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Leg pain: causes and treatment

Leg pain can have a number of causes, such as poor circulation, sciatica, excessive physical exertion or neuropathy, and therefore to identify the cause of the pain, you must observe the exact location and characteristics of the pain, as well as whether the two legs are affected or only one and if the pain worsens or improves with rest.

Usually leg pain that does not improve with rest indicates circulation problems, such as peripheral vascular disease, while leg pain on waking may be a sign of nocturnal cramp or lack of circulation. Already the pain in the legs and in the back can be symptom of problems in the spine or compression of the sciatic nerve, for example.

Common causes for leg pain

Leg pain: causes and treatment

Some possible causes for leg pain can be:

1. Muscle or tendon changes

Leg pain with osteomuscular does not follow the path of the nerves and worsens when moving your legs. Some changes that may be the cause of pain include myositis, tenosynovitis, thigh abscess and fibromyalgia. Muscle pain may occur after sudden physical exertion, such as after strenuous exercise or wearing an uncomfortable shoe. In these cases, the pain usually arises at the end of the day and is often felt as "leg fatigue". Another common cause for leg pain of muscular origin is cramps that usually occur at night and are very common during pregnancy.

Leg pain in the calf region can also be caused by compartment syndrome, which causes severe leg pain and swelling, which appear 5-10 minutes after starting physical activity and the region remains painful for long periods. Pain in the anterior leg can also be caused by tendonitis of the anterior tibial, which occurs in athletes and people who engage in very intense physical activity, such as long distance runners.

What to do: Take a warm bath and lie down with your legs elevated because this facilitates blood circulation, reducing tiredness. Rest is also important, but there is no need for absolute rest, only avoided training and great efforts. In case of tendinitis the use of ice and anti-inflammatory ointments can aid in faster healing.

2. Joint problems

Especially in the elderly, leg pain may be related to orthopedic problems such as arthritis. In these cases other symptoms should be present such as joint pain and stiffness in the first 15 minutes of the morning. The pain may not be present every day but tends to worsen with exertion, and reduces with rest. The deformity of the knees may indicate arthrosis, whereas a reddish and hot appearance may indicate arthritis. However, knee pain may also be present after a fall, hip disease or difference in leg length.

What to do: Apply a hot patch on the affected joint, such as the knee or ankle, for about 15 minutes. In addition, it is recommended you see an orthopaedist as you may need to take anti-inflammatory drugs or do physiotherapy.

3. Spinal disorders

When the pain in the legs is aggravated by the movement of the spine, it can be caused by vertebral injuries. Spinal stenosis can cause moderate or severe pain with a feeling of heaviness or cramp in the lower back, buttocks, thighs and legs while walking. In this case the pain only relieves when sitting or tilting the torso forward, the sensation of numbness may be present. Spondylolisthesis is also a possible cause of back pain that radiates to the legs, in which case the pain is in a sensation of weight in the lumbar spine, the person walks with pain but it relieves during rest. The herniated disc also causes back pain that radiates to the legs; the pain is acute, intense and can radiate to the buttocks, posterior of the leg, lateral of the leg and the ankle and sole of the foot.

What to do: Putting a warm patch on the pain region may relieve the symptoms, but your doctor may recommend taking anti-inflammatory drugs and recommending physical therapy.

4. Sciatic pain

When leg pain is caused by changes in the sciatic nerve, you may feel pain in the back, buttocks and back of the thigh, and there may be a tingling sensation or weakness in the legs. The pain can be lancinating, in the form of a pang or shock that suddenly sets in the back and radiates to the legs, affecting the buttocks, the back of the thigh, the side of the leg, ankle and foot.

If you think the pain is caused because of your sciatic nerve, answer the following questions:

  1. 1. Tingling pain, numbness or spinal shock, gluteal, leg or sole of the foot.
    Yes
    No
  2. 2. Burning sensation, cracked or tired leg.
    Yes
    No
  3. 3. Weakness in one or both legs.
    Yes
    No
  4. 4. Pain that gets worse by standing too long.
    Yes
    No
  5. 5. Difficulty walking or staying too long in the same position.
    Yes
    No
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What to do: Put a warm patch on the pain region, let it act for 20 minutes, avoid stress, lift heavy objects, and in some cases may need physical therapy.

