What physical exam sign suggests spinal stenosis in a patient with calf cramps?

The sign indicating spinal stenosis in a patient with calf cramps is characterized by pain relief when bending at the waist. This occurs because flexing the spine reduces the pressure on the lumbar spinal nerve roots that may become compressed due to narrowing of the spinal canal or its openings. When a patient bends forward, whether it’s leaning against a grocery cart or simply bending at the waist, it can create more space for the nerves, alleviating the discomfort and cramps associated with spinal stenosis.

This symptom is commonly referred to as neurogenic claudication, where patients experience leg pain, usually in the calves, during walking due to nerve compression. When they flex forward, the symptoms often improve, which differentiates this condition from more vascular causes of claudication, where symptoms typically do not improve with body position changes.

The other options indicate different responses that do not align with spinal stenosis. Specifically, an increase in pain while walking downhill or persistent pain after resting tends to suggest other underlying conditions such as vascular insufficiency. Similarly, a lack of symptom change while bending would also diverge from the expected response of improvement in a case of spinal stenosis. Understanding these nuances is crucial for effective diagnosis and treatment planning.