Leg pain can range from a mild nuisance that comes and goes, to debilitating pain that makes it difficult to sleep, walk, or engage in simple everyday activities.
Leg pain and numbness can be experienced in many forms—some patients describe the pain as aching, searing, throbbing, or burning, or like standing in a bucket of ice water.
See Accurately Diagnosing Leg Pain
The pain can also be accompanied by neurological symptoms, such as a pins-and-needles sensation, numbness, or weakness. The weakness may be persistent, or it may come on suddenly or unpredictably, often described as the leg “giving out.”
Leg pain may be caused by a problem in the leg, but often the root cause of the problem starts in the lower back, where the sciatic nerve originates, and then travels along the path of the nerve (called sciatica).
See What You Need to Know About Sciatica
Or it could start at the L3-L4 level, where a nerve branches off from the lumbar spine and travels through the front of the thigh.
The medical term for leg pain that is caused by irritation of a lumbar nerve root is lumbar radiculopathy.
Read about Lumbar Radiculopathy
Because the lumbar nerves travel through various parts of the leg and foot, a diagnosis of anyone with leg pain, foot pain, and/or leg or ankle or foot weakness or numbness, should include an examination of the lower back.
See Lumbar Spine Anatomy and Pain
In This Article:
- Leg Pain and Numbness: What Might These Symptoms Mean?
- Causes of Leg Pain and Foot Pain
- Accurately Diagnosing Leg Pain
- Causes of Leg Pain Video
Leg Pain Symptoms and Descriptions
Not all leg pain derived from low back problems presents the same way. Some typical descriptions of leg pain and accompanying symptoms include:
- Burning pain. Some leg pain is experienced as a searing pain that at times radiates from the low back or buttocks down the leg, or it may present as intermittent pain that shoots from the lower back down the leg and occasionally into the foot. Words that patients use to describe this type of burning leg pain include radiating, electric, or shooting pain that literally feels like a jolt. Unlike many forms of low back pain that can often be a dull ache, for many, leg pain can be excruciating and nearly intolerable. This type of burning pain is fairly typical when a nerve root in the lower spine is irritated, and it is often referred to as sciatica.
- Leg numbness or tingling. Anyone who has had a leg or foot “fall asleep” and then gradually return to normal can imagine what numbness in a leg would feel like. Not being able to feel pressure, or hot or cold, is unnerving. Unlike the short-lived numbness of an asleep limb, numbness coming from a low back problem can be nearly continuous and can severely affect a person’s quality of life. For example, it can be difficult or almost impossible to walk or drive a car if one’s leg or foot is numb. Typical symptoms can range from a slight tingling sensation to complete numbness down the leg and into the foot.
- Weakness (foot drop) or heaviness. Here, the predominant complaint is that leg weakness or heaviness interferes significantly with movement. People have described a feeling of having to drag their lower leg and foot or being unable to move their leg as quickly and easily as needed while walking or climbing stairs, for example, because of perceived weakness or slow reaction. Patients with foot drop are unable to walk on their heels, flex their ankle, or walk with the usual heel-toe pattern.
See What Is Foot Drop?
- Constant pain. This type of pain is normally felt in the buttock area, so it is not technically leg pain but it may accompany some form of pain felt in the legs. It may also be pain that occasionally radiates past the buttock into the leg. This type of pain is usually described as “nerve pain,” versus an aching or throbbing pain. It is typically present only on one side, and is commonly called sciatica or lumbar radiculopathy. It may often be relieved by stretching, walking, or other gentle movement. While the pain is typically on one side, it can occur on both sides if both sides are affected.
See Stretching for Back Pain Relief and Easy Exercise Program for Low Back Pain Relief
- Positional leg pain. If leg pain dramatically worsens in intensity when sitting, standing, or walking, this can indicate a problem with a specific part of the anatomy in the low back. Finding more comfortable positions is usually possible to alleviate the pain. For example, bending or leaning forward slightly may relieve pain from spinal stenosis, while twisting (as in a golf swing) can increase facet joint related groin, hip, and leg ache.
For most leg pain symptoms, an accurate diagnosis of the underlying cause of problems is an important first step in getting effective treatment.
Causes of Leg Pain and Foot Pain
Many conditions can cause leg pain and foot pain. Commonly, the main cause of the symptoms has its origin in the lower back, which is where the nerves branch out from the spine to provide function to the muscles in the leg, ankle, and foot.
See Getting an Accurate Back Pain Diagnosis
Low back conditions that are common causes of leg pain and/or foot pain—and associated neurological symptoms such as numbness or foot drop—are outlined below.
