Overview Of Leg Pain

Leg pain explained by San Antonio, Austin, Houston, Dallas Texas top pain doctors

Leg pain is a term used to describe symptoms of pain or discomfort that occur anywhere within the region of the legs. Symptoms of leg pain tend to be more commonly reported among athletes, and the most common causes of leg pain include overuse, daily wear and tear, or injury occurring within the muscles, joints, ligaments, bones, tendons, or other soft tissue found within the leg.

Leg pain symptoms can occur suddenly, such as those symptoms that occur immediately following trauma or injury to the area. Leg pain symptoms can also exhibit a more blunted and drawn-out onset, which is most characteristic of chronic pain. Chronic symptoms of leg pain are defined as refractory and unremitting symptoms of pain or discomfort that have been going on for at least twelve weeks. It is not uncommon for symptoms of chronic leg pain to fluctuate between periods of either reduced pain and improved functional impairments or exacerbated symptoms of pain, stress, and physical complaints.

The precise mechanism underlying symptoms of leg pain is not fully understood. Moreover, the symptoms of leg pain can occur as the result of a number of vastly different conditions. Most of these conditions are non-serious and not life-threatening. There are three main categories that account for the conditions that are related to symptoms of leg pain and discomfort. These condition categories include: leg pain symptoms that are related to injury or pathology of the vascular system; leg pain symptoms that are related to injury or pathology within the musculoskeletal system; and leg pain symptoms that are related to an underlying neuropathic condition.

In terms of leg pain that results from problems within the vascular system, it is not uncommon for patients with these conditions to describe that their symptoms of pain and discomfort were localized to only one side of the body. In terms of leg pain that is associated with the musculoskeletal system, these conditions tend to affect the various structures that make up the musculoskeletal system, including the ligaments, bones, tendons, and muscles. And finally, leg pain that is associated with the peripheral nervous system tends to affect the sciatic nerve. The sciatic bundle begins deep within the buttocks and extends downward through the back of the legs.

There are a number of different treatment options available for the management of these symptoms of leg pain and discomfort. In most cases, deciding the appropriate treatment technique depends largely upon the type of condition believed to be the source of the pain. It is recommended that patients who are interested in exploring treatment options for the management of their symptoms of leg pain and discomfort speak with their physician about which of these treatment options may be most beneficial for their case.

All patients who are interested in the treatment options available for managing symptoms of chronic pain must go through an in-depth initial diagnostic evaluation. Typically, the physician will gather information regarding the patient’s personal and familial history. Next, the physician will also want to conduct a thorough physical examination. During this examination, the doctor is watching for signs of inflammation or swelling, bruising, stiffness, or soreness. During this initial evaluation, your doctor will also want to gather very detailed information regarding your current condition, its progression, and any impairment the condition has caused to your ability to function independently on a day-to-day basis.

Results from this initial evaluation will provide the performing physician with a guide for making treatment recommendations. Given the important role that the proper diagnosis can play in terms of developing an effective treatment plan, in many cases, the physician will utilize the assistance of imaging techniques in order to confirm diagnosis and to aid in arriving at an appropriate diagnosis. Once the initial evaluation has been completed, your physician will discuss with you the available options for treatment, along with the risks and benefits associated with each of these interventions. Available treatments for leg pain can range from conservative, at-home interventions (such as non-steroidal anti-inflammatory drugs, NSAIDS) to more aggressive, interventional approaches (such as epidural steroid injections).

What Types Of Conditions Cause Leg Pain?

Conditions affecting the underlying tissues and other structures within the legs can lead to a variety of symptoms of pain and discomfort within the legs. For example, a patient who has sustained a blunt force trauma to the area is expected to be suffering from symptoms of acute onset severe pain. It is believed that injury, irritation, and damage all can account for the symptoms of pain and discomfort across all conditions affecting the legs.

Pain conditions affecting the legs can be grouped into three broad categories. Each of the most commonly occurring pain conditions within these three categories are reviewed in more detail below.

