Intermittent claudication

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...

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

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.

  1. Chiropractic Help
  2. Leg pain
  3. Intermittent claudication

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

Do you have a problem that is not getting better?

Are you looking for a different slant on your pain?

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Interesting questions from visitors

CLS writes:

Greetings, Dr B.

You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong. Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what a DC does.

The quickest and most interesting way is to read one of my eBooks of anecdotes. Described by a reader as gems, both funny and healthful from the life and work of a chiropractor, you will love them. Priced right at $2.99, though Kindle fiddles the amount without telling me.

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