15
ORIGINAL ARTICLE
The Effectiveness of Walking Stick Use for Neurogenic
Claudication: Results From a Randomized Trial and the
Effects on Walking Tolerance and Posture
Christine M. Comer, MSc, Mark I. Johnson, PhD, BSc, PGCHE, Paul R. Marchant, PhD, CStat, BSc, MSc, FRAS,
Anthony C. Redmond, PhD, MSc, Howard A. Bird, MD, FRCP, Philip G. Conaghan, MBBS, PhD, FRACP, FRCP
ABSTRACT. Comer CM, Johnson MI, Marchant PR, Red-
mond AC, Bird HA, Conaghan PG. The effectiveness of walk-
ing stick use for neurogenic claudication: results from a ran-
domized trial and the effects on walking tolerance and posture.
Arch Phys Med Rehabil 2010;91:15-9.
Objectives: To determine the immediate effects of using a
stick on walking tolerance and on the potential explanatory
variable of posture, and to provide a preliminary evaluation of
the effects of daily walking stick use on symptoms and function
for people with neurogenic claudication.
Design: A 2-phase study of neurogenic claudication patients
comprising a randomized trial of 2 weeks of home use of a
walking stick and a crossover study comparing walking toler-
ance and posture with and without a walking stick.
Setting: A primary care– based musculoskeletal service.
Participants: Patients aged 50 years or older with neuro-
genic claudication symptoms (N⫽46; 24 women, 22 men,
mean age⫽71.26y) were recruited.
Intervention: Walking stick.
Main Outcome Measures: Phase 1 of the trial used the
Zurich Claudication Questionnaire symptom severity and phys-
ical function scores to measure outcome. The total walking
distance during a shuttle walking test and the mean lumbar
spinal posture (measured by using electronic goniometry) were
used as the primary outcome measurements in the second
phase.
Results: Forty of the participants completed phase 1 of the
trial, and 40 completed phase 2. No significant differences in
symptom severity or physical function were shown in score
improvements for walking stick users (stick user scores ⫺
control scores) in the 2-week trial (95% confidence interval
[CI], ⫺.24 to .28 and ⫺.10 to .26, respectively). In the second
phase of the trial, the ratio of the shuttle walking distance with
a stick to without a stick showed no significance (95% CI,
From the Academic Unit of Musculoskeletal Disease, University of Leeds (Comer,
Redmond, Bird, Conaghan); Faculty of Health, Leeds Metropolitan University (John-
son), and Faculty of Information and Technology (Marchant), Leeds Metropolitan
University, NIHR Leeds Musculoskeletal Biomedical Research Unit and Section of
Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds
(Conaghan), Leeds, UK.
Supported by a project grant from Leeds Primary Care Trusts Research Consor-
tium. Comer is funded in part by the Arthritis Research Campaign UK (grant no.
18183).
Trial registration is ISRCTN registered (ISRCTN35836727) and NRR registered
(N0436193958).
No commercial party having a direct financial interest in the results of the research
supporting this article has or will confer a benefit on the authors or on any organi-
zation with which the authors are associated.
Correspondence to Philip G. Conaghan, MBBS, PhD, FRACP, FRCP, Section of
Musculoskeletal Disease, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7
4SA, United Kingdom, e-mail: p.conaghan@leeds.ac.uk. Reprints are not available
from the author.
0003-9993/10/9101-00452$36.00/0
doi:10.1016/j.apmr.2009.08.149
.959 –1.096) between the groups. Furthermore, the use of a
walking stick did not systematically promote spinal flexion; no
significant difference was shown for mean lumbar spinal flex-
ion for stick use versus no stick (95% CI, .351°–.836°).
Conclusions: The prescription of a walking stick does not
improve walking tolerance or systematically alter the postural
mechanisms associated with symptoms in neurogenic claudi-
cation.
Key Words: Rehabilitation; Spinal stenosis; Walking stick.
© 2010 by the American Congress of Rehabilitation
Medicine
EUROGENIC CLAUDICATION is described as the clas-
N sic clinical syndrome associated with lumbar spinal ste-
nosis and is characterized by symptoms of pain, numbness,
weakness, or paresthesia in the legs exacerbated by walking
and relieved by stooping forward or sitting.1,2 Surgical proce-
dures for NC are complex and costly and may be associated
with limited improvement in symptoms or function.3,4 Conse-
quently, conservative (nonsurgical) treatment is normally ad-
vocated as first-line management for patients with NC. To date,
there has been little high-quality research investigating the
effectiveness of conservative treatments. Many conservative
treatment programs attempt to capitalize on theoretic benefits
of postural modification. The “shopping cart sign” is com-
monly reported in the literature, referring to the phenomenon
that patients with NC obtain symptomatic relief from walking
with a shopping trolley for support,5,6 which allows them to
lean forward slightly. Because of this phenomenon, a recom-
mendation to use a walking stick is sometimes incorporated
into the conservative management of these patients.
This study had 2 aims: (1) to determine the immediate
effects of using a walking stick on walking tolerance and
posture in order to understand potential mechanisms of action
of the intervention and (2) to provide a preliminary evaluation
of the effectiveness of the daily use of a walking stick in
improving symptoms and function.
METHODS
To address the 2 aims, the study comprised 2 discrete
phases: phase 1 consisted of a pragmatic randomized trial of 2
weeks of home use of a walking stick in which 1 group was
prescribed a walking stick and the control group was not, and
phase 2 consisted of a cross-sectional study comparing walking
tolerance and posture with and without a walking stick during
a shuttle walk test using a crossover design (fig 1). The study
List of Abbreviations
CI confidence interval
NC neurogenic claudication
Arch Phys Med Rehabil Vol 91, January 2010
16 WALKING STICKS FOR NEUROGENIC CLAUDICATION, Comer