Musculoskeletal Conditions Causing Leg Pain

Muscle Sprain Or Strain

Sprains or strains that occur within the tissue of the muscles are among the most commonly reported sources of leg pain. Ligaments within the leg can be excessively stretched and torn, leading to symptoms of pain characterized by a muscle sprain. Moreover, the muscle tissue that comprises the leg can also become excessively stretched and torn, which is known as muscle strain. These symptoms following excessive strain or tissue tearing may also have suggested that there is underlying tissue damage. Other commonly reported symptoms that can occur in conjunction with sprains or strains of muscle tissue include swelling within the area and tenderness. Patients who are experiencing more severe symptoms of muscle strain or sprain may also begin to suffer from loss of function of the leg. For instance, it is easy to imagine how patients who have sprained their ankle would not want to bear full weight on the injured knee. Moreover, a relatively small portion of patients may even lose complete function of the area.

Muscle Cramps

runner legsMuscle cramps are among the most commonly reported sources for leg pain. This phrase refers to the cramping up of the muscle tissue, which can also be known as a muscle spasm or charley horse. When this occurs, the muscle itself will involuntarily contract within the leg. Muscle cramps are widely recognized as occurring very suddenly and without warning. The factors that may contribute to an increased likelihood of suffering from muscle cramps include poor circulation within the legs, dehydration, muscle exertion in a hot climate, insufficient pre-exercising stretch routine, overexertion, muscle fatigue, mineral deficiencies (i.e., calcium, magnesium, and potassium), and dysfunctional peripheral nerves.

There are some medications that are known to cause unpleasant side effects in relation to muscle cramping. More specifically, diuretic medications (furosemide or hydrochlorothiazide) are used to remove excess fluid from within the body. Though the exact cause to explain why these medications are associated with muscle cramps is not known, it is believed that as fluid levels within the body drop, the availability of important minerals also becomes lower. Indeed, these minerals are necessary for healthy functioning of both muscles and neurons. Another medication that causes unpleasant side effects that are believed to contribute to muscle cramping within the area include raloxifene (osteoporosis), statins (high cholesterol), nifedipine (high blood pressure), neostigmine statins (high cholesterol), tolcapone (Parkinson’s patients), albuterol (asthma), and donepezil (Alzheimer’s disease).

Bone Fractures

Bone fractures occurring within the leg can lead to symptoms of severe and sudden onset pain within the area. There are four types of bone found within the leg. These bones include the tibia, fibula, patella, and the femur which is the longest and strongest bone found within the body. The structure of bone tissue is very dense, which gives bones the ability to provide support within the body. Most individuals who have a healthy degree of bone density would have a difficult time fracturing a bone. However, conditions like osteoporosis can lead to loss of bone density, which makes it much easier for the bone tissue to fracture when placed under pressure. Bone fractures can be described as open (“compound fracture”; which means that the fractured bone has broken through the surface of the skin) or closed, incomplete (which means that a portion of the bone has remained intact) or complete (which means that the bone has completely fractured into two pieces), comminuted (which means that the bone has fractured into several much smaller pieces), and displaced (which means that a portion of the fractured bone has migrated and that the ends of the bone don’t line up exactly). When a patient sustains a bone fracture it is expected that they will experience acute onset symptoms of pain that can range from achy to a dull pain. Other symptoms of a bone fracture include swelling within the area and even a visible deformity where the fracture occurred. It is not uncommon for the physician to take an X-ray of the area in order to provide confirmation of the fracture, evaluate the severity of the fracture, and determine the alignment of the bones.

Shin Splints

Shin splints, also known as medial tibial stress syndrome, is a pain condition occurring within the legs. Further, this condition is found more frequently among athletes, as it is believed to be the result of an overuse of the muscles and tendons near the shinbone or tibia. The symptoms that occur as the result of shin splints include pain and discomfort along the front portion of the lower leg. Symptoms of shin splints are believed to occur as the result of irritation or injury, which led to an increase in the degree of inflammation within the tissue comprising the bone, tendons, ligaments, and muscles that comprise the area. For the majority of shin splints incidents, patients are asked to refrain from physical exertion for approximately two to four weeks. Patients can expect to heal from shin splints within three to six months following the injury.

Arthritis 

A musculoskeletal condition that affects the joints within the lower limbs is known as arthritis. One type of arthritis is osteoarthritis, which is a degenerative disease. More specifically, over time daily wear and tear can damage the connective tissue within the joint. This wear and tear causes the cartilage to become stiff and unforgiving, whereas normally this connective tissue is soft and supple to provide a cushion to prevent the bones of the leg from rubbing up against each other. Currently, there is no known cure for osteoarthritis.

