A common problem that elderly people experience is pain which comes on only when walking. Lying or sitting down is not painful, but attempting to walk can produce pain in the back, the thighs, or the calves.
The pain can be accompanied by a feeling of numbness or heaviness in the legs. In mild cases, the pain only takes the form of an annoyance when walking more than a mile. In severe cases, the pain can get so bad that a person with this problem needs to sit down and rest after walking only a block. What causes these symptoms? They are called claudication, which describes pain with walking. There are two common causes, and they can often be told apart by carefully examining the symptoms present.
If the pain begins in the back or buttocks and radiates down into the hips and thighs, then a likely cause is a condition called spinal stenosis (“stenosis” is Latin for “narrowing”.) This is a condition in which the spinal canal has gradually become narrowed, usually by a combination of thickened ligaments, bone spurs, and bulging disks. When the canal becomes narrow, the nerves in the canal are put under a squeezing pressure. The nerves usually don’t hurt if they are at rest. However, if they are asked to work hard, such as when they make the legs move, they begin to complain because they can’t get enough blood flow in their squeezed condition. The pain then begins where the nerves go, namely the legs. When the pain gets too much to bear, a patient will sit down and rest, allowing the nerve to “catch its breath.” Then walking is possible again. If the pain is mainly in the calves, then a likely cause is arterial stenosis.
This is where the arteries that lead to the legs become clogged with plaque. It restricts blood flow to the muscles in the legs. If the muscles are at rest, they can live with the reduced blood flow. However, if they work hard, then just like the nerves they can’t get enough blood and then begin to hurt. Most of the time, the pain from arterial stenosis is relieved merely by standing still a minute or two; a patient usually doesn’t need to sit down, and the pain clears up faster than in spinal stenosis. How best to make the diagnosis? Usually, a scan such as an MRI of the back will make the diagnosis of spinal stenosis. Treatments can include medication, physical therapy, cortisone injections in the back, or if all else fails, surgery to remove the nerve pinching. In the case of arterial stenosis, an ultrasound test of the arteries will determine whether there is any blockage. Treatment can include medications to thin the blood or relax the arteries, but often surgery will be necessary to widen out the arteries.