Execution
- 1Screen the patient for safe treadmill walking and record baseline leg and back symptoms.
- 2Have the patient walk on a level treadmill and record time to symptom onset, symptom intensity, and total walking time.
- 3Allow symptoms to return to baseline.
- 4Repeat walking on an inclined treadmill to place the lumbar spine in relative flexion.
- 5Compare symptom onset, walking duration, and recovery time between level and inclined walking.
Positive outcome
Earlier symptom onset or shorter walking tolerance during level walking, with improved tolerance during inclined walking, supports neurogenic claudication from lumbar stenosis. Prolonged recovery after level walking may also support the finding. Similar limitation on level and incline walking makes vascular claudication or nonstenotic causes more plausible.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Fritz et al. (1997) | NA | NA | NA | NA | NA |
| Deen et al. (1995) | NA | NA | NA | NA | NA |
CommentThe two-stage treadmill test uses the flexion-relief behavior of neurogenic claudication. It is more of a functional provocation and differentiation test than a pure diagnostic accuracy test. It should be avoided or modified when cardiopulmonary, vascular, balance, or gait limitations make treadmill testing unsafe.
Low Clinical Value