Bicycle (van Gelderen) Test: Differentiating Leg Pain

The Bicycle Test of van Gelderen is a functional assessment used to distinguish between two common causes of leg pain: neurogenic claudication (caused by spinal stenosis) and intermittent claudication (caused by peripheral arterial disease).

1. Purpose

The primary purpose of the Bicycle Test (van Gelderen's Test) is to **differentiate** between:

• Intermittent Claudication: Vascular origin (Peripheral Arterial Disease - PAD).
• Neurogenic Claudication: Spinal origin (Lumbar Spinal Stenosis).

It helps determine if leg pain is caused by lack of blood flow or nerve compression.

2. How to Perform

1. The patient sits on a stationary bicycle.
2. Phase 1 (Erect): The patient pedals with an upright, straight posture until leg pain/symptoms appear. The time to onset is noted.
3. Phase 2 (Flexed): While continuing to pedal, the patient is instructed to lean forward into lumbar flexion (a slumped or racing posture).
4. The examiner observes if the symptoms change, resolve, or persist with the change in posture.

3. Positive & Negative Sign

The interpretation depends on how the symptoms respond to the change in position:

• Positive for Neurogenic Claudication (Spinal Stenosis): The leg pain disappears or significantly reduces when the patient leans forward. Flexion opens the spinal canal and intervertebral foramina, relieving nerve compression.
• Positive for Intermittent Claudication (Vascular): The leg pain persists regardless of whether the patient is upright or leaning forward. The metabolic demand on the muscles is the same in both positions, so ischemia (lack of blood flow) continues.