LEG PAIN
Leg pain is a common symptom following accidents or trauma but it can also signify many different diseases.
Depending on the cause, leg pain is a common cause of disability and sick days from work. It affects men and women, young or old. It is usually mild but can be severe and debilitating. It can start suddenly or slowly. It can be felt it in a small area of the leg or over a wide area and even affect the whole leg. It can last days or years, and can sometimes be hard to treat.
Leg pain is often short-term or acute, and lasts a few days to a few weeks. It usually improves on its own with self-care. It is called subacute leg pain if it lasts between 4 and 12 weeks.
Chronic leg pain, on the other hand, lasts for 3 months or longer, even after the initial injury or underlying cause of pain has been treated. Chronic leg pain can occur in a small percentage of people that get acute leg pain. This means that the pain can continue for much longer than expected and in some of those cases the chronic lower leg pain can be difficult to treat.
LEG PAIN SYMPTOMS
There are many causes of leg pain which can occur suddenly or slowly. Leg pain can also occur immediately after an injury or the onset of symptoms can be delayed.
Symptoms can include a sharp or dull pain. There might be burning, aching, tingling, numbness, pins and needles, or weakness. Leg pain commonly occurs with pain higher up in the buttock, lower back or spine, and down into the foot.
Severity can be anywhere from 1 to 10, or from mild to severe.
Sometimes people can be very unwell if there is a more serious cause like an infection or fracture. If it is associated with peripheral neuropathy or vascular disease there may be changes in colour of the leg, feet with or without ulcers and slow healing wounds.
If there is an infection, the area could also be red, swollen and warm.
LEG PAIN CAUSES
The precise location of the leg pain and associated symptoms can provide valuable clues about the underlying cause.
When leg pain experts make an assessment, a few things need to be considered. The pain could be caused by a number of problems in or around the area. A few leg pain causes are:
Leg cramps are short episodes of pain that can last for a few minutes. The muscles tighten and go into spasm. This commonly involves the calf muscle at the back of the lower leg. Cramps are a common cause of leg pain at night and in older people.
Strain and sprains of surrounding muscles, ligaments, and tendons. Sometimes leg muscle pain can be related to myofascial pain syndrome which causes muscle spasms and exquisite tenderness. Muscles that could be sprained or strained might be the rectus, vastus and adductor muscles in the front of the thigh, the hamstring muscles at the back of the thigh or the anterior or lateral calf compartment muscles in the front or the soleus or gastrocnemius muscles at the back of the lower leg. Shin splints are a certain type of muscle injury that can occur following intense repetitive exercise like jogging or running where the impact forces cause muscle and tendon overload.
Joints nearby: the joints in the lower back are called facet joints. The facet joints can become inflamed and swollen (arthropathy), which can cause stiffness and pain. Sometimes facet joint pain can be debilitating and long-lasting and refer down to thigh pain. Other joints that may cause pain in the leg are the sacroiliac joint, which can cause pain down the back of the leg or the hip, knee or even ankle joint that can cause leg pain.
Myofascial pain is pain that occurs because of problems with the surrounding muscles, ligaments and tendons of the leg as mentioned above. The muscles may develop discrete little tight knots (taut bands) that are called myo-fascial trigger points. Trigger points are hyperirritable spots in the covering (fascia) surrounding muscle and can be very painful and quite debilitating. When a trigger point is touched or examined, it can cause exquisite pain in and around the area.
Lumbar spondylosis (osteoarthritis) is spinal arthritis, which is an age-related condition that affects the joints, discs and ligaments of the spine. This can also occur in the sacroiliac joint. These conditions usually causes back pain but arthritis leg pain occurs sometime.
Spondylolisthesis: pronounced spon-di-low-list-thee-sis. Misalignment of spine bones occurs when one vertebra slips over the one below it. It can be caused by problems with the bone or disc degeneration or ligament issues. It usually occurs with spondylosis. This condition usually causes back pain but it can sometimes cause pain in the leg.
Another type of misalignment is when there is a curved spine (scoliosis).
Referred pain: referred pain is where pain in one part of the body can be felt in another part of the body that is nearby. This occurs when different parts of the body share the same nerves to send signals to the spine and brain. Spine problems like facet joint arthritis or disc prolapses can both contribute to spinal nerves being compressed where they leave the spinal column (pinched nerves). This compression condition is called lumbar foraminal stenosis and can cause radiating pain anywhere down into the buttock, leg or foot. This type of pain that refers down the leg is called radicular pain and is a relatively common cause of chronic leg pain. Sometimes pain that runs down the leg is also referred to as sciatica.
Nerve leg pain: sometimes neurological problems can cause leg pain. Neurological causes might include shingles (zoster), post herpetic neuralgia, cluneal neuralgia, meralgia paraesthetica or even conditions like multiple sclerosis.
When a compression occurs into the spinal column itself, this may be called lumbar spinal stenosis and if the compression is serious it can compress the spinal cord itself, which is called myelopathy. Myelopathy is when the compression of the spinal cord starts causing symptoms, such as weakness or problems with coordination in the arms, hands, legs, or even feet.
