Sonya already has a long history of back pain. Several months ago she noticed that her legs were starting to hurt as well. The pain, which occurs mainly in her thighs, begins whenever she walks for longer than a few minutes—the farther she goes, the more her legs ache, forcing her to sit down. Within minutes, her leg pain disappears and she can start walking again. But the pain returns and cycle repeats.
After her first bout of back pain, Sonya thought it might be a good idea to start a “spin” class at a fitness club to help her get into better shape and increase her stamina. Bending forward on the stationary bike made her back ache but her legs felt fine.
“My back pain is a nuisance, but it’s the leg pain keeps me from doing the things I want to do. I can’t go shopping with my husband without stopping every few minutes to sit and rest. Funny thing is I can walk farther in the supermarket when I have a shopping cart to lean on. When I am not active my legs feel fine, but as soon as I get going I am in trouble again.”
My pattern of symptoms is similar to Sonya’s. Tell me more.
Sonya’s pain is due to aging changes in her spine that produce a boney overgrowth and a narrowing of the canals through which the nerves pass on their way to her legs. Her back pain is mechanical but it is the pressure on the nerves as they exit her spine that is giving her the leg dominant pain. Bending forward as she does when she sits, uses the shopping cart or attends “spin” class opens the space between the bones and gives the nerves more room so they can function without causing pain.
Sonya is already helping herself by sitting down briefly after walking a certain distance. She should incorporate frequent forward bending into her daily routine and consider an exercise program that targets her posture. Because fitness in this pattern is so important she should try and remain as active as possible.
Sonya will know she’s getting better when her walking distance improves and the pain in her legs becomes less intense. Pain control is not an issue for this pattern; improvement is signalled by improving function. If her leg symptoms increase and her walking ability deteriorates she should consult her family doctor or another health care provider.
If their symptoms don’t respond to exercise and posture training and if Sonya remains unable to walk more than a few minutes at a time, surgery is a possibility. If diagnostic imaging can identify the exact site of the narrowing this is a pattern that can be fixed with an operation (see When Surgery is an Option).