Claudication, anyone?

[Nancy T]

Anyone get strained or painful legs/hips when walking more than a couple of blocks?

I've had this problem for many years and it's getting worse. When I walk continuously more than a couple of blocks, I have to either slow WAY down or stop and rest for a minute before continuing, because the muscles in my upper thigh/hip area get VERY strained such that I absolutely have to stop.

After a minute or so of rest I can continue for another block or two.

In the last 8 years I've talked to two neurologists, one rheumatologist, two internists, and a spine specialist (orthopedist) about it. No one could tell me what was wrong, though I heard theories ranging from bursitis to deconditioning to shrug of the shoulders.

FINALLY I think I have the answer. A new neurologist mentioned CLAUDICATION, which is when due to nerve or vascular problems your leg muscles don't get enough oxygen during exercise and you have to stop. Typically it's pain in your calf, but apparently it can be what I have too, in the upper legs/hips.

Wondering if anyone else with scoliosis has this problem or knows anything about it? Apparently with neurogenic claudication (like if the spinal canal is narrowed) the pain stops if you bend over, but mine seems to be vascular claudication because rest alleviates it.

I've also had all kinds of weird paresthesias and electric shocks over 10 years, including Lhermitte's, and had brain MRIs looking for MS. This new neurologist is sure I don't have MS, but he mentioned claudication when I described the walking trouble. Oddly, he then said he DIDN'T think my walking trouble was due to claudication.

But when I went home and looked up claudication, BINGO, it describes what happens to me when walking to a T!

Anyone else?

I have a 35-degree curve at age 52, have had scoliosis since adolesence but only 3 years ago found out the degree of curvature and the fact that it's only lumbar scoliosis (only my shoulders are uneven, not my hips). No pain issues until recent weeks when my lower right back has begun to bother me at times. I started having incredible painless popping in my mid-back sometime last year.

Nancy T.

[LindaRacine]

Hi Nancy...

I have the same thing, but it comes and goes. It's really apparent when I climb a lot of stairs. When it occurs, I try to do a lot of deep breathing to get more oxygen to my lungs.

I hope your back pain improves.

Regards,
Linda

[betty14]

Hi Nancy:

Since you have had various medical conditions as a cause for your symptoms ruled out, it is reasonably likely that the cause is in fact musculoskeletal, perhaps either neurogenic or vascular claudication, as you say.

The best type of person to perform a good physical evaluation would be, in my opinion (my bias in my sig. below), a physical therapist with advanced training in the spine / manual therapy. (you might have to ask around to find one that meets these criteria)

He or she would observe your posture, evaluate your active movement quality, then passively move your hips, pelvis and spinal joints, as well as testing your muscles and neurodynamics (nerve mobility). The findings of the physical tests are then considered along with the MRI and x-rays to determine the likely "physical diagnosis", also called "movement dysfunction diagnosis" and suggest what the appropriate treatment might be.

Cheers, from B.

[Nancy T]

Linda--thanks for the reply. I can climb the stairs in our house but still often feel very fatigued just from that--I often have to immediately sit down, or at least stand for a minute before continuing what I was doing. Thanks for the tip about deep breathing--I'll try it.

Betty--what a great idea--it never occurred to me to ask about a PT specializing in the spine. Probably the orthopedist could suggest one? I would LOVE to find out for sure exactly what is going on in my legs. Thank you VERY MUCH for the information.

I did see a general PT a year ago about the walking issue; she did some tests but really didn't say (or didn't know) what was causing the problem. The main thing she found was that I couldn't raise my legs while lying on my stomach, which apparently one should be able to do. She gave me a couple of exercises to do, which I admit I didn't keep up with, but the good thing that came out of the appointment was her suggestion of walking sticks, which I now use on my neighborhood walks (my main problem had been that I couldn't get up enough speed anymore to even break a sweat and thus get some decent exercise). They allow me to walk faster and more easily, presumably by taking some of the weight/strain off my legs. I still cannot walk as fast as I did 8 years ago, when my legs were in great shape and I could walk VERY fast for indefinite periods. Even with the sticks, I can't walk half as fast or far as I used to, because of this problem.

I plan to ask my doctor to help me get a correct diagnosis of this problem (since I can't get a diagnosis for my Lhermitte's, dizziness, paresthesias, and other problems!). I would feel much better knowing the true cause of the walking slowdown. And I will ask him to send me to a more specialized PT, as you suggest. Thanks very much!!