Another common form of arthritis that can lead to inflammation of the tissue within the knee is known as rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease, such that the immune system within the body has begun to malfunction, causing it to attack itself. In particular, this condition affects the synovial membrane within the knee joint. If this condition is left untreated, there is a very high risk that other tissue within the body will be affected including tissue that comprises the organs.

Hamstring Injury

Along the back of the thigh, beginning from deep within the buttocks and extending down to the knee, is a group of three muscles known as the hamstring. The function of these muscles is to work together to allow the leg to bend at the knee. Hamstring injuries are incredibly common and are found to more commonly occur among athletes. Typically, they occur as the result of excessive stretching or strain. In most instances of hamstring injury, the patient will describe a sudden and severe onset of symptoms at the time of the incident. Further, it is not uncommon for patients to also report the sensation of a popping or snapping at the time of the injury as well. Additional symptoms may also include tenderness and bruising near the area.

Myalgia

Muscle pain that can occur within the legs is known as myalgia. The specific symptoms of myalgia can run from a mild, dull ache to a more severe and debilitating pain condition. The pain of this condition can also be associated with symptoms of tenderness, redness, inflammation of the area, and fever. The specific cluster of symptoms reported by each individual is expected to be strongly associated with the underlying condition. The muscle pain associated with myalgia is most frequently attributed to minor injury, excessive tension, high degrees of stressed, and overexertion. Other conditions that are related to myalgia include fibromyalgia and fatigue syndrome.

Compartment Syndrome

Compartment syndrome is a musculoskeletal pain condition that is caused by the excessive build up of pressure within the various enclosed spaces of the leg. The compression that occurs during this condition can also lead to pressure placed along the blood vessels, within other important organs of the body, and may require emergency surgery. In terms of the acute onset form of compartment syndrome, the symptoms tend to develop over the span of several hours after an injury or trauma to the leg. In terms of more chronic instances of compartment syndrome, the symptoms tend to come and go as the result of the individual’s degree of physical exertion.

In most instances of chronic compartment syndrome, patients describe that their symptoms worsen within a half hour of initiating exercise. Further, their symptoms are then reported to remit during periods when they have returned to more normal levels of activity. Signs that are indicative of underlying compartment syndrome include inflammation, tightness, bruising within the affected area, painful tingling (i.e., sensation of pins and needles), numbness, and symptoms of pain that are much more severe than what would have been predicted for the situation.

Osteosarcoma

Osteosarcoma is a condition that occurs as the result of a malignant bone tumor. This tumor tends to develop during childhood and adolescence. In fact the mean age of onset, or when the condition was first diagnosed, generally occurs around fifteen years of age.  Osteosarcoma is one of the most common forms of bone cancer affecting children. Symptoms that may occur include pain while walking, bone fractures, limited rang of motion, pain when lifting, pain within the tissue that comprises the bone, and limping while ambulating.

Neuropathic Conditions Causing Leg Pain

Sensory and motor feedback to the legs is provided by the peripheral nerves, which are found within the lumbar region of the lower back. This area is also known as the sacral region of the tailbone. Injury or irritation of these nerves is expected to lead to symptoms of pain that radiate down through the areas of the lower limbs.

There are a number of neuropathic conditions that are known to cause symptoms of pain and discomfort within the legs.

Sciatica 

SciaticaIrritation or injury to the sciatic nerve, which is a relatively large nerve running deep within the buttocks and extending down through the back of the legs, can lead to symptoms of pain and discomfort that radiate down the legs. This condition is known as sciatica. Other symptoms associated with the condition may also include numbness and tingling sensations. Symptoms of sciatica pain worsen during prolonged periods of sitting. Patients with sciatica pain likely report difficulty upon standing and difficulty with ambulation. The commonly reported sources for sciatica pain include piriformis syndrome, degenerative disc disease, sacroiliac joint dysfunction, isthmic spondylolisthesis, lumbar herniated disc, and lumbar spinal stenosis.

