unilateral leg pain: Only walking up hill

I wonder if any one can help.

I have a scenario to work through. I have a 71 year old male patient . Presents with unilateral caLf pain (left) only on walking up hill.

He is very active, golf and spinning ( i know at 71) and sqquash. Never ever bothers him .

Saw GP he sent to vascular surgeon who perfomed doppler: small occlusion on left but he says of little or no significance.

He says he only gets it walking up hill. Says is ender to touch.

Is it spinal?? Is it only vascular 9 but not responded to long term aspirin.

Any help or differental diagnosis and testing would be greatly appreciated

Hi pjpooba,
Check first gastrocnmeus trigger points, biceps femoris and gluteus minimus as well. Could just also clear L4and 5 but my guess is its probably a gastroc TP. More info needed though

(Small occlusion?)

Hi there

Tahnks for your reply. What I found a little puzzling is the fact that if it where a TrP then why does it only bother him on walking up hill. NO other activity bothers him.

Is this not more of a stenotic L5/S1 nerve root pattern????

The vascular guy just said a small occlusion but did comment that he did NOT feel it was related to his symptoms and no further action was required.

I wonder ....any more helpo is appreciated

Hi,
I am thinking of stretch to the gatrocs on the stance part of the leg whilst going uphill and possibility of stretch pain on push off. Check the activity again and see how it relates, If not implicated. Then sure check the spine and see if you reproduce it from there.

All the best!

Hi Check if he has equal weight bearing through each leg. If he predominately uses his left leg he will potentially cause problems as he increases his effort on the hill. Failing that is is suspicious that he is stressing his lumbar spine into flexion and has a SLR limitation. Assess his slump position and actually watch how he climbs up hill.
Steve
Hallamshire Physiotherapy

if it is vascular, pain should disappear on rest, ask for the nature of pain if he says it is a dead feeling of leg- which correlates with vascular problem. I had similar patient which was treated with loads of spinal flexion ex.s. My first guess would be stenotic or treat as you find.

No offense to GP's but just cause he/she says it is not significant on the test does not mean it is not a significant problem functionally. Do your own tests. Check ankle/brachial index, rubor of dependency etc. What does his left lower leg look like? Any differences vs right ie Atrophy, dermalogical changes (edema, Hemosiderin staining, hairloss). As stated earlier if the pt rest and it gets better that would be a big telltale. Good luck

More testing and assessment would be great to discover an appropriate diagnosis.

It is never harmful to run through the various tests, and there is no reason they can not be done on subsequent visits. Preparing thoroughly beforehand to quickly and effectively run through them would rule out various possibilities.

Regards