CINN Medical Group Physician Blog

The Shopping Cart Sign

Some people love shopping carts.  Not because they love shopping, but because holding the cart allows them to bend over at the waist a little bit, a position that is called lumbar flexion.  If they stand straight up, they quickly develop pain in the buttocks and the back of the thighs.  Bending over usually feels better, and allows them to walk further without developing incapacitating pain.  These patients have a condition called  lumbar stenosis.  Stenosis means narrowing, and lumbar refers to the part of the spine that is the lower back.  The nerves from the spinal cord are contained in a canal that runs inside the bones(vertebrae) in the lower back.   This canal frequently gets narrow because of changes that happen with arthritis(you can think about how a pipe gets gradually blocked when debris sticks to the sides of the pipe- the space gradually gets more narrow).  If the narrowing reaches a critical point, the nerves are compressed.  The usual symptoms are pain in the buttocks and the backs of the thighs.  The canal opens up a little with sitting and laying down, so patients frequently have little to no problems in these positions.  However, the canal narrows a little with standing straight up(also known as lumbar extension), and sometimes this is like the straw that breaks the camel’s back; it causes a  little more pressure on the nerves so that it is painful.  The pain gradually increases with more standing and walking, and goes away with sitting, laying down, or bending over on something, like a shopping cart.