Fig 1. Trial design and time-

table.

was approved by Harrogate Local Research Ethics Committee
and was given Research Governance approval by The Leeds
Teaching Hospitals National Health Service Trust and West
Yorkshire Primary Care Research and Development Unit.
The sample size for the study was powered for the primary
outcome, which was the change in shuttle walking test distance
with a walking stick in phase 2 of the study. It was designed to
detect what was considered to be a clinically meaningful im-
provement of 20% in population mean walking distance when
using a stick based on a mean walking distance of 150m in
similar patients from a previous study.7 A standard deviation of
38m from the previous study was assumed,7 and a significance
level of 5% and power of 95% were used. Calculation (after
Kirkwood and Sterne8 for a single mean) gave a sample size of
21 participants for each of the 2 subgroups arising from the
order of stick use in the shuttle walking tests. To account for
attrition, recruitment was set at 24 participants per group.
Potential study participants with clinical symptoms of NC
were identified within the Leeds primary care– based Muscu-
loskeletal Service. All patients gave informed consent before
entering the trial. Inclusion for both phases of the study was
based on a clinician diagnosis of NC combined with a limita-
tion in walking tolerance because of NC (table 1). NC symp-
toms were defined as lower-limb pain, cramping, heaviness, or
paresthesia brought on by walking and relieved by sitting or
stooping forward. Radiologic confirmation of lumbar spinal
stenosis was not an inclusion criterion because NC represents
a clinical syndrome recognized and treated by physiotherapists
in the primary care setting. Full inclusion criteria for phases 1
and 2 of our study are given in table 1.
Phase 1 Clinical Protocol: 2-Week Home Trial of
Stick Use
Participants who were not using a walking stick routinely
were randomized into 1 of 2 groups for a 2-week trial: a group
of participants who were given a walking stick for daily use or
a control group of participants who were not given a walking
stick. Randomization was performed by using a computer-
generated randomization scheme prepared in 5 blocks of 8
participants. A sealed envelope system was used for blinding
the trial investigator to treatment allocation until the point of
treatment delivery. Prescribing a walking stick involved issu-
ing a standard National Health Service wooden walking stick
with a curved handle adjusted to the height of the participant’s
wrist joint with the arm held comfortably at the side. This
protocol adhered to the normal recommended prescription of
walking sticks in standard orthopedic and physiotherapy prac-
tice.9 Participants with predominantly unilateral symptoms
were advised to hold the stick in the hand opposite to the
symptomatic side, whereas those with bilateral symptoms were
advised to use the stick in whichever hand felt most comfort-
able. Each participant was required to show safe use of the
walking stick while in the clinic before being instructed to use
the stick when walking during all day-to-day activities. The

Table 1: Inclusion and Exclusion Criteria for Trial Phases 1 and 2

Inclusion Criteria Exclusion Criteria

Age 55 years or greater
Unilateral or bilateral neurogenic claudication
symptoms (ie, exercise induced leg pain on
walking, relieved in sitting or flexion)
Patient-reported limitation in walking tolerance
because of NC symptoms
Cognitive impairment preventing full understanding or participation in study
Medical conditions limiting walking (lower-limb joint pathology, neurologic,
cardiovascular, or respiratory conditions)
Signs or symptoms of acute cauda equina syndrome or severe or
worsening neurologic status requiring medical or surgical assessment.
(This includes significant or worsening nerve root or cauda equina
function, significant or sinister weight loss, pyrexia, unremitting pain, and
significant inflammatory joint disease.)
Current use of a walking aid*

*Phase 1 only.