When pain persists following acute pain, this can sometimes cause changes within the nerves and set up some forms of nerve pain, also called neuropathic pain. Nerve pain can sometimes be hard to diagnose and usually needs to be assessed and treated by pain specialists.
Sensitisation: sometimes a problem in the nervous system called sensitisation can occur. This is when the pain, usually a nerve pain, seems to be spreading up into the body and or down into the arm, or even into the other side of the body. People with sensitisation can even have sensitive skin in the legs and even light touch using a brush can be exquisitely painful.
Post-surgical pain: after an operation or surgery, pain can sometimes persist after the tissue has had sufficient time to heal. This can occur in up to 25% of all surgeries and sometimes the persistent leg pain can be intolerable and debilitating. Post-surgical pain can be caused by almost any type of operation, and can be caused by many things, including nerve injury or scarring, ongoing inflammation or infection, muscle weakness and stiffness. This is a complex pain condition and should be assessed and managed by pain specialist physicians in conjunction with the operating surgeons. When this leg pain occurs following spinal surgery it is called post-laminectomy syndrome or also called Failed Back Surgery Syndrome (FBSS).
Peripheral vascular disease is a blood circulation problem that can cause blood vessels to narrow, block or even go into spasm. It commonly affects the legs and occurs with exercise.
Diabetes mellitus can cause nerve damage called diabetic neuropathy, which can cause leg pain and cramps. When diabetes damages nerves in the arms or legs, it is called diabetic peripheral neuropathy.
Restless leg syndrome is a neurological disorder that causes unpleasant or uncomfortable sensations in the legs with an irresistible urge to move them. Restless leg syndrome typically occurs while sitting or lying down in the afternoon or evening. It generally worsens with age and can severely disrupt sleep.
Varicose veins, which are swollen and enlarged veins, most commonly occur in the legs and these can be painful.
Contact us to find out what's causing your pain.
WHO GETS LEG PAIN?
Although anyone can get leg pain some people are more likely to develop it. Here are a few risk factors that might make the development of leg pain more likely:
Older age people tend to have more spinal problem or other diseases like diabetes, which can cause or contribute to leg pain.
Lack of exercise and low fitness level
Excessive physical activities like running can predispose to lleg muscle problems and shin splints
Being overweight
Certain jobs or activities that require heavy lifting, pushing or pulling, particularly when it involves twisting or vibrating the spine can cause spinal pain which inturn can cause leg pain. An inactive job like a desk job may also contribute to leg pain especially with a poor posture or a chair without adequate back support.
Poor circulation
Long flights can predispose people to developing deep vein thrombosis (DVT)
Direct injury or trauma to the leg can predispose to dangerous conditions like compartment syndrome.
HOW DO I GET A LEG PAIN DIAGNOSIS?
Leg pain is usually mild and settles by itself however in some circumstances the pain can be complex and should be assessed by a medical professional or pain specialist who will take the time to understand the pain story and perform a physical examination before setting forward a diagnosis and treatment plan.
In some circumstances imaging tests may be required. Types of imaging tests might be X-rays, CT scan, MRI scan, bone scan or ultrasound.
Once a leg pain diagnosis is made, the medical professional or pain specialist will determine the best treatment.
Book an appointment to have a Pain Specialist make a leg pain diagnosis.
WHAT LEG PAIN TREATMENT IS AVAILABLE?
Treatment of the leg pain depends on whether the problem is acute (meaning it only occurred recently i.e. days and weeks) or chronic (meaning it has been present for more than 2-3 months).
ACUTE LEG PAIN TREATMENT
Most acute hip pain is mild and settles with simple treatments. Treatment usually depends on the cause.
Simple treatments like hot or cold packs, physical activity, exercise and physical therapy.
Pain medications like anti-inflammatories and anti-spasm medications to provide pain relief.
If pain is long lasting (chronic pain), debilitating and has not been responding to treatments an assessment should be made by a pain management specialist, who can assess and treat most types of chronic pain.
CHRONIC LEG PAIN TREATMENT
Through years of experience, we’ve figured out that good and long-lasting chronic leg pain relief doesn’t work unless all bases are covered.
The best leg pain management combines pain-reducing treatments combined with other selected therapies like physical and psychological rehabilitation treatment.
TYPES OF TREATMENT
Medications to reduce the pain. These may be simple over the counter medications or can be medications prescribed by a pain specialist. Medications might include muscle relaxants or anti-neuropathic (nerve pain) medications. Sometimes analgesic compound creams are used to ease pain.
Pain interventions: injection therapies can be used to target, diagnose and manage chronic pain caused by muscle, joint and nerve pain. This includes interventional therapies like nerve blocks (medial branch nerve, lumbar nerve roots, cluneal nerves, gluteal nerves, sciatic nerve, lumbar plexus), radiofrequency ablation (RFA), pulsed radiofrequency (PRF) to the nerves previously blocked. Epidural and nerve root steroid injections. Sympathetic nerve blocks can also be performed on the lumbar sympathetic plexus.
