What is Back and Leg Pain?
Back and leg pain can be defined as discomfort or uncomfortable sensations felt in the back and leg areas of the body. The pain can be persistent or intermittent, develop gradually or suddenly, and can be felt on your whole back or leg or a specific region. It can be characterized as stabbing, sharp, dull, or aching pain.
Causes of Back and Leg Pain
Pain in the back and legs may occur as a result of problems that affect the bone, joints, muscles, tendons, ligaments, blood vessels, nerves, or due to problems in your spine. The most common cause for pain is inflammation or infection of the tissues, due to wear and tear, injury or disease. Since the back and legs contain a number of different structures and tissue types, various conditions and injuries can cause pain. Some of the common back and leg conditions include:
- Sciatica: This is one of the most common painful neurologic condition that occurs when the sciatic nerve that originates in the lower back (lumbar spine), running along the hip and back of the leg and branching off at the knee becomes compressed or entrapped along its path resulting in pain and other neurologic symptoms. The compression most often occurs as a result of a herniated disc.
- Meralgia paresthetica: Meralgia paresthetica, also known as Bernhardt-Roth syndrome is a neurological condition characterized by pain and numbness in the thigh. It is caused when the lateral femoral cutaneous nerve (LFCN) that supplies sensation to the outer part of the thigh is damaged or compressed.
- Peripheral Neuropathy: The peripheral nervous system transmits signals from the brain and spinal cord to the rest of the body. Any disruption in the normal functioning of the peripheral nervous system can result in numbness, pain, and weakness in your legs as well as other parts of your body. This is known as peripheral neuropathy.
- Piriformis syndrome: Piriformis syndrome is a neuromuscular condition caused by compression of the sciatic nerve by the piriformis muscle. It is characterized by pain, tingling, and numbness in the buttocks. The pain may also extend down along the nerve and involve the leg as well (extraspinal sciatica).
- Lumbar herniated disc: A herniated disc is a condition in which the outer fibers (annulus) of the intervertebral disc are damaged, causing the soft inner material of the nucleus pulposus to rupture out of its space. It is the most common cause of lower back pain and pain that radiates down the leg (radiculopathy).
- Ankylosing spondylitis: The term ankylosis stands for loss of mobility of the spine, whereas spondylitis means inflammation of the spine. Therefore, ankylosing spondylitis is a condition where chronic inflammation of the spine and sacroiliac joint results in complete fusion of the vertebrae leading to pain and stiffness in the low back.
- Arachnoiditis: The brain, spinal cord, and nerves are covered and protected by three membranes; the dura mater, the arachnoid mater, and the pia mater. Arachnoiditis is inflammation of the arachnoid membrane covering the spinal nerves which are mainly characterized by a stinging or burning pain. It usually affects the nerves supplying the lower back and legs.
- Fibromyalgia: Fibromyalgia is a chronic disorder characterized by widespread stiffness and pain, sensitivity, and numbness and tingling which can affect the back and legs. Patients may experience intermittent pain or pain that worsens over time.
Ways to Relieve Back and Leg Pain
Both non-surgical, as well as surgical treatment, can be utilized to relieve back and leg pain based on the severity of the condition.
Most cases of back and leg pain can be treated with non-surgical treatment and may include:
- Medications: Your doctor may prescribe certain non-steroidal anti-inflammatory or anti-seizure medications to relieve pain.
- Physical therapy: Your doctor will recommend exercises to reduce body weight, strengthen muscles, and optimize joint function. You can also utilize aerobic exercises, yoga, and other exercises to strengthen core muscles.
- Stretches: Incorporating gentle stretching exercises into your daily routine is an excellent way to improve range of motion and spinal flexibility, while also improving spinal and core strength.
- Transcutaneous electrical nerve stimulation (TENS): During this procedure, small electrodes are placed on the skin to stimulate the nerves near the affected area.
- Ice/hot packs: Application of ice packs wrapped in a towel to the affected area for 20 minutes can help alleviate swelling and pain. Alternatively, hot packs or heating pads may be used on the affected area to relieve discomfort.
- Activity modification: Avoiding activities that may trigger painful/neurologic symptoms can help with pain relief in the back and legs.
- Lifestyle changes: Regular exercise regimen and healthy food habits can help prevent conditions such as diabetes and obesity which are common risk factors of conditions such as sciatica and meralgia paresthetica.
- Manual manipulation: This therapy involves manual adjustment of the spine by a certified chiropractor to treat restricted mobility. The objective of manual manipulation is to restore spinal motion, and as a result, decrease pain and improve spine function.
- Steroid injections: Degenerative conditions of the spine such as a herniated disc and spinal stenosis may compress associated spinal nerves and cause back pain. Your physician may recommend the administration of steroid injection to the affected area for pain relief. The injection contains a strong anti-inflammatory agent called corticosteroid and an anesthetic (a numbing agent) which on administration helps to provide short- or long-term relief from pain and inflammation.
Surgical treatment is only utilized for severe cases and when non-surgical treatment for back and leg pain has failed to provide the desired results. This may include:
- Microdiscectomy: This is a minimally invasive surgical procedure in which sections of a herniated disc that are entrapping or pressing on a nerve such as the sciatic nerve are removed using special instruments to relieve pressure on the spinal nerves and provide pain relief. This is a surgery for sciatic nerve compression in the spine region.
- Laminectomy: Laminectomy refers to the removal or cutting of the lamina (roof) of the vertebral bones to provide space for the nerves to exit from the spine. It can also be performed to relieve the symptoms of a narrowed spinal canal known as spinal stenosis, which also causes painful neurologic symptoms in the back and legs.
- Nerve decompression: Sciatic nerve compression may also occur due to reduced space between the ischial tuberosity (pelvic bone projection) or femur (thigh bone) through which the sciatic nerve passes. The nerve may become compressed due to surrounding soft tissue or skeletal structures which causes narrowing of space through which the nerve passes. Your surgeon may recommend nerve decompression surgery to remove the structures causing nerve compression or open up any narrow spaces to provide more room for the nerve, or both.
- Neurolysis: This is a procedure that involves injecting chemical agents into nerve fibers to reduce nerve pain by destroying the damaged nerves. These agents degenerate the nerve fibers blocking the transmission of pain signals. Neurolysis may also involve surgery to remove scar tissue around or within the nerve tissue or to remove the nerve itself.
- Neurolytic blocks: A neurolytic block is a form of nerve block injection that utilizes phenol or alcohol to deliberately damage nerves and accomplish pain relief. This form of injection is utilized particularly to accomplish long-term pain relief of segments in the trunk of the human body. Neurolytic block injections focus on destroying nerve fibers transmitting pain, rather than numbing them for short-term pain relief. Also, focused amounts of cold (cryoablation) or heat (radio-frequency lesioning) may be utilized to destroy the painful nerve fibers.