Often symptoms that arise from Lumbar spinal stenosis (narrowing of the spinal canal) and arterial occlusive disease can demonstrate similar traits posing a challenge to the diagnostic physician. Lumbar stenosis can generally be congenital or acquired in origin. Whereas lumbar stenosis can result in low back pain or radicular pain (sciatica) worse with standing and ambulation arterial occlusive disease can also affect the lower extremities and worsen with exertion. A flexed stationery bike may help to discern the cause of a patient’s pain.  If there is no clear pain generator in the back that can be garnered with the history and exam and there is suspicion for arterial vascular disease an arterial Doppler and ankle brachial index may be indicated (check BP at the ankle and arm).