Some of these therapies can be focused on various structures that might be causing or making the pain worse like the lumbar facet joints, the spinal nerve roots and other nearby nerves. Platelet-rich plasma can also be used in some locations around this area. Botox injections can be considered for certain types of muscular or nerve pain. For muscular pain, it can be injected into the muscle and for nerve pain it is usually injected under the skin of painful areas and can be helpful in providing pain reduction that can last many months at a time.
Nerve stimulation, also called neuromodulation or spinal cord stimulation is an advanced pain reduction technique that can work really well for severe leg pain. Some forms of spinal cord stimulation include high frequency stimulation (HF10), tonic stimulation, multi-waveform stimulation, Burst DR stimulation and even dorsal root ganglion (DRG) stimulation. Spinal cord stimulation is a commonly used treatment for leg nerve pain that does not respond to other forms of treatment.
Surgery is generally recommended when tests show structural changes, which needs corrective surgery. The type of surgery offered usually depends on the cause of the leg pain for example if there is a fracture of the leg then an orthopaedic surgeon would need to fix the break or if there is a dangerous problem with poor circulation or a compartment syndrome then a vascular surgeon would be required. Surgery is not a common treatment for chronic leg pain but when other therapies fail, surgery may be considered an option to relieve leg pain caused by serious musculoskeletal problems or nerve compression particularly if it is thought that the pain is being referred from the spine or lower back. These surgeries are typically performed by a neurosurgeon or a spinal surgeon. Types of surgery might include, decompression surgery (laminotomy, laminectomy, discectomy) and or stabilisation surgery (fusion).
Rehabilitation: most types of chronic pain treatment should be managed alongside some form of specialist rehabilitation. This is when the best results occur.
HOW DO I GET LEG PAIN RELIEF?
Significant leg pain is best assessed by a medical doctor like a general practitioner (GP). They will make an assessment and make sure there are no warning signs for something serious.
If they suspect something more serious is causing the leg pain, they may do some scans or blood tests and make a referral to the appropriate specialist for treatment. But if no serious cause is diagnosed, the referral may be to a pain specialist for an assessment and therapy with the use of advanced pain reduction techniques.
If the pain is mild or improving, GPs may:
Reassure that there is no serious cause for concern and advise that the pain should improve with physical activity and simple pain medications.
If the pain persists or returns GPs may:
Use stronger pain medications
Suggest management by an expert pain physiotherapist if the leg muscles are suspected to be a cause or contributor to the pain or if there is significant weakness associated with lack of movement caused by the pain.
Refer to a pain specialist physician to provide more comprehensive pain management using options like joint and nerve blocks, sympathetic blocks and radiofrequency ablation (RFA), pulsed radiofrequency or nerve stimulation and neuromodulation using spinal cord stimulation as mentioned above.
Refer to a neurosurgeon or spine surgeon for an opinion.
Contact us to book an appointment with a pain specialist.
WARNING SIGNS OF MORE SERIOUS LEG PROBLEMS
In some instances, pain can indicate more serious leg problems or diseases. These problems might include cancer, fractures, infection, severe nerve compression (pinched nerve), compartment syndrome or DVT.
If there is cancer in the bones of the spine, this usually means metastases (the cancer has spread to the spine). Other cancers that may result in leg pain might be for example pelvic and ovarian cancers, which can cause damage to pelvic nerves and or obstructions to blood flow in the pelvis resulting in leg pain and or swelling.
Fractures of the spine can be caused by a direct hit, fall or accident but sometimes can occur without trauma, called spontaneous fractures. Spontaneous fractures of the spine usually can occur in elderly people with osteoporosis or those who may be taking steroid medications that weaken the bone. These fractures can result in spinal nerves being pinched and cause referred pain in the leg(s). Fractures can occur in any of the bones in the leg, after accidents or trauma, which includes the hip.
Infections of the leg or spine tend to occur if patients have a weakened immune system from any cause or medical condition. Sometimes infections of the spine can occur if there is an infection elsewhere in the body. People with spinal or leg infections usually feel unwell and can have sweats and a fever.
Nerve compression, called myelopathy, where there is a dangerous compression of the spinal cord in the spine. Myelopathy could cause symptoms that might include, weakness or problems with coordination in the legs or feet.
Compartment syndrome occurs when an injury to the leg results in swelling, and a dangerous build up of pressure in the muscles of the leg, which can cut off the blood flow.
Deep vein thrombosis (DVT) is when a blood clot develops in the deep veins of the leg. It can occur after spending a long time sitting down, for example, on a long flight. If a DVT breaks away and travels (embolus) to the lungs it can be life threatening (pulmonary embolus).
Seek urgent and specialist medical advice if you experience:
Sudden, unrelenting, disabling and severe leg pain
Pain during or after walking
Swelling in one or both legs
A leg that is pale or abnormally cool
Calf pain, especially after prolonged sitting, such as on a long car journey or flight
Recent weight loss
Recent injury or fall
Signs of infection are present like fever or feeling unwell, the area is red, hot or swollen
Numbness or tingling of the leg(s)
Weakness in the legs
Problems with bladder or bowel function
Pain does not settle by itself after a few days or weeks
