Importantly, remember the 5 P-s of vascular claudication, as follows:

• Pulselessness;
• Paralysis;
• Paresthesia;
• Pallor;
• Pain.

The absence of these symptoms, excluding pain and paresthesia, which are common to neurogenic and vascular claudication, should give the clinician confidence in the diagnosis of NC. If vascular claudication is suspected, referral to an internist for a workup is indicated. This includes a serum cholesterol level, arterial Doppler studies, ankle-brachial index values, and, in some cases, arteriography.

Dural tension signs should be unremarkable. Lumbar segment mobilization often fails to reproduce pain, and trigger points are typically not present.