Are there any specific courses, certifications, etc. that I should ask about in regard to a PT of this type?

Nancy

[Nancy T]

Linda, do they think that you have claudication (neurogenic?) due to your scoliosis?

I re-read my lumbar MRI from 3 years ago and it's very clear that there is NO central canal or foraminal narrowing. There is, however, some central canal narrowing due to osteophytes in the cervical spine (no scoliosis there), yet the cord signal remains normal. And the ortho guy said he saw nothing to account for any of my symptoms.

[betty14]

Are there any specific courses, certifications, etc. that I should ask about in regard to a PT of this type?

Nancy

Hi Nancy:

I'm in Canada, so here I'd look for a PT who is a resident or fellow of the Canadian acadamy of manual therapy; or I'd seek a PT that does consultations for other PT's; or I'd seek one of the PT's that actually instructs the advanced courses.

I definitely believe in "going for the top" when you have a complex problem. If you call the clinics in your area and ask for the type of PT you need to see, you could get some names. I doubt that any clinic you call would be offended by this, although not many people actually ask. I think most people think all PT's are the same, but they all have very different styles, levels of knowledge, and interests.

If you do get assessed, could you post about the results please?

[LindaRacine]

Linda, do they think that you have claudication (neurogenic?) due to your scoliosis?

I re-read my lumbar MRI from 3 years ago and it's very clear that there is NO central canal or foraminal narrowing. There is, however, some central canal narrowing due to osteophytes in the cervical spine (no scoliosis there), yet the cord signal remains normal. And the ortho guy said he saw nothing to account for any of my symptoms.

Hi Nancy...

I never thought to ask, and I never made the connection previously.

--Linda

[Nancy T]

Hi Linda. If you do find out about any relationship with your scoliosis, please let me know. I'm just curious about this.

Betty--thanks much for the tips. I will let you know if I find anything out. I do know that some PTs have their own "specialties." I went to a vestibular rehab therapist once for my dizziness issues and am aware (through a lot of layperson's studying of dizziness) that it makes a big difference to see a PT who concentrates in a particular area and really knows their stuff.

I too have found that it PAYS to see specialists from the get-go, whether it's about dizziness or taking your guinea pig to the vet. The difference is astounding.

Thanks again,

Nancy

[Nancy T]

I saw my PCP about the walking problem. He says it is not claudication--my circulation in my legs is fine, and I am not at high risk for claudication anyway (not old enough, not a smoker or diabetic, etc.). He tested my circulation and examined my hips and spine.

He thinks it is some kind of muscular imbalance related to the scoliosis. He is sending me to a physiatrist, which sounds like a great idea! I hope to really find out what is going on and figure out what to do about it.

Thanks again for all the info, everyone!

Nancy

[jrnyc]

Hi Nancy
read your post w/interest..i have severe pain in hips...& struggle to walk...worse of scoli is lumbar...61 degrees right now...also have spinal stenosis & degenerative disc...my hips started hurting 5 years ago when i herniated discs in lumbar region...now arthritis adds to it...lyme disease worsened all the arthritis in my body, too...when i do walk, i have worsening pain, weakness, & often end up bent over as i struggle to keep going!

i wish you help with your search for answers! pain management doctors have helped me with injections of various types & burning off nerves helped too (nerve ablation)...but that is treating the symptoms..i fear surgery is inevitably in my future, which actually is now, since the big problem in my case is the soliosis..i do know that discs can cause pain that radiates all over the place!!!

i hope you find doctor(s) who understand, stick with you, & give you answers & help...(correct answers, that is)

best of luck
jess

[Nancy T]

Belated thanks for your reply, Jess! Sorry to hear you have so much trouble--Lyme disease on top of everything!! Ouch!!

[mdtaffet]

Nancy,

I'm a new subscriber to this forum. I have been diagnosed with leg pain due to compressed nerves related to my scoliosis. I have a left lumbar curve somewhere between 25 and 26 degrees which I've known about since 2003. I was just diagnosed two weeks ago with 2 thoracic curves of 19 degrees at the bottom (to the right) and 15 degrees at the top (to the left).

I started having pain in both hips, but a bit worse on the left, in the summer of 2008. Everything I read on WebMD at the time led me to believe that it was probably trochanteric bursitis, because the pain at that time was limited to just my hip, and was worst when I was standing still, such as waiting in the sandwich line at Subway.