Peripheral Neuropathy

Peripheral neuropathy is a pain condition that occurs as the result of damage to the tissue of the peripheral nerves. Common symptoms reported by patients with peripheral neuropathy include pain that either emerges or radiates toward the extremities, numbness, tingling sensations, and weakness of the area. Moreover, these symptoms are fairly common for patients exhibiting neuropathy of the sensory nerves. In some cases of peripheral neuropathy, the tissue damage has occurred within a motor nerve. Owing to this, these patients may experience a loss in functioning and inactivity. As the condition progresses, symptoms worsen and may lead to severe muscle cramping and even problems with ambulation.

The neural damage that occurs in patients suffering from peripheral neuropathy can typically be traced back to injury or irritation of the peripheral nerves as the result of degeneration over time, blunt force trauma or injury, and compression as the result of inflammation. Individuals who present with more sedentary lifestyles are considered to be at an augmented risk for developing complications with regard to this condition. Continual and unrelenting inactivity places excessive amounts of pressure on the peripheral nerves, which can cause them to become irritated and inflamed.

Diabetic Peripheral Neuropathy

Individuals with diabetes are at an increased risk for developing complications with regard to peripheral neuropathy. While the exact cause is not known, there have been several factors identified as contributing to the development of these symptoms, including genetic factors (e.g., family history of neural conditions), metabolic factors (e.g., elevated levels of blood glucose), neurovascular factors (e.g., compromised blood vessels), factors related to mechanical injury (e.g., carpal tunnel syndrome), autoimmune factors (e.g., irritated and inflamed neural tissue), and lifestyle factors (e.g., smoking status or alcohol consumption). In some instances of diabetic peripheral neuropathy the patient may not report any symptoms of pain or discomfort. When pain is reported in relation to this condition, it tends to be localized only to the extremities, such as the legs.

Shingles 

Shingles is a widely known neuropathic pain condition that occurs as the result of a re-outbreak of the herpes zoster virus (the virus that causes chickenpox during childhood). A shingles outbreak is characterized by the development of a painful skin rash and blisters, as well as inflammation and irritation of the nerve tissue in the area of the original outbreak. Typically, a shingles rash emerges in only one localized area and generally only occurs on one side of the body. In most instances, the characteristic skin rash resolves itself within several weeks of the outbreak. However, the associated neuropathic pain that accompanies a shingles outbreak may persist for several weeks after the rash itself has been resolved. The symptoms of pain associated with shingles are known as post herpetic neuralgia.

Post-Laminectomy Syndrome 

Post-laminectomy syndrome is a relatively rare pain condition. This condition is also referred to as failed back surgery. It is characterized by the persistence of the patient’s severe chronic pain symptoms following back surgery in an attempt to treat the patient’s symptoms. These patients, who have attempted back surgery to treat their symptoms of chronic pain, have also likely attempted a number of other forms of treatment, including opioid medication or epidural corticosteroid injections, with no success. Indeed, undergoing back surgery as a way of treating symptoms of chronic pain is not a guaranteed method. In many instances, the risks associated with undergoing surgery outweigh the predicted potential benefits. In fact, a portion of patients will experience more severe symptoms of pain following this procedure.

Vascular Conditions Causing Leg Pain

Deep Vein Thrombosis

Deep vein thrombosis is a vascular pain condition that emerges as the result of the development of a blood clot, which is also known as a thrombus, within the veins that run through the legs. While the exact cause is not completely understood, it is generally agreed that individuals who lead a more sedentary lifestyle or who sit for extended periods of time are most at risk for developing a blood clot. Indeed, this is not the only factor known to contribute to the development of deep vein thrombosis and there are a number of other conditions that contribute to the emergence of blood clots within the vascular system. The condition of deep vein thrombosis is associated with symptoms of radiating pain within the legs and tissue inflammation, which generally occurs in the area of the ankle and foot.

Peripheral Artery Disease

Another vascular pain condition is known as peripheral artery disease. This condition emerges as the result of a blocking or constriction of the blood vessels within the body. The risk for constriction of a blood vessel as the result of peripheral artery disease can occur within any area of the body. The condition tends to develop more frequently within the legs. Blockage or constriction of the blood vessels in peripheral artery disease occurs as the result of an excessive build-up of fatty plaque within the inner lining of the arteries. Constriction of these blood vessels typically leads to very severe symptoms of pain that tend to radiate down the leg, toward the foot.