Lumbar Degenerative Disc Disease
As we age, our intervertebral discs dehydrate (lose water), degenerate, lose their flexibility and allow small movements, which can cause pain from the disc that may radiate down the leg. While the primary symptom of lumbar degenerative disc disease is usually low back pain, leg pain and foot pain are also common symptoms.
When lumbar degenerative disc disease presents with leg pain and/or foot pain, this is called “referred pain.” Another common example of referred pain includes neck/arm or shoulder pain caused by heart attacks. The brain cannot always distinguish exactly where the pain source is, and so feels pain more vaguely in multiple areas. Referred pain is typically dull, achy, and poorly localized.
Leg pain from degenerative disc disease can also result if the nerve root is compressed. This happens because as the disc degenerates it shrinks and moves, and as a result, there is not as much room for the nerve roots. This is also known as foraminal stenosis. Leg pain from a compressed and inflamed nerve root is typically shooting and electric.
Lumbar Herniated Disc
Lumbar Herniated Disc Video
A disc herniation tends to put pressure on the weakest spot in a disc, an area that happens to be right under the nerve root. This results in pain that can radiate all the way down the sciatic nerve throughout the patient’s leg and into the foot. Depending on the nerve root affected, other nerves (beside the sciatic nerve) may also be involved.
Symptoms of a lumbar herniated disc tend to vary depending upon where the disc herniation occurs. There is a wide range of non-surgical treatments that can alleviate leg pain for the majority of types of herniated discs. For severe pain or disability, a microdiscectomy (or micro-decompression) surgery to remove a portion of the disc can relieve the pressure on the nerve, which allows the inflammation to subside as the pinched nerve heals.
Lumbar Spinal Stenosis
Lumbar Spinal Stenosis Video
Spinal stenosis in the low back occurs when the spinal nerve roots are compressed or choked, usually by enlarged facet joints located in the back of the spinal column. Spinal stenosis usually, but not always, occurs in elderly patients as the facet joints enlarge due to degeneration of the spine that tends to occur with age.
The narrowing can be confirmed with an MRI scan. The symptoms of spinal stenosis are often referred to as sciatica: leg pain, radiating pain, tingling, leg weakness and/or numbness. Doctors usually use the words radiculopathy or radiculitis to describe the same symptoms.
The leg pain from stenosis tends to develop gradually over time (mirroring the cumulative narrowing process taking place in the spine as the facet joints enlarge). Spinal stenosis symptoms tend to improve when the patient leans forward, a position that has the effect of opening up the back of the spinal column, taking pressure off the spinal nerve roots.
Spondylolisthesis occurs when a vertebra in the spine slips forward over the next, lower vertebra, compromising the natural structure of the spine segment as well as its stability and flexibility.
The resulting instability can lead to a nerve being pinched and/or inflamed, which causes leg pain. Many patients find pain relief through a combination of physical therapy and rest during episodes of acute pain, although significant instability and persistent pain may be treated with fusion surgery. Targeted injections may also be beneficial at times to help alleviate the inflammation from around an inflamed nerve root.
See Exercise for Sciatica from Isthmic Spondylolisthesis
Sciatica Is a Symptom of Low Back Problems
All symptoms of leg pain caused by the conditions listed above are often referred to as sciatica. This is because the pain often radiates along the sciatic nerve, which originates with certain nerve roots in the low back and runs through the back of each leg into the foot.
Sciatica can present as either a constant pain (usually in the buttock) or a shooting pain through the leg. See:
- What You Need to Know About Sciatica
- Sciatica Exercises for Sciatica Pain Relief
- Sciatica Treatment
In addition, two other common conditions, piriformis syndrome and sacroiliac joint dysfunction, can also cause leg pain and sciatica-type symptoms.
It is likely that a more accurate diagnosis of the cause of the patient’s leg pain will be made if the patient is able to provide clear information about the nature of their pain and symptoms.
Clear, descriptive terms that will help inform an accurate diagnosis include the following:
- Position or path of the pain as it radiates down the leg
- Body position when pain occurs
- Sensation (e.g. aching, tingling, shooting, lancinating, burning pain)
- Frequency (e.g. occasional, getting more frequent, constant)
- Description of what makes the pain feel better or worse
This information, as part of a comprehensive patient history, combined with a physical exam and diagnostic tests (such as MRI scan, CT myelography, etc.), allows a spine specialist to more accurately isolate the probable causes of spine-related leg and foot pain and outline potential treatment options.
The purpose of this article is to emphasize that there are many spinal conditions that may cause leg pain, foot pain, and other lower extremity symptoms. Most successful treatments are based upon having an accurate anatomic diagnosis for the basis of a specific pain syndrome.
Spine care professionals—such as physiatrists, orthopedic surgeons, chiropractors, and other appropriately trained health professions—are particularly well suited to oversee the diagnosis and treatment of these situations.