The Dutch are heavy smokers, so intermittent claudication is a not uncommon finding.
Relevant links if you have pain in the leg.