Available Treatments For Leg Pain

Leg PainThere are several available options for treating the symptoms of leg pain. If you are considering treatment for your symptoms of leg pain, it is strongly recommended that you speak with a physician first. A physician will spend time discussing the risks and benefits associated with each of the treatment techniques. Further, a physician will ensure that a proper evaluation has been conducted, so that they may provide recommendations for the most effective treatment option available. For most cases of mild leg pain, it is recommended that the patient attempt at least one round of a more conservative treatment method before moving on to aggressive pain relieving techniques.

One of the more common treatment methods recommended for patients exhibiting problems with pain is pharmacotherapy. This form of treatment includes non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, which is a class of medication that provides pain relief owning to its anti-inflammatory properties. These medications can be purchased over the counter and can be highly effective in providing temporary relief from more minor symptoms of pain. Possible side effects associated with taking NSAIDs include stomach ulcers, bleeding, and gastrointestinal irritation.

Another class of medications that are recommended for managing the symptoms of leg pain includes antidepressants. These medications have received early support for their effectiveness in treating symptoms of chronic pain, though much more work is necessary. One type of antidepressant medication that may be effective in providing relief from chronic pain is tricyclics, such as doxepin, amitriptyline, and clomipramine. This group of medications is believed to be effective for treating pain owing to their role in blocking the reuptake of the two neurotransmitters, norepinephrine and serotonin, within the synapse.

Two other groups of antidepressants that have shown some initial promise for chronic pain include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, fluvoxamine, and citalopram; and serotonin and norepinephrine reuptake inhibitors (SNRIs), such as desvenlafaxine, duloxetine, and venlafaxine. These two groups of medications in particular are preferred by a number of physicians, as they are accompanied by a favorable side-effect profile. More specifically, these medications are accompanied by fewer risks for side effects in comparison to other antidepressants, such as tricyclics.

Individuals who have suffered from unremitting symptoms of pain within the leg, yet have not found relief from previous trials of oral analgesics such as NSAIDs, may be considered appropriate candidates for the short-term use of a more aggressive form of pain medication. More specifically, these patients may be able to achieve symptoms relief with the short-term use of opioid medications. Use of these medications must be monitored very closely though, as they run the risk of dependence or abuse.

Opioids are contraindicated in instances when long-term management of pain is necessary. Some of the more commonly found drugs that fall into this classification include codeine, morphine, oxycodone, and tramadol. Previous work has provided support for the beneficial effects of opioids in terms of the short-term management of severe, refractory symptoms of pain. Taking opioid medications is associated with an increased risk for the side effects of sweating, sexual impotence, constipation, and dizziness.

Treatments For Musculoskeletal Leg Pain

A group of oral analgesic medications known as muscle relaxants have received some support for beneficial effects in terms of symptoms of leg pain, in particular those symptoms that are associated with muscle cramping or spasms. A second treatment option for managing the symptoms of musculoskeletal leg pain includes Botox injections. Botox is a purified toxic enzyme that is a product of the Clostridium botulinum bacteria. Injections of Botox into tissue within the body have paralytic effects of the musculature. This is thought to occur by blocking the neural impulses of overactive sensory nerves, as well as blocking the release of neurotransmitters that are involved in the transmission of pain information from the periphery nerves to the spinal cord and brain. Studies that have examined the effectiveness of Botox injections provide some support for their use in treating conditions of chronic pain. Indeed, additional studies are warranted to examine the use of Botox specifically for treating musculoskeletal leg pain.

Treatments For Leg Pain Associated With The Nervous System

osteoporosis fracturesA number of medications that fall into the class of anticonvulsants have begun to receive attention for their contribution to the treatment of symptoms of chronic neuropathic pain. These medications function to balance the ratio of gamma-aminobutyric acid (GABA) to glutamate. Additional studies are warranted to examine the role that anticonvulsant medications may play in the treatment of chronic and refractory symptoms of leg pain.

It is well-known that an individual’s degree of stress has an impact on their degree of overall health, as well as their ability to cope with various challenges faced on a day-to-day basis. As such, training in biofeedback is believed to be an excellent complementary treatment option for managing symptoms of chronic pain. More specifically, the goal of this intervention is in teaching individuals to increase their awareness of their internal physiological responses. Next, the program teaches the individual skills in exerting conscious control over their autonomic responses, as well as practicing skills in relaxation practice. Taken together, it is believed that participating in this program increases the individual’s ability to engage in self-regulation in terms of their level of stress and thereby prevent their symptoms of stress from exacerbating their symptoms of chronic pain.