Arch Phys Med Rehabil Vol 91, January 2010

 WALKING STICKS FOR NEUROGENIC CLAUDICATION, Comer
following data were collected at both baseline and at 2 weeks:
(1) Zurich Claudication Questionnaire (primary outcome), (2)
Oswestry Disability Index, (3) pain history including visual
analog scales for leg pain and for back pain, and (4) Hospital
Anxiety and Depression Scale.
The primary hypothesis was that changes in symptom sever-
ity scores of the Zurich Claudication Questionnaire scale were
equal in both groups. A descriptive analysis of data was per-
formed initially to explore changes over the 2-week interven-
tion period for both groups. The hypothesis was tested by
comparison of the mean change by using an independent sam-
ples t test.
Phase 2 Clinical Protocol: Walking Tolerance Test
On completion of the 2-week home trial period, all partici-
pants were invited to participate in phase 2 of the trial. Subjects
who were unwilling to participate in phase 1 were given the
option of being recruited directly to phase 2. Phase 2 involved
undertaking 2 shuttle walking tolerance tests; 1 test was per-
formed by using a walking stick, and the other test was per-
formed without a stick. The order of the tests was randomized,
and allocation was concealed by using presealed envelopes as
in phase 1.
The shuttle walking test is a standardized test10 that involved
the participant walking repeated laps of a 10-m distance on a
flat surface. The start of each new lap of the shuttle walk test
was indicated by prerecorded beeps, with the time between
beeps becoming incrementally shorter during the test. The test
ended when the participant could no longer complete a shuttle
before the next beep or when the participant needed to stop
because of pain or other symptoms.
During the shuttle walking test, the sagittal plane posture of
the lumbar spine (flexion/extension movements) was recorded
by using an electronic strain gauge goniometer.a The electro-
goniometer consists of 2 end blocks (distal block 50mm length,
proximal block 120mm length) connected by a biaxial strain
gauge that provides flexion data in 2 planes. In line with the
manufacturer’s operating instructions, the distal end block was
fixed with tape over the level of S1, with the proximal end
block fixed at the level of T12 to L1 so that the strain gauge
connecting the 2 probes is at near minimal length. The data-
acquisition unit was calibrated to 0 with participants in a fully
upright stance, with the heels, sacrum, and shoulders flat
against a vertical wall. Spinal posture was recorded at 5Hz and
logged in real time on the data-acquisition unit before being
downloaded and analyzed by using Biometrics DataLOG soft-
Patients Recruited to Trial (n=46)
Walking stick users (n=6)
Two weeks continue stick use (n=6) Two weeks stick use (n=20)
Randomized Randomized
Shuttle Walk Test: Shuttle Walk Test: Shuttle
Shuttle Walk
Walk Test:
Stick then no stick No stick then stick Stick then
Test: no then
Stick stick
(n=3) (n=3) (n=7)
no stick
Fig 2. Flow of participants to trial.
17
ware version 3.00.a This provided an individual temporal mean
measurement of lumbar spinal flexion (in degrees) from an
upright stance during each shuttle walking test with and with-
out the use of a stick.
The outcome for phase 2 was the difference in distance in
meters walked with or without a walking stick. Evaluation of
the shuttle walking test data involved initial descriptive and
graphic analysis to explore differences in the mean walking
distance and in posture between the 2 test conditions. A general
linear model respecting the crossover design was used to test
the hypothesis that there was no difference in the distance
walked and no difference in spinal posture with or without a
walking stick.
RESULTS
Forty-six patients (24 women, 22 men; mean age, 71.26y
[range, 58 – 89y]) entered the study over a 15-month period. Of
the 46 participants overall, 34 completed both phases of the
study. Six participants undertook phase 1 of the study but were
not able or prepared to take part in phase 2 of the study because
of transport and time constraints (n⫽5) or illness (n⫽1). Six
participants who did not undertake phase 1 (current stick users)
were recruited directly to phase 2 of the trial. Therefore, a total
of 40 participants were recruited in each phase of the study.
There was no loss to follow-up in either phase once participants
had been recruited (fig 2).
Phase 1 Results: 2-Week Home Trial of Stick Use
Baseline characteristics for the 40 participants in the 2-week
home trial are presented in table 2. There were no dropouts or
missing data, and all participants stayed within the allocated
treatment arm. Therefore, analysis was performed on an inten-
tion-to-treat basis.
Both groups showed small improvements in the symptom
severity score of the Zurich Claudication Questionnaire. The
mean difference in improvement between the 2 groups (stick
group ⫺ no-stick group scores) was 0.02 points (95% CI,
⫺0.24 to 0.28), which was neither statistically nor clinically
significant.
The mean difference (stick group ⫺ no-stick group) in
improvement in the Zurich Claudication Questionnaire physi-
cal function scale scores of 0.08 points (95% CI, ⫺0.10 to
0.26) was neither clinically meaningful nor statistically signif-
icant. Secondary outcome measures for pain severity, function,
and psychologic factors also showed changes in scores that did
not reach statistical significance (table 3).
Non - walking stick users (n=40)
Randomized
Two weeks stick use (n=20)
Unwilling / unable to Randomized
undertake Shuttle
Walk Test (n=6)
Shuttle Walk Test: Shuttle Walk Test: Shuttle Walk Test:
No stick then stick Stick then no stick No stick then stick
(n=10) (n=11) (n=6)
Arch Phys Med Rehabil Vol 91, January 2010
18 WALKING STICKS FOR NEUROGENIC CLAUDICATION, Comer

