Dr Ozello's Sports Medicine Report: Neurogenic Intermittent Claudication (NIC)

Neurogenic Intermittent Claudication (NIC)
Intermittent Claudication (IC) refers to leg symptoms that are elicited by walking and relieved by rest. Neurogenic means the source of the condition is pressure on nerves. Neurogenic Intermittent Claudication is associated with Lumbar Central Stenosis (LCS).

***Disclaimer: Viewing this video does not take the place of seeing a medical professional, working with a nutritional professional, working with a fitness professional and receiving proper training in the medical profession. Please visit a medical professional for evaluation, diagnosis and treatment. Please work with a nutritional profession to develop individualized nutrition strategies. Please work with a fitness professional to learn proper exercise technique and to develop a proper training program. Never perform an exercise that elicits or intensifies symptoms. If an exercise elicits or intensifies symptoms, stop immediately and use a viable substitute. Always perform all exercises through a symptom free range of motion. Begin your training at your current health, fitness and strength levels. Increase intensity in small gradual calculated increments. Please use nutritional strategies that are designed to work for your individual needs.

Claudication can occur from two primary causes: Vascular (related to blood vessels) and neurogenic (related to the nervous system). Although the symptoms of both types are fairly similar, the reasons behind what’s causing them are different. Vascular claudication stems from a lack of adequate blood supply from the arteries, while neurogenic claudication is a nerve compression issue.
Neurogenic intermittent claudication is usually the result of narrowing of the spinal canal, known as central stenosis. Any process that narrows the spinal canal in the lumbosacral area may result in neurogenic intermittent claudication.

Symptoms of Neurogenic Intermittent Claudication include: Pain in the lower extremities (Glutes, thighs and calves that only occurs with activities such as walking or standing. Pain is usually equal on both sides. Symptoms are lessened while sitting or not walking. Symptoms are elicited and/or intensified with bending backwards, in medical terms is called lumbar extension.
A key feature of neurogenic claudication is its relationship to body positioning. Lumbar extension increases symptoms and lumbar flexion decreases symptoms. Symptoms are exacerbated by walking, standing or upright exercises. Symptoms decrease with sitting or lumbar flexion when squatting, leaning forward or lying down. Many patients are asymptomatic when inactive. Lumbar extension while standing leading to the development of symptoms which promptly resolve by leaning forward 20 to 40 degrees at the waist is a classic presentation of Neurogenic Intermittent Claudication.
Additional symptoms may include general discomfort, weakness in legs, numbness in lower extremities and tingling in lower extremities. Most patients typically experience bilateral symptoms, but some may be unilateral. Either case usually involves the entire leg.

Imaging: Lumbar Spine XRays and MRI are useful in diagnosing NIC,

Prevention and Rehabilitation
Spine and core strengthening exercises. Avoid lumbar extension exercises. Stretch lumbar spine, glutes and lower extremities. Williams Flexion Exercises. Seated lumbar stretch. Supine Knees to chest stretch.

Strengthening exercises for deep core. Abdominal Drawingin Maneuver. Abdominal Hollowing. Abdominal Bracing. Supine Pelvic Tilt.

References
Spinal Stenosis And Neurogenic Claudication https://www.ncbi.nlm.nih.gov/books/NB...
Spinal Stenosis with Neurogenic Claudication https://www.healthcentral.com/conditi...
Neurogenic intermittent claudication caused by vasculitis in the cauda equina: an autopsy case report https://link.springer.com/article/10....
Ligamentum flavum hypertrophy significantly contributes to the severity of neurogenic intermittent claudication in patients with lumbar spinal canal stenosis https://journals.lww.com/mdjournal/F...

Dr Donald A Ozello DC of Championship Chiropractic in Las Vegas, NV
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