Shopping Cart Sign · What Is It, What It Means, and More

The shopping cart sign refers to the temporary relief of back pain that occurs when a person bends over as if they were leaning on a shopping cart. 

The shopping cart sign may be indicative of lumbar (i.e., lower) spinal stenosis, a very common condition in which there is a narrowing of the spaces within the spine, which can put pressure on the spinal cord and spinal nerves. The act of bending over provides relief of the pain by increasing the amount of space between the spinal cord and the vertebrae or discs that are impinging it.

The shopping cart sign is assessed primarily following a thorough history and physical exam. Pertinent findings in the individual’s history may include lower back pain brought on by walking and exercise, and pain that is typically relieved with sitting or by maintaining a position in which the spine is flexed forward (i.e., bending over). Upon physical examination, the clinician might observe that the individual walks with a hunched posture. Pain may worsen when asking the individual to bend backwards. Lumbar spinal stenosis can also be diagnosed using imaging techniques, such as magnetic resonance imaging (MRI). 

Spinal stenosis occurs when the spinal canal is narrowed. Some individuals are born with a congenitally small spinal canal which can make them more likely to develop spinal stenosis. Other congenital causes include spinal deformity, such as scoliosis; or genetic diseases that affect bone and muscle development throughout the body (e.g., Hurler syndrome, Paget disease of bone). Individuals may also be born with inherited gene mutations that predispose them to spinal tumors, which can grow into the spinal canal and cause nerve compression and spinal stenosis. 

Other signs and symptoms of spinal stenosis include pain or cramping in one or both legs when standing or walking for long periods of time; numbness or tingling in a foot or leg; weakness in a foot or leg; and back pain. These symptoms can worsen over time. Typically the neurologic examination is normal in those with spinal stenosis, meaning the individual does not have a loss of strength, sensation, or coordination in the trunk or lower extremities. However, more severe cases of spinal stenosis may result in a loss of bladder control or difficulty walking. Rarely, some people with spinal stenosis may not experience any symptoms at all. 

Milder cases of spinal stenosis may be treated with minimally invasive methods. Self-directed balance and flexibility exercises and/or physical therapy have been shown to increase strength of the back muscles. Hot and cold packs and over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also be used. 

The shopping cart sign refers to the relief of back pain experienced by someone with spinal stenosis when they assume a hunched position, as if they were leaning over a shopping cart. Spinal stenosis refers to the narrowing of the spinal canal, which may be congenital or caused by osteoarthritis, disc herniation, or trauma. This results in pain in the lower back that can also radiate to the legs and feet. Individuals can also experience numbness, tingling, and weakness in the lower extremities. Severe cases of spinal stenosis can result in a loss of bladder control or an inability to walk. Treatment options may be conservative for mild cases of spinal stenosis and can include physical therapy, NSAIDs, and epidural injections. More severe cases may require surgery, including laminectomy to increase the space surrounding the affected nerves.