Table 2: Baseline Characteristics for Phase 1 Participants
Group Prescribed
Group Walking Stick Control Group
Age (y) 71.0⫾6.7 70.8⫾8.3
VAS leg pain 6.90⫾1.95 6.72⫾2.57
VAS low back pain 5.49⫾2.93 6.91⫾2.55
ZCQ symptom severity 3.08⫾0.61 3.25⫾0.76
ZCQ physical function 2.48⫾0.61 2.44⫾0.45
Oswestry Disability Index 39.20⫾11.70 44.55⫾16.36
HAD depression 6.90⫾3.49 7.84⫾3.30
HAD anxiety 6.45⫾3.68 7.89⫾4.58
NOTE. Values are mean ⫾ SD.
Abbreviations: HAD, Hospital Anxiety and Depression scale; VAS,
visual analog scale; ZCQ, Zurich Claudication Questionnaire.
Phase 2 Results: Walking Tolerance Test
Baseline characteristics of the 40 participants who com-
pleted the shuttle walking crossover trial are presented in table
4. Inferential analysis was undertaken by using the standard
statistical model.11 Data were analyzed by using a mixed model
with a random effect for the participants as well as the fixed
effects for the 2 factors: (1) use of a walking stick and (2) the
order of the tests.
Effect of a walking stick on walking distance. All 40
participants completed 1 shuttle walking test with a walking
stick and 1 without a stick. With randomization of order and
subsequent model fitting, the order of the tests was found to
exert no significant systematic effect on the walking distance.
The mean distance completed without a stick was
217.5⫾118.7m, and with a stick it was 215.5⫾108.1m. Before
inferential analysis, walking distance values were log trans-
formed to ensure that the residuals from the fitted model (eij)
were normally distributed. The 95% CI for the increase in
mean log distance with a stick was found to be ⫺0.044 to
0.094, which after back transformation via the exponential
function yielded a 95% CI for the median ratio of distance
walked with and without a walking stick (0.959 –1.096). There-
fore, the ratio was seen to be about 1, and the upper confidence
limit suggests at most a 10% increase of distance achieved
when using a walking stick. These results indicate that there
was no significant effect on the walking distance, either statis-
tically or clinically meaningful, when using a walking stick.
Effect of walking stick on lumbar spinal posture. Twenty-
eight of the participants undertaking the shuttle walking test
had detailed electrogoniometric data available. Data for the
remainder of the participants were either incomplete or missing
because of recording faults. The mean lumbar flexion during
the walking test without a walking stick was ⫺1.60°⫾8.63°,
and with a stick it was ⫺1.28°⫾8.78°. The 95% CI for the
mean increase in spinal flexion when using a stick was ⫺0.351
to 0.836, indicating no statistically significant difference. In
Table 4: Baseline Characteristics of Participants in Phase 2
Group Median (5th and 95th Percentiles)
Age (y) 70 (59 and 85)
Low back pain duration (mo) 42 (0 and 482)
Leg symptom duration (mo) 24 (4 and 179)
VAS leg pain 6.7 (2.1 and 9.7)
VAS low back pain 6.3 (0 and 9.6)
ZCQ symptom severity 3.07 (2 and 4.69)
ZCQ physical function 2.50 (1.6 and 3.2)
Abbreviations: VAS, visual analog scale; ZCQ, Zurich Claudication
Questionnaire.
this case, there was an effect of period (order of test) such that
the 95% CI for the change in flexion in “period 2” versus
“period 1” (⫺1.501 to ⫺0.314) showed a statistically signifi-
cant decrease. Although the overall mean flexion was
0.32°⫾1.73° greater when using a stick compared with not
using a stick, this difference was mostly in those using a stick
in the first test in which there was an increase in flexion of
1.12°⫾1.26°.
DISCUSSION
There are few trials investigating the effectiveness of non-
surgical treatments for NC, and this is the first randomized trial
of walking aid use in people with NC. The results of the first
phase of this study showed that using a walking stick had no
discernable effect on either symptoms or function over a
2-week period in this patient group.
Equally, no discernable difference in walking tolerance was
shown with or without a walking stick in the second phase of
the trial. This contrasts with findings in a previous study12
evaluating the effects of a walking aid; in Goldman et al’s12
case series study of patients using a wheeled walker, good or
excellent improvement (more than a 250% increase) in self-
reported walking distance was observed in 71% (37/52) of
patients with NC. However, the direct comparability with our
data is limited by the use of a different type of walking aid and
the use of self-reported walking distance as an outcome mea-
sure, which has been shown to have limitations compared with
objective measures of walking tolerance.13
This second phase of the trial provides some insight into the
possible reasons why using a walking stick did not improve
symptoms or function. The mechanism expected to produce
improvements was a hypothesized increase in spinal flexion
when using a stick. This was not evident, however, and it may
be that shorter walking sticks are required to produce measur-
able postural change. Goldman14 has noted previously that
taller people with NC report good improvement in walking
tolerance when leaning on a standard-height wheeled walker,
but those of a shorter stature required a smaller wheeled walker
to benefit. Furthermore, Goldman15 noted that some patients