Later in 2008, the hip pain subsided, but then I began to notice weakness in my left thigh area. I noticed it most obviously when walking down the stairs, when my left leg wanted to pop right up off the stair, and I got the unmistakable feeling that if I had to support my entire weight on my left leg, it would just buckle out from under me. Initially it was just the stairs that brought it on, but later I noticed that there was weakness and also a bit of numbness after both my Healthy Back Class and my Pilates class at the local YMCA. Both classes included resistance moves involving lifting legs in the air, and my left upper thigh felt really strange after class. Somewhat weak, somewhat numb, but mostly just really strange.

Then in February of 2009 it started really hurting, particularly as I walked the 3 blocks between where I parked and where I worked. By the time I would get to either the office or the car, I felt like I really didn't want to take another step. Sitting down at my desk would ease the pain -- so I knew it wasn't sciatica. The pain came anytime I was in a weight-bearing position with weight on my left leg. When it was simply bad, standing was worse than walking. But it got to the point that it was excruciating, at which point picking my left leg up enough to move my foot a step ahead was more painful than I could bear. At that point in time, I could barely make it a full block before I didn't want to take another step. Fortunately I found that I could park right across the street from where I worked, so that helped a lot and the pain eased after that.

My primary care doctor sent me to a hip specialist when it got so bad that I really just didn't want to take another step. The hip specialist took both lumbar spine Xrays and hip Xrays. He said the hip Xrays were fine, so he couldn't help me, then he led me over to the part of his group practice that dealt with spines due to the obvious scoliosis on the lumbar Xray. At that point, I saw a scoliosis specialist for the first time in my life. He ordered an MRI, which showed both central canal stenosis and neuroforaminal stenosis, along with severe disk degeneration at L3-L4.

I then had 3 lumbar transforaminal epidural steroid injections. I didn't feel anything during the first one, but it also didn't really help me either. I must not have been properly sedated before the 2nd one, because I could feel everything, and really fidgeted and squirmed during most of the procedure, and couldn't relax my muscles no matter how hard I tried. I felt much worse after that 2nd injection. Those first two injections were L3-L4 and L4-L5. Then I had a nerve conduction study. They couldn't find any definite problems, but said that L5 was suspicious. So the 3rd injection was L4-L5 and L5-S1. I told them to make sure I was properly sedated first; I didn't feel a thing, and that 3rd injection actually improved my leg symptoms for about a month.

At this point, I still have the leg pain but much milder, perhaps because I now work at home 4 days a week. I could get another injection if I want. Other than that, I'm told that the best option for relieving the leg pain is a laminectomy, which I'm told is minimally invasive. But I don't really want to have surgery on my back, even minimally invasive surgery, if it's not going to address my back pain at all. He said that a fusion could help with the back pain, but that is major surgery, which I would prefer to avoid if possible.

I suppose if the leg pain ever returns to the point it was at last winter where I couldn't even take another step without excruciating pain, I'll consider a laminectomy, but I'm avoiding it now if at all possible.

You said that your walking problem caused you to slow down -- so did mine; so much so that my husband got really frustrated with me when we were walking between a parking garage and the symphony one evening. But when things get really bad for me, standing still doesn't help me one little bit because there is still weight on my left leg. The only thing that helps is to take weight off of the leg, by sitting down, lying down, or even riding a bike.

I do hope you eventually find a diagnosis for your leg pain, but I don't think your problems sound like mine, since standing still helped you whereas it doesn't help me at all.

My compressed nerves are due to the stenosis, but the stenosis is due to the scoliosis, because the worst pinching is in the worst part of my curve.

-- Mary

[JulieBW]

leg weakness and discomfort

I also have weakness and discomfort in my left leg, most noticeable when I go up stairs. It is hard to walk longer distances, I move way more slowly than I used to, it's even more difficult to stand in one place. My knee feels tight, sensation is diminished. I had a lot of studies done when this first started, including vascular and MRI, nerve conduction. Results were inconclusive. More recently I've developed occasional shooting pain in my lower leg, my foot also feels hypersensitive and tight. My symptoms are not severe, and I got tired of all the doctors and tests. Walking poles help, also counting while I walk helps me go faster (more cognitive focus), and semi-custon shoe orthotics. I can still ride my bike like the wind (except for the snow.....).

[LindaRacine]

Nancy,

I'm a new subscriber to this forum. I have been diagnosed with leg pain due to compressed nerves related to my scoliosis. I have a left lumbar curve somewhere between 25 and 26 degrees which I've known about since 2003. I was just diagnosed two weeks ago with 2 thoracic curves of 19 degrees at the bottom (to the right) and 15 degrees at the top (to the left).

