Leg Pain

Loeffler Chiro, Leg Pain, Herniated Disc, Numbness in LegsQuite often leg pain or foot pain is not caused by a problem in the leg or foot, but rather by a condition in the lower back. Diagnosis of leg pain and other lower extremity symptoms should focus not only on the legs and hips, but should also include examination of the low back. In fact, with many low back problems, there is actually little or no low back pain. Instead, there may be leg pain, foot pain, and/or lower extremity numbness or weakness.

Compression or pressure on any of the nerve roots in the low back can cause pain, numbness or weakness along the different nerves as they travel down through the leg and into the foot. Because the sciatic nerve is commonly affected, leg pain and related symptoms are often generally referred to as sciatica, although medical professionals prefer the term radiculopathy.

Leg pain symptoms and descriptions
Not all leg pain derived from low back problems presents the same way. Leg pain caused by a low back problem is often accompanied by additional symptoms, such as leg numbness or weakness, or foot pain, and the type of leg pain experienced may vary widely from patient to patient.

Some typical descriptions of leg pain and accompanying symptoms include:

Leg numbness or tingling. Anyone who has had a leg or foot ‘fall asleep’ and then gradually return to normal can imagine what numbness in a leg would feel like. Not being able to feel pressure, or hot or cold, is unnerving. Unlike the short-lived numbness of an asleep limb, numbness coming from a low back problem can be nearly continuous and can severely affect a person’s quality of life. For example, it can be difficult or almost impossible to walk or drive a car if one’s leg or foot is numb. Typical symptoms can range from a slight tingling sensation to complete numbness down the leg and into the foot.Weakness (foot drop) or heaviness. Here, the predominant complaint is that leg weakness or heaviness interferes significantly with movement. People have described a feeling of having to drag their lower leg and foot or being unable to move their leg as quickly and easily as needed while walking or climbing stairs, for example, because of perceived weakness or slow reaction. Patients with foot drop are unable to walk on their heels, flex their ankle, or walk with the usual heel-toe pattern.
Burning pain. Some leg pain sufferers experience a searing pain that at times radiates from the low back or buttocks down the leg, while others complain of intermittent pain that shoots from the lower back down the leg and occasionally into the foot. Words that patients use to describe this type of burning leg pain include radiating, electric or shooting pain that literally feels like a jolt. Unlike many forms of low back pain that can often be a dull ache, for many, leg pain can be excruciating and nearly intolerable. This type of burning pain is fairly typical when a nerve root in the lower spine is irritated, and it is often referred to as sciatica.

Constant pain. This type of pain is normally felt in the buttock area, so it is not technically leg pain but it may accompany some form of pain felt in the legs. It may also be pain that occasionally radiates past the buttock into the leg. This type of pain is usually described as “nerve pain,” versus an aching or throbbing pain. It is typically present only on one side, and is commonly called sciatica. It may often be relieved by stretching, walking or other gentle movement.

Positional leg pain. If leg pain dramatically worsens in intensity when sitting, standing or walking, this can indicate a problem with a specific part of the anatomy in the low back. Finding more comfortable positions is usually possible to alleviate the pain. For example, bending over may relieve pain from spinal stenosis, while twisting (as in a golf swing) can increase facet joint related groin, hip and leg ache.

All of these leg symptoms can be evidence of a problem in the low back, and it is usually advisable to seek medical attention to determine the cause of the pain and to find a course of treatment. Leg pain along with certain other symptoms may be a sign of a potentially serious condition and warrant urgent medical attention, such as:

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Progressive weakness in the legs, which can be a sign of nerve damage
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Bowel or bladder dysfunction
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Fever and/or chills
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Recent unintended weight loss
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Significant trauma preceding symptoms
Several specific low back conditions, such as degenerative disc disease, herniated discs, and more, are common causes of leg pain and foot pain.
Causes of Leg Pain and Foot PainMore accurate anatomic diagnoses are made easier when patients document or catalog the characteristics of their leg pain, foot pain and other symptoms in clear descriptive terms. For example:
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Position or path of the pain as it radiates down the leg
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Body position when pain occurs
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Sensation (e.g. aching, tingling, shooting, lancinating, burning pain)
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Frequency (e.g. occasional, getting more frequent, constant)
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Description of what makes the pain feel better or worse
Lumbar degenerative disc disease
As we age, our intervertebral disc dehydrate (lose water), degenerate, lose their flexibility and allow small movements, which can cause pain from the disc that may radiate down the leg. While the primary symptom of lumbar degenerative disc disease is usually low back pain, leg pain and foot pain are also common symptoms. When lumbar degenerative disc disease presents with leg pain and/or foot pain, this is called “referred pain”. Another common example of referred pain includes neck/arm or shoulder pain caused by heart attacks. The brain cannot always distinguish exactly where the pain source is, and so feels pain more vaguely in multiple areas. Referred pain is typically dull, achy, and poorly localized.
Leg pain from degenerative disc disease can also result if the nerve root is compressed. This happens because as the disc degenerates it shrinks and moves, and as a result, there is not as much room for the nerve roots. This is also known as foraminal stenosis. Leg pain from a compressed and inflamed nerve root is typically shooting and electric.
Lumbar herniated lumbar disc
A disc herniation tends to put pressure on the weakest spot in a disc, an area that happens to be right under the nerve root. This results in pain that can radiate all the way down the sciatic nerve throughout the patient’s leg and into the foot. Depending on the nerve root affected, other nerves (beside the sciatic nerve) may also be involved. Symptoms of a lumbar herniated disc tend to vary depending upon where the disc herniation occurs. There is a wide range of non-surgical treatments that can alleviate leg pain for the majority of types of herniated discs. For severe pain or disability, a microdiscectomy (or micro-decompression) surgery to remove a portion of the disc can relieve the pressure on the nerve, which allows the numbness to subside as the pinched nerve heals.
Lumbar spinal stenosis
Spinal stenosis in the low back occurs when the spinal nerve roots are compressed or choked, usually by enlarged facet joints located in the back of the spinal column. Spinal stenosis usually, but not always, occurs in elderly patients as the facet joints enlarge due to degeneration of the spine that tends to occur with age. The narrowing can be confirmed with an MRI scan. The symptoms of spinal stenosis are often referred to as sciatica - leg pain, radiating pain, tingling, leg weakness and/or numbness. Doctors usually use the words radiculopathy or radiculitis to describe the same symptoms.
The leg pain from stenosis tends to develop gradually over time (mirroring the cumulative narrowing process taking place in the spine as the facet joints enlarge). Spinal stenosis symptoms tend to improve when the patient leans forward, a position that has the effect of opening up the back of the spinal column, taking pressure off the spinal nerve roots.
Spondylolisthesis
This condition occurs when a vertebra in the spine slips forward over the next, lower vertebra, compromising the natural structure of the spine segment as well as its stability and flexibility. The resulting instability can lead to a nerve being pinched, which causes leg pain. Many patients find pain relief through a combination of physical therapy and rest during episodes of acute pain, although significant instability and persistent pain may be treated with fusion surgery.
All symptoms of leg pain caused by the conditions listed above are often referred to as sciatica. This is because the pain often radiates along the sciatic nerve, which originates with certain nerve roots in the low back and runs through the back of each leg into the foot. Sciatica can present as either a constant pain (usually in the buttock) or a shooting pain through the leg. Two other conditions, piriformis syndrome and sacroiliac joint dysfunction, can also cause leg pain and sciatica-type symptoms.
The purpose of this article is to emphasize that there are many spinal conditions that may cause leg pain, foot pain, and other lower extremity symptoms. Most successful treatments are based upon having an accurate anatomic diagnosis for the basis of a specific pain syndrome. Spine care professionals are particularly well suited to oversee the diagnosis and treatment of these situations.