Comparison of walking variations during treadmill walking test between neurogenic and vascular claudication: a crossover study

Houle et al. Chiropractic & Manual Therapies https://doi.org/10.1186/s12998-021-00382-5 (2021) 29:24 RESEARCH Open Access Comparison of walking variations during treadmill walking test between neurogenic and vascular claudication: a crossover study Mariève Houle1* , Julie O’Shaughnessy2, Charles Tétreau1, Claude-Édouard Châtillon3, Andrée-Anne Marchand2 and Martin Descarreaux1 Abstract Background: Lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD) are two distinct conditions characterized by similar symptoms including leg pain and walking limitations due to claudication. Differentiation between both origins can be difficult and characteristics such as symptom manifestations, time to relief in rest position and pain localization should be considered when determining diagnosis and the treatment plan. The objectives of this study were to compare changes in walking time to symptom change during treadmill tests and self-reported outcomes measures related to claudication, kinesophobia and global health between individuals with LSS, PAD and non-specific low back pain (nLBP). Method: Fifty-five patients (23 with LSS, 14 with PAD and 18 with nLBP) were recruited from May 2018 to March 2020 to complete a treadmill walking test involving two 5-min walking tasks (Upright and Forward Leaning Trunk (FLT) Walking tasks). The speed was set at 1.9 km/h (1.2 mph), and each task was followed by a 5-min rest period. Walking time to symptom change and Total walking time were recorded during each walking task. Patients were asked to complete four questionnaires related to the impact of claudication, walking impairment, kinesiophobia and global health. One-way ANOVAs were performed to compare walking time difference from the Upright to the FLT walking tasks and to compare questionnaires results between groups. Results: One-way ANOVAs showed a significant difference between groups regarding difference in Walking time to symptom change between both tasks (F = 4.12, p = 0.022). The LSS group improved its Walking time to symptom change from the Upright to the FLT walking tasks more than the PAD (p = 0.34) and the nLBP group (p = 0.12). The nLBP group was less impacted by claudication and less impaired during walking compared to the LSS and PAD groups (ps < 0.001). The nLBP group also had less kinesiophobia than the LSS one (p < 0.001), but was similar to the PAD group. The global health rating was not statistically different between groups (p = 0.118). Conclusion: The test was able to distinguish neurogenic from vascular or nLBP related claudication. However, further studies are needed to validate this new treadmill walking test. Trial registration: clinicaltrials.gov (NCT04058171), Registered August 15, 2019 –Registered during recruitment * Correspondence: 1 Département des Sciences de l’activité physique, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, QC G8Z 4M3, Canada Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Houle et al. Chiropractic & Manual Therapies (2021) 29:24 Page 2 of 11 Keywords: Lumbar spinal stenosis, Peripheral artery disease, Low back pain, Treadmill test, Walking time, Walking posture Background Intermittent claudication (IC) is defined as lameness due to leg pain while standing or walking [1], with the leg pain attenuating within seconds to a few minutes when stopping activity or sitting [2–4], based on the underlying health condition. Vascular and neurogenic claudication represent both possible origins of IC, and their symptoms are frequently described as pain, cramps, numbness and tingling in the lower limbs [5]. Vascular claudication is a common manifestation in individuals with peripheral arterial disease (PAD), while neurogenic claudication occurs in lumbar musculoskeletal disorders with neurological involvement such as specific low back pain (LBP) conditions. One of these specific LBP conditions causing neurogenic claudication is lumbar spinal stenosis (LSS). In some cases, individuals with nonspecific low back pain (nLBP) will experience referred pain into the lower limbs which will also cause difficulty during walking [6]. Peripheral arterial disease is a condition affecting the blood vessels caused by a narrowing of the arteries, usually brought on by the accumulation of atheroma plates (atherosclerosis) [1]. This accumulation leads to insufficient blood supply to the muscles which is accentuated with increasing intensity of activities such as walking [7]. Vascular claudication is the most common manifestation of PAD [8] and its prevalence is estimated at 10 to 20% [9] in 40-year-old individuals, whereas this number doubles in individuals older than 60 years of age [10]. When PAD patients are walking the need in oxygen increases in muscles and the insufficient blood supply leads to pain into the leg(s) and subsequently to the need to stop or to sit to relieve the pain. Lumbar spinal stenosis is a condition leading to mechanical compression or ischemia of the nerve roots causing neurogenic claudication [1, 11]. LSS is a degenerative musculoskeletal condition affecting up to 20% of the global population [12] with an increase in the incidence with advancing age [13], and it affects mainly individuals 65 years and older [14]. The acquired central LSS form arises from the degenerative process of the lumbar spine. Different osteoarthritic manifestations including ligamentous hypertrophy (ligamentum flavum), disc degeneration (bulging or hernia), spondylolisthesis and/or facet osteoarthritis [3, 15, 16], may result in decreased space in the vertebral canal, leading to central LSS. In LSS, leg pain occurs while walking or standing for a moment and is relieved in seated position or by flexing the trunk forward [17]. Non-specific low back pain is a musculoskeletal condition defined as pain located between the 12th (...truncated)