I started having pain in both hips, but a bit worse on the left, in the summer of 2008. Everything I read on WebMD at the time led me to believe that it was probably trochanteric bursitis, because the pain at that time was limited to just my hip, and was worst when I was standing still, such as waiting in the sandwich line at Subway.

Later in 2008, the hip pain subsided, but then I began to notice weakness in my left thigh area. I noticed it most obviously when walking down the stairs, when my left leg wanted to pop right up off the stair, and I got the unmistakable feeling that if I had to support my entire weight on my left leg, it would just buckle out from under me. Initially it was just the stairs that brought it on, but later I noticed that there was weakness and also a bit of numbness after both my Healthy Back Class and my Pilates class at the local YMCA. Both classes included resistance moves involving lifting legs in the air, and my left upper thigh felt really strange after class. Somewhat weak, somewhat numb, but mostly just really strange.

Then in February of 2009 it started really hurting, particularly as I walked the 3 blocks between where I parked and where I worked. By the time I would get to either the office or the car, I felt like I really didn't want to take another step. Sitting down at my desk would ease the pain -- so I knew it wasn't sciatica. The pain came anytime I was in a weight-bearing position with weight on my left leg. When it was simply bad, standing was worse than walking. But it got to the point that it was excruciating, at which point picking my left leg up enough to move my foot a step ahead was more painful than I could bear. At that point in time, I could barely make it a full block before I didn't want to take another step. Fortunately I found that I could park right across the street from where I worked, so that helped a lot and the pain eased after that.

My primary care doctor sent me to a hip specialist when it got so bad that I really just didn't want to take another step. The hip specialist took both lumbar spine Xrays and hip Xrays. He said the hip Xrays were fine, so he couldn't help me, then he led me over to the part of his group practice that dealt with spines due to the obvious scoliosis on the lumbar Xray. At that point, I saw a scoliosis specialist for the first time in my life. He ordered an MRI, which showed both central canal stenosis and neuroforaminal stenosis, along with severe disk degeneration at L3-L4.

I then had 3 lumbar transforaminal epidural steroid injections. I didn't feel anything during the first one, but it also didn't really help me either. I must not have been properly sedated before the 2nd one, because I could feel everything, and really fidgeted and squirmed during most of the procedure, and couldn't relax my muscles no matter how hard I tried. I felt much worse after that 2nd injection. Those first two injections were L3-L4 and L4-L5. Then I had a nerve conduction study. They couldn't find any definite problems, but said that L5 was suspicious. So the 3rd injection was L4-L5 and L5-S1. I told them to make sure I was properly sedated first; I didn't feel a thing, and that 3rd injection actually improved my leg symptoms for about a month.

At this point, I still have the leg pain but much milder, perhaps because I now work at home 4 days a week. I could get another injection if I want. Other than that, I'm told that the best option for relieving the leg pain is a laminectomy, which I'm told is minimally invasive. But I don't really want to have surgery on my back, even minimally invasive surgery, if it's not going to address my back pain at all. He said that a fusion could help with the back pain, but that is major surgery, which I would prefer to avoid if possible.

I suppose if the leg pain ever returns to the point it was at last winter where I couldn't even take another step without excruciating pain, I'll consider a laminectomy, but I'm avoiding it now if at all possible.

You said that your walking problem caused you to slow down -- so did mine; so much so that my husband got really frustrated with me when we were walking between a parking garage and the symphony one evening. But when things get really bad for me, standing still doesn't help me one little bit because there is still weight on my left leg. The only thing that helps is to take weight off of the leg, by sitting down, lying down, or even riding a bike.

I do hope you eventually find a diagnosis for your leg pain, but I don't think your problems sound like mine, since standing still helped you whereas it doesn't help me at all.

My compressed nerves are due to the stenosis, but the stenosis is due to the scoliosis, because the worst pinching is in the worst part of my curve.

-- Mary

Mary...

In case you do ever decide to have surgery, be careful about the laminectomy. Laminectomies in people with scoliosis often lead to further destablization of the spine. Laminectomies are still a good choice for some patients with scoliosis, but it's something you should address with the surgeon (if it ever comes to that).

Regards,
Linda

[Nancy T]

Mary & others--thanks for the further comments and good luck to all!

Sorry I have not looked in here since last fall (and didn't realize I wasn't "subscribed" to get e-mail notification of activity on threads that I posted in).

Nancy