Spinal shock when walking is a frightening back pain symptom that can be caused by several possible sources. Many patients write to us wondering about the relevance of feelings of pressure, impact or shock when they drop their heel to walk. In essence, they complain that the impact of the ground is transmitted through the leg and experienced in the spine or surrounding musculature.
Feelings of impact in the spine can be harbingers of some very serious conditions, such as central spinal stenosis with cord compression. However, virtually identical expressions can be harmless symptoms caused by muscular tensioning, commonly experienced in the bilateral lumbar paraspinal region, the central buttocks or the upper end of the trapezius.
Since the specter of shock in the spine has many readers worried, and is such a commonly reported event, we have decided to demystify the symptom by discussing its possible causes, consequences and therapy recommendations, based on years of professional and personal experience with this exact symptomology.
Patients report varying expressions of spinal shock from walking, depending on the particulars of their own condition and circumstances. The following are all typically cited symptomologies reported by our readership:
Many patients complain of pressure in the buttocks and lower back, typically directly over the central buttocks crease or bilaterally in the paraspinal muscles on each side of the lumbar region. This shock most often occurs immediately when dropping the heel to walk on a hard surface. Wearing cushioned shoes may or may not relieve some degree of pressure for some patients. Some patients cite similar shock even when walking gingerly on a soft surface, such as on sand or thick carpeting.
Fewer patients report similar feelings of shock and pressure in the neck and upwards to the base of the skull, at the junction of the occiput and the cervical spine, where the trapezius muscle connects. Once again, this impact feeling is most often experienced when dropping the heel to walk on a hard surface, although some patients experience similar patterns when walking carefully on a softer surface, as well.
The least common expression is shock experience elsewhere in the spine, such as in the middle or lower thoracic regions, upper lumbar area or lower cervical spine, near the base of the neck. In these cases, symptomology is usually identical, with heel pressure against the ground transferring impact and pressure to the affected area of the vertebral column.
Many doctors instantly associate all of these described feelings with central canal stenosis involving spinal cord or cauda equina compression. This is because these diagnoses can and do produce feelings of impact and shock in the spine upon walking in many patients. However, in spinal stenosis cases, the patient often can not walk for long and typically experiences progressive numbness in the legs with each step.
Acute varieties of spinal injury may also cause feelings of pressure, pain and shock when vibrations from walking transfer up the vertebral column. These types of injuries range from extreme intervertebral herniations to fractured vertebrae to misaligned vertebrae.
The most common cause of spinal shock from walking is surely muscular involvement of the postural soft tissues. Although the symptoms feel like they originate in the spine itself, they are actually experienced in the immediate surrounding musculature that supports and moves the spinal structures, such as in all the muscular locations listed above.
When shock is experienced high in the buttocks, or high at the base of the skull, the causation is virtually universally muscular in nature, since these are attachment points for various soft tissues and also sites of tension in many spinal anatomies. Underlying causation might point towards muscular imbalance, injury, ischemia or related attachment tissue condition, such as those affecting ligaments and tendons in identical locations.
When diagnosing feelings of shock and pressure in the spine due to walking, it is vital that the physician really listens to the description of the symptom and takes the location into account by comparing the exact affected region to the clinical spinal anatomy.
You would be amazed how many patients were diagnosed with cervical spinal stenosis as the cause of impact feelings, when the symptoms were felt wholly in the occiput. This is illogical from a diagnostic point and view and could not come about due to cervical cord compression at C5 to C7 as is commonly diagnosed. Regardless, the diagnosis is made nonetheless, because the patient demonstrates typical canal narrowing at the expected locations and no other spinal abnormalities are visualized on diagnostic imaging studies. It seems that the obvious muscular origin of trapezius causation was not even considered, which is strange, since these same patients universally demonstrate pain upon palpation of these muscular tissues at the base of the skull, upper shoulder and often into the upper back, over the shoulder scapula, certainly implicating the trapezius tissues.
Likewise, we see many diagnoses of lumbar stenosis made when shock feelings reside low in the buttocks crease, far past the end of the spinal cord, where only a few nerve roots remain traversing the cauda equina. Lumbar 4 and 5, as well as sacral 1, are the usual locations, although symptoms do not correlate to central stenosis, with the exception of impact feelings when walking. In our experience, the symptomology often occurs due to tendon, ligament and muscular tension in the lower sacral-coccygeal region, while the findings of typical canal narrowing in above levels of the lumbar spine seem normal and expected; certainly not symptom-generating.
In cases where impact, shock and pressure symptoms reside elsewhere, such as in the upper lumbar region, middle back and upper back, and particularly when severe leg weakness and difficulty ambulating occur, the diagnosis of central stenosis is sometimes made and is often correct. This rule is not universal, as other causations can be explanatory in these locations, as well, but statistically, these diagnoses turn out to be accurate more often than in the previously mentioned anatomical targets.
A couple of summers ago, I experienced terrible feelings of shock when dropping my heel to walk, even on the softest of surfaces. I had the symptom occur both in the upper buttocks, at the crease of the sacral-coccyx, along with the addition of pressure and tight feelings of impact at the occiput. I went through the usual diagnostic processing, knowing already that my extensive collection of spinal abnormalities would most likely be implicated as the cause, particularly in my neck.
However, upon careful study and objective reflection, I soon realized, before my doctors, that the tissues involved were certainly not spinal, but instead, purely muscular. Upon meeting with my neurologist and a recommended neurosurgeon, my arguments were heard, my suspicions were confirmed and armed with this knowledge of the innocence of the symptomology, it did not last long.
I caution patients to become ardent students of the anatomy when seeking correlation of these types of symptoms to potential spinal sources. Ask diagnosticians for the expected clinical symptomology of any proposed causative theory and compare it carefully to your own exact expressions. In many cases, there will be discrepancies. Be mindful and watchful to prevent entering into potentially invasive treatment for what might be an innocent structural alteration, such as typical age-related canal narrowing in the neck or lower back.