Back pain that worsens with walking and improves with rest is most consistent with which condition?

• A. Spinal Stenosis
• B. Mechanical Back Strain
• C. Disc Herniation
• D. Osteoarthritis of the Hip

Answer: (A)

Pain that starts or worsens with walking and improves with rest is classic for neurogenic claudication from lumbar spinal stenosis. When the spine is extended during walking, the already narrowed spinal canal compresses nerve roots, producing leg pain, numbness, or weakness that limits activity. Sitting or bending forward (flexion) relieves the pressure and often stops the symptoms, so rest provides relief. This pattern differentiates spinal stenosis from other back conditions.

Mechanical back strain tends to cause localized low back pain that worsens with movement and improves with rest, but it doesn’t typically produce reproducible leg symptoms during walking. A disc herniation can cause leg radicular pain, but it usually follows a specific dermatomal distribution and may be aggravated by sitting or Valsalva maneuvers rather than uniquely relieved by rest. Osteoarthritis of the hip presents with groin or hip pain and reduced hip motion rather than the characteristic neurogenic leg symptoms tied to spinal canal narrowing.