Why Do My Legs Hurt When I Walk But Feel Better When I Sit - Answered

Your legs start hurting after walking to the mailbox. You sit down for a minute, and the pain goes away. You get up to walk again, and the pain comes right back.

Why?

Leg pain when walking affects millions of people. Dr. Frank Kuwamura, a spine doctor San Antonio trusts at MD Spine Care, and Dr. Jeffrey Martinez, a vascular surgeon, discussed this exact problem in detail, explaining why patients experience these symptoms and how doctors determine the cause.

The Real Patient Story

"A patient comes to me, he's about 65 years old," Dr. Kuwamura describes during the discussion. "He says 'you know I was a really active guy and I played sports in high school' and he works actually in the construction field and he came to me and says 'you know Dr. K, my back is hurting a lot and I'm having problems walking.'"

The patient explained: "I start feeling some cramping in my back, I'm getting some cramping in my legs but if I walk further and further, it starts to go numb."

Two Different Problems

Dr. Martinez, who has known Dr. Kuwamura for over 15 years, explains the vascular side: "From the vascular side we have what's called intermittent claudication. Intermittent claudication is where the blood supply to the muscle isn't enough during exercise."

He describes it simply: "You have this pipe going to your muscles and you've got a clog in that pipe, like in the artery. As you're walking, those muscles need more blood flow because they're exercising and they need that nutrition to keep going. When they don't get it, they begin to hurt."

The classic pattern? "Doc, I can walk 30 feet and my legs start to hurt, my thigh, maybe my hip, my buttock, my calf, and after 50 feet I have to stop and I have to rest."

The Shopping Cart Sign

Dr. Kuwamura describes a diagnostic tool called the shopping cart sign: "If you and I went to HEB and we had a long list of things to shop for, and I got my honey-do list that I'm going to do, and I start my day and I start walking, could I complete my walk and complete my task without a shopping cart?"

Many patients say no. But with a shopping cart? "I never thought about it but the answer is yes," patients tell him.

"What they're doing is really flexing their spine just a little bit forward," Dr. Kuwamura explains. "That simple action opens up the space in the spinal canal and unpinches nerves." The shopping cart sign helps differentiate spine problems from vascular issues.

Standing Versus Walking

Dr. Martinez shares a key diagnostic question about leg pain when walking but not standing: "One of the main questions I will ask, especially when I'm just not quite sure what is this, is this nerve or artery, I'll ask them if they have the same pain if they stand for a while. What about when you wash dishes or you're at church and you're standing, can you do those things?"

"Standing should not affect the arterial system at all. The muscles are still at rest. So if they start complaining that standing seems to bring on the pain, then I start digging through my phone for your phone number."

This distinction between leg pain when walking but not standing is crucial. If standing causes the same pain, you need a back pain specialist San Antonio relies on for spine evaluation.

The Back Pain Confusion

"How can it be a problem with my back doctor, I don't have any back problems," Dr. Kuwamura says patients often ask. This confusion about why do my legs hurt when I walk when the back feels fine is extremely common.

His explanation: "Your problem is your calf or your foot because you have a pinched nerve in your back. We go through the anatomy of where the nerve ends, which is where they're having the symptoms, and we follow that back to the spine and then show them yes, this nerve right here is pinched. You're lucky you're not having back problems but you're having something where that nerve goes to."

Physical Exam Findings

Dr. Martinez describes what he looks for: "I think one of the main things we do is feel pulses. You can actually, there's points in the foot, in the groin area, behind the knee that you can actually palpate the pulse."

He also notes: "There's other softer signs like some thickened toenails can sometimes mean that they're developing, they've got some arterial disease. They may have a loss of hair over their lower leg."

"Some people lose some hair on the lower leg but it's preserved in their feet and toes. If you have good hair on your feet and toes, you've probably got pretty good circulation." These findings help distinguish vascular intermittent claudication from spine-related leg pain when walking.

Risk Factors

"About 5% of men over the age of 70 have vascular disease," Dr. Martinez states. "There's other risk factors like diabetes and smoking, high blood pressure, coronary artery disease, renal failure. All those things can increase your risk for it."

He emphasizes: "Most patients do not progress very significantly over time unless they have diabetes or they're smokers. Those are the two biggest risk factors."

Whether you need a spine doctor San Antonio recommends or a vascular specialist depends on these risk factors combined with your specific symptoms.

Getting Diagnosed

"I don't think there's any one fact in their history or particular part of the physical exam or test that can make the diagnosis for you," Dr. Martinez explains. "You've got to take a piece from all that and put that whole thing together."

Both doctors emphasized the importance of evaluation. As Dr. Kuwamura states: "I'd urge you all to reach out to your doctor. You're always welcome to come to our practice MD Spine Care, and Dr. Martinez is accepting new patients. If you have this problem of cramping, tingling, numbness in your legs, activity related, it's a topic that we struggle with between his specialty and our specialty. What is it, a blood vessel problem or is it a nerve problem?"

"If you have those symptoms, don't ignore them. Come visit us at 3503 Paesanos Pkwy Suite 201, Shavano Park, San Antonio, TX 78231 and be evaluated. We're accepting patients and certainly we welcome you to our family." As a trusted back pain specialist San Antonio patients recommend, MD Spine Care provides comprehensive evaluation for these complex symptoms.


Leg pain when walking? Top San Antonio spine surgeon Dr. Kuwamura explains the shopping cart sign and why standing vs walking matters. Find answers