Doctors' Choice Physical Medicine

Oh, My Aching Leg

Schuylkill County and Pottsville residents:  Did you know that some low back conditions give rise to more than just low back pain.  For example, leg pain can be more intense than low back pain, even though the cause of the leg pain is coming from the low back.  When this happens, many patients complain that they have “sciatica”, which refers to radiating pain that starts in the low back and extends down into the leg.  When the leg pain is worse than the low back pain, it can make patients wonder, “…where is my problem really coming from?”  Why do I have and aching leg?

Causes Of An Aching Leg

To understand this better, a short “anatomy lesson” is appropriate.  The spine can be divided into two halves, front, and back.  The structures in the front half include the larger, heavier bones called vertebral bodies and the shock absorbing cushions that lie between the vertebral bodies called the disks.

Bone Spur on Left

The disk is like a jelly donut where the center is liquid-like and the outer portion is a tough, criss-cross pattern cartilage arranged like the rings on a tree stump.  There are also ligaments that hold the vertebrae and disks tightly together.

The back half of the spine includes the spinal cord, nerve roots, as well as the small joints of the back called facet joints.  Every movable joint has a joint capsule that helps lubricate the joint and limits the amount of movement, along with surrounding ligaments.  The larger, heavier vertebral bodies and shock absorbing disks carry the majority of the weight (approximately 80%) while the smaller facet joints carry much less weight (only 20%) but are more responsible for guiding the movements of our back.

When aching leg pain is present, it can be caused by either a pinched nerve, or, an inflamed facet joint.

When a nerve is pinched, the cause is usually from the disk where the jelly-like center leaks out and presses on the nerve that goes down the leg, commonly referred to as a “herniated disk with sciatica”. This type of pain is quite specific, easy to describe and often extends below the knee to the ankle or foot.  It can include muscle weakness, numbness in certain areas of the leg, and bending forward increases low back and leg pain while bending backwards may reduce the leg pain (and sometimes the LBP).

When a facet joint capsule tears (technically, called a “sprain”), the pain is “referred” down the leg in a generalized, non-specific manner.  Patients usually describe this pain as a “deep ache”.  It is often hard to describe the location of the pain.  This pain usually does not go below the level of the knee.  With this problem, it feels better to bend forward and worse to bend backwards.

Disk related aching leg pain carries a very small potential for surgery if all non-surgical approaches fail.  Facet joint referred leg pain rarely requires invasive treatments or surgery.

The good news is that both of these sources of low back and leg pain are very treatable with conservative treatment, as we offer at our office!  The important point to remember is that obtaining prompt treatment, when symptoms first appear is best – as waiting and hoping it will subside on its own often results in a longer treatment course and is less satisfying for all concerned.