Table 3: Pain, Dysfunction, and Psychologic Outcomes in Phase 1

Difference in Score Changes Between Mean Change in Walking Stick Group Mean Change in Control Group
Outcome Measure Groups Mean (95% CI) Mean (95% CI) Mean (95% CI)

VAS leg pain 0.52 (⫺0.52 to 1.56) ⫺0.38 (⫺1.11 to 0.35) 0.14 (⫺0.64 to 0.92)
VAS low back pain 0.81 (⫺0.66 to 2.29) ⫺1.13 (⫺2.47 to 0.20) ⫺0.32 (⫺1.14 to 0.50)
ODI ⫺2.22 (⫺8.35 to 3.91 ⫺3.22 (⫺8.76 to 2.33) ⫺1.00 (⫺4.07 to 2.07)
HAD depression 0.39 (⫺1.25 to 1.32) ⫺0.25 (⫺1.18 to 0.68) ⫺0.21 (⫺1.16 to 0.73)
HAD anxiety ⫺1.13 (⫺2.79 to 0.52) 0.45 (⫺0.89 to 1.79) 0.68 (⫺1.74 to 0.37)

Abbreviations: HAD, Hospital Anxiety and Depression scale; ODI, Oswestry Disability Index; VAS, visual analog scale.

Arch Phys Med Rehabil Vol 91, January 2010

 WALKING STICKS FOR NEUROGENIC CLAUDICATION, Comer
maximize spinal flexion postures by resting their forearms on
the transverse handlebar when walking with a shopping trolley
for support, but this is not possible with a wheeled walker with
2 separate handles or with a walking stick. This raises a further
possibility that unloading of the spine may also play a role in
the mechanism of symptom relief along with postural modifi-
cation. A previous study16 showed that walking tolerance in
people with NC was influenced more by loading or unloading
of the spine with weights or harnesses than by adopting dif-
ferent spinal postures. It is possible that using a walking stick
does not offer sufficient unloading to improve symptoms and
function.
Study Limitations
The 2-phase design introduced the potential for the shuttle
walking tolerance tests to be influenced by previous use or
nonuse of a walking stick during the 2-week home trial phase.
However, this potential confounder was explored explicitly in
the analysis, and no systematic effects were identified.
In addition, the crossover design of phase 2 carries an
inherent risk that the response in the second shuttle walk test
might be influenced by carryover effects from the first shuttle
walk test. There was no systematic effect on walking distance
from the order of the tests in this trial, but test order did affect
changes in spinal posture with and without a walking stick.
Therefore, a washout period of greater than the 30 minutes
allowed in this trial would be advocated for future studies
incorporating postural analysis during walking.
CONCLUSIONS
The trial results indicate that using a walking stick did not
improve posture, symptoms, or function in our participants
with NC. Further work to evaluate the effectiveness of a shorter
than normal walking stick in promoting a flexed lumbar spinal
posture and improving symptoms and function might be war-
ranted. On the basis of our trial, the prescription of a walking
stick cannot be routinely recommended as an intervention for
all NC patients, although the benefits of a more substantial
walking aid warrant further investigation.
Acknowledgment: We thank Heikki Vanharanta, MD, DMSc,