5. Poor blood circulation

Leg pain caused by poor circulation mainly affects the elderly and can appear at any time of the day but worsens after spending some time sitting or standing in the same position. The feet and ankles may become swollen and purplish in color, indicating difficulty in returning blood to the heart.

A somewhat more serious situation is the onset of thrombosis, which occurs when a small clot can interrupt part of the circulation to the legs. In this case, the pain is more often located in the calf, and there is difficulty in moving the feet. This is a situation that can happen after surgery or when using contraception without medical advice.

What to do: Lying with your belly up with your legs elevated for 30 minutes may help, but your doctor may indicate the use of medication to improve circulation, as well as the use of elastic compression stockings. In case of suspected thrombosis, you should go to the hospital quickly.

6. Growth pain

Leg pain in children or adolescent can be caused by rapid bone growth, which can happen around 3 to 10 years of age and is not a serious change. The location of the pain is closer to the knee but can affect the entire leg reaching up to the ankle, it is common for the child to complain at night before going to sleep or after having performed some kind of more intense physical activity.

What to do: Putting pebbles of ice inside a sock and putting on the sore area, letting it act for 10-15 minutes can help in relieving the pain. Parents can also perform a massage with moisturizing cream or almond oil and leave the child resting. There is no need to cease physical activity, only decrease its intensity or weekly frequency.

Other less common causes

Other less common causes are hemochromatosis, gout, Paget's disease, osteomalacia or tumors. When leg pain is more related to fatigue and lack of energy the doctor may suspect fibromyalgia, chronic fatigue syndrome or myofascial pain, for example. Therefore, to know exactly what is causing leg pain may require a medical or physical therapy evaluation.

Leg pain in pregnancy

Leg pain in pregnancy is a very common and normal symptom, especially in early pregnancy, as there is a large increase in estrogen and progesterone production, which causes dilatation of the veins in the legs, increasing the volume of blood. The growth of the baby in the womb, as well as the weight gained during the pregnancy, leads to the compression of the sciatic nerve and the inferior vena cava leading to swelling and pain in the legs.

To alleviate this discomfort, the woman can lie on her back with her knees bent, doing a stretching exercise of the spine and resting with her legs raised.

How is the diagnosis reached

The doctor may observe the symptoms and examine you, observing the curvatures of the spine, bone ends, may perform examinations by provoking pain, and also the palpation of the abdomen to evaluate if there is pain in the abdominal or pelvic region. Performing blood tests, synovial fluid examination may be helpful if synovitis or arthritis is suspected, and imaging tests such as X-rays or MRIs may be ordered if there are suspected spinal changes. Based on the results, the diagnosis can be reached and the most appropriate treatment for each case is indicated.

When to go to the doctor

It is advised to go to the doctor when the pain in your legs is very intense or when there are other symptoms as well. It is also important to go to the doctor:

  • When the pain in the leg is localized and very intense;
  • When there is stiffness of the calf;
  • In case of fever;
  • When the feet and ankles are very swollen;
  • In cases of suspected fracture;
  • When it does not allow you to work;
  • When it makes walking difficult.

At the doctor's appointment you should refer the intensity of the pain, when it appeared and what was done to try to soften it. The doctor may order tests to indicate the appropriate treatment, which can sometimes include the use of medication or physical therapy.


Bibliografia

  • KISNER, Carolyn; COLBY Lynn Allen. Exercícios terapêuticos: Fundamentos e Técnicas. 6ª.ed. São Paulo: Manole, 2016.
  • Mark Dutton. Fisioterapia ortopédica: exame, avaliação e intervenção. 2ª.ed. Porto Alegre: Artmed, 2010.
  • TEIXEIRA, Manoel Jacobsen, et al. Dor nos membros inferiores. Rev. Med. (São Paulo). Vol.80. 2.ed; 391-414, 2001
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