Leg Pain
WHEN TO SEE YOUR DOCTOR
* The pain lasts more than three days.
* You also experience numbness, coldness or weakness in your legs.
* Pain occurs in both the upper and lower leg.
* You notice bluish skin coloration, ulceration or tender lumps below the skin.
* You sustain an injury that produces swelling or discoloration or you suspect bone damage from the injury.
* You have an overuse injury that does not improve after three weeks.
What Your Symptom Is Telling You
Several years ago, Secretariat—perhaps the greatest thoroughbred in racing history—suffered a leg injury. Even though his career was long since over and he had been put out to stud, the pain was such that the legendary Triple Crown winner had to be destroyed.
It's a thoroughly sad story. But look on the bright side—you're not a horse!
As with Secretariat, injuries are always the first suspect when leg pain arises. Something like a broken bone is usually pretty obvious, because it's caused by a sudden trauma, like a fall. Ditto for a muscle tear or strain. But an overuse injury comes on gradually. This category includes the malady every athlete knows all too well—shin splints.
"Shin splints is a catchall term for any sharp overuse pain in the bones and tissues of the lower leg," says Lyle Micheli, M.D., director of the Sports Medicine Division at Boston Children's Hospital and associate clinical professor of orthopedic surgery at Harvard Medical School. In reality, shin splints are things like stress fractures, tendinitis or compartment syndrome—an irritation of the tissue that surrounds the shin muscles. And shin splints have many causes, including hard running surfaces, inadequate footwear, not warming up or overzealous exercise.
The legs are also hot spots for various types of painful diseases of the veins or arteries. Thrