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Leg pain (sciatica)

If you have pain going down your leg it is possible that this is due to a trapped nerve in the back. The nerves that come out from the lower back provide sensation to the leg and if they are trapped or irritated then pain may be felt in the region of the body that they normally provide sensation to. Depending on which nerve is trapped will determine where you feel the pain. The trapping could be as a result of a disc prolapse, thickening of the bones and ligaments, a change in the alignment of the spine or other growths. The majority of trapped nerve causes settle down within a few weeks and if the pain going down the arm does not settle you may want to consider discussing this with your GP or a specialist. It is important to remember that leg pain may also be caused by problems from other areas such as the hip, knee, ankle or foot or even due to a trapped nerve in the leg rather than in the back.

Sciatica is pain that is caused by irritation of the sciatic nerve and classically someone will experience pain in the leg past the knee that goes to the calf, ankle or foot. This may be associated with pins and needles, numbness or even weakness. Any worsening of these symptoms is a reason to consult an expert. The majority of episodes do settle with time, but it may be worth getting some treatment to reduce the pain and discomfort whilst this happens. Occasionally arthritis of some of the joints can present in a similar manner but are less likely to cause the other problems of the pins and needles, numbness or weakness. Diabetes or other diseases that can involve the nerves may also produce similar symptoms.

Femoratica is irritation of the femoral nerve and like sciatica it produces the same symptoms but classically down the front of the thigh. In the same way as sciatica it can be confused with other causes of pain.

If the pain does not settle further treatment will be determined by the cause of the pain and for this reason it is worth seeing someone who treats back problems or lower limb problems.

What is the cause of my leg pain

People with leg pain do not always associate this as coming from a back problem. There are some things which may alert you to the case that it may well be a problem of the spine. Typically someone may have a history of back problems and have noticed that the pain was starting to spread from their back into their legs. Additionally pins and needles, numbness or leg weakness, which suggest changes to the way that your nerves are working may make you think of a trapped nerve.

• A loss of sensation or change in your ability to move your bowels or empty your bladder.
• Any significant leg pains, weakness and pins and needles.
• Feeling unwell with a raised temperature.
• Pain that wakes you up in the middle of the night persistently
• Noticeable weight loss suggesting poor general health
• A significant injury with a sudden onset of the problem
• If you have any of the above red flag features you must seek a doctors opinion.

If a nerve is irritated the person will feel pain in the area that that nerve provides sensation too. Hence a person with a disc prolapse causing irritation to the lower lumbar nerve may have pain in the ankle and foot or sciatica.This is called radicular pain.

Leg pain can also be felt as a result of irritation or wear and tear of the joints, ligaments and muscles of the spine. Because these structures share the same nerve supply as part of the legs, the body can become confused and although the problem is purely in the spine the pain can be felt to travel into the legs. This is called referred pain.

Pain in the legs can also be produced by problems from the joints, muscles, ligaments, blood vessels and even nerves within the legs themselves. Often by listening to a description of the pain and what seems to make the pain worse and better, it is possible to try to distinguish where the pain is coming from. An examination adds greatly to this. In addition other tests such as a imaging can be performed to confirm the impression that a doctor may have.

Generally so long as you do not have any of the worrying features mentioned above it is not unreasonable to try any treatment. This can include exercises, stretches, acupuncture, pain management with pain killers, cognitive behaviour therapy, physical treatments including physiotherapy, chiropractic and osteopathic. This is not an exhaustive list. The important thing is that if the treatments are not working then maybe it is worth thinking of another type of treatment and discussing the problem with your GP. If your pain changes or becomes worse this is another reason to stop and seek advice.