for his contribution to the study concept and design during the devel-
opment stage of the trial.
References
1. Porter RW. Spinal stenosis and neurogenic claudication. Spine
1996;21:2046-52.
2. Willen J, Danielson B, Gaulitz A, Niklason T, Schonstrom N,
Hansson T. Dynamic effects on the lumbar spinal canal: axially
19
loaded CT-myelography and MRI in patients with sciatica and/or
neurogenic claudication. Spine 1997;22:2968-76.
3. Atlas SJ, Delitto A. Spinal stenosis: surgical versus nonsurgical
treatment. Clin Orthop Relat Res 2006;Feb(443):198-207.
4. Gibson JN, Waddell G. Surgery for degenerative lumbar spondy-
losis: updated Cochrane Review. Spine (Phila Pa 1976) 2005;30:
2312-20.
5. Bulstrode C, Buckwalter J, Carr A, et al, editors. Oxford textbook
of orthopaedics & trauma. 1st ed. Oxford: Oxford University
Press; 2002.
6. Evans JG, Williams TF, Beattie BL, Michel JP, Wilcock GK,
editors. The Oxford textbook of geriatric medicine. 2nd ed. Ox-
ford: Oxford University Pr; 2003.
7. Pratt RK, Fairbank JC, Virr A. The reliability of the Shuttle
Walking Test, the Swiss Spinal Stenosis Questionnaire, the Ox-
ford Spinal Stenosis Score, and the Oswestry Disability Index in
the assessment of patients with lumbar spinal stenosis. Spine
(Phila Pa 1976) 2002;27:84-91.
8. Kirkwood B, Sterne J, editors. Essential medical statistics. 2nd ed.
Oxford: Blackwell Science; 2003.
9. Watson MS, editor. Oxford handbook of palliative care. 1st ed.
Oxford: Oxford University Press; 2005.
10. Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Devel-
opment of a shuttle walking test of disability in patients with
chronic airways obstruction. Thorax 1992;47:1019-24.
11. Matthews JN, editor. An introduction to randomised controlled
clinical trials. London: Arnold Publishers; 2000. Arnold; 2000.
12. Goldman SM, Barice EJ, Schneider WR, Hennekens CH. Lumbar
spinal stenosis: can positional therapy alleviate pain? J Fam Pract
2008;57:257-60.
13. Zeifang F, Schiltenwolf M, Abel R, Moradi B. Gait analysis does
not correlate with clinical and MR imaging parameters in patients
with symptomatic lumbar spinal stenosis. BMC Musculoskelet
Disord 2008;9:89.
14. Goldman SM. Neurogenic positional pedal neuritis. Common
pedal manifestations of spinal stenosis. J Am Podiatr Med Assoc
2003;93:174-84.
15. Goldman S. Value of a grocery cart and walker in identification
and management of symptomatic spinal stenosis in diabetic
patients presenting with peripheral neuropathy or claudication
[Letter]. Diabetes Care 2003;26: p 1943.
16. Oğuz H, Levendoğlu F, Oğün TC, Tantu A. Loading is more
effective than posture in lumbar spinal stenosis: a study with a
treadmill equipment. Eur Spine J 2007;16:913-8.
Supplier
a. Goniometer with DataLOG data acquisition unit P3X8, and DataLOG
software ver 3.00; Biometrics Ltd, Unit 25, Nine Mile Point Indus-
trial Estate, Cwmfelinfach, Gwent NP11 7HZ, UK.
Arch Phys Med Rehabil Vol 91, January 2010