Case Report: A Patient with Low Back Pain and Somatic Referred Pain Concomitant with Intermittent Claudication in a Chiropractic Practice



Approximately 12% of older patients in the general population have atherosclerotic disease of the aorta and lower extremity arteries, i.e., peripheral artery disease (PAD). Intermittent claudication is the most common symptom. When a patient with low back pain complains of lower extremity pain that is worsened with mild exercise (e.g. walking), the etiology is often not clear.

Case Presentation

A 56 year-old male presented with low back pain, left hip and buttock discomfort, numbness in thigh and calf, and left knee weakness while walking.

Intervention and Outcome

Chiropractic care was provided and the low back pain improved. The patient developed leg weakness. Radiographic evaluation showed calcification of abdominal aorta and common iliac arteries. The patient was referred for medical evaluation and diagnostic ultrasound findings of arterial occlusion lead to surgical referral. The surgeon reported a “significant amount” of blockage of the left external iliac artery. Leg weakness resolved following placement of surgical stents.


Claudication may go undiagnosed because many people consider the pain a consequence of aging, and may therefore just reduce their activity level to avoid the pain. Early diagnosis of PAD/intermittent claudication is important since PAD is a major risk factor for adverse cardiovascular events.


Patient management in the chiropractic clinical setting required appropriate medical referral in this case. Surgical implantation of stents in the left external iliac artery resolved the complaint of leg weakness. It is imperative for health care professionals to have awareness of the high occurrence of PAD in the general population.


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