Another alternative treatment method for managing symptoms of pain is capsaicin skin patches. These patches contain a layer of capsaicin, which is derived from chili peppers. Capsaicin is known to bind to the nociceptors of the skin, thus exciting the underlying neurons. Once the capsaicin patch has been applied, symptoms generally begin as a momentary increase in sensory sensitivity. This burst of sensory input is characterized by intense itching, burning, and pricking sensations, which is then followed by a refractory period of blunted sensory sensitivity feedback. This refractory period is when patients are able to achieve relief from pain.

A final alternative treatment technique that may be used as a complementary intervention is acupuncture. This technique stimulates various acupuncture points using very tiny needles, which are anywhere from 1cm and no bigger than 10cm in length. Each needle is placed in a specific acupuncture point along the length of the leg. These acupuncture points are believed to contribute to the individual’s symptoms of chronic pain. Acupuncture has received support for its beneficial effects in blood circulation and circulation of other fluids within the body. Side effects from this procedure include slight soreness, light bruising, and minor bleeding at the sites of needle insertion.

Symptoms of leg pain that emerge as the result of injury or irritation within the spinal nerves and that have been largely unresponsive to trials of more conservative methods of pain management may be ideal candidates for epidural steroid injections. For this procedure, an analgesic medication (generally corticosteroids) is injected into a specified region surrounding the spinal cord and within the epidural space, depending on the source of the pain. For example, sciatic nerve pain may be treated using the sciatic nerve block. Pain conditions that affect the sacroiliac joint may be effectively managed with sacroiliac joint injections.

These injections are minimally invasive and can be completed on an outpatient basis. There are some risks associated with these techniques for pain management. Some of the most commonly reported side effects following epidural injections or nerve blocks include slight bruising, bleeding at the site of the injection, inflammation, loss of sensory sensation, nerve damage, inadvertent injection into a blood vessel, and even paralysis. Some patients may experience temporary neurological symptoms, including headaches.

Spinal cord stimulation is another technique utilized for treating chronic and refractory symptoms of neuropathic pain. These techniques work by impeding the transmission of sensory pain signals to the spinal cord and brain. For example, radiofrequency ablation uses electro-thermal techniques to disrupt the function of the underlying neural tissue. Similarly, transcutaneous electrical nerve stimulation (TENS) uses electrical impulses to stimulate portions of the peripheral nerves in order to disrupt their transmission of pain information.

While the procedures for epidural steroid injections and spinal cord stimulation are regarded as effective for treating refractory symptoms of neuropathic, vascular, and musculoskeletal pain, these treatment techniques are generally not effective in treating the symptoms of refractory pain following a failed back surgery. This is likely due to the fact that the pain associated with this condition emerges as the result of scar tissue that has built up within the epidural space surrounding the spinal nerves. For patients suffering from refractory pain following failed back surgery, the lysis of adhesions procedure may be the most appropriate for treating the pain. This technique uses a chemical compound to destroy the scar tissue surrounding the spinal nerves to relieve any excessive compression within the area.

Conclusion

Complaints of leg pain are relatively common. The symptoms of pain and discomfort within the legs can range in severity from a mild soreness to a sharp stabbing pain. Symptoms of leg pain can also be accompanied by other symptoms, including numbness, tingling, muscle weakness, joint weakness, muscle or joint stiffness, sensory sensitivity, or pressure. These symptoms largely depend on the type of underlying condition. There are a wide variety of conditions known to cause symptoms of leg pain and discomfort.

Before deciding on an appropriate treatment option, it is strongly recommended that patients who are struggling with debilitating symptoms of leg pain discuss the various options available with their physician. Their physician will be able to assess their individual symptom profile in order to arrive at the most accurate diagnosis. This diagnosis will then inform the treatment. Just as there are a number of different conditions underlying leg pain, there are also a variety of treatment options available.

At Texas Pain our goal is to relieve your pain and improve function to increase your quality of life.
Give us a call today at 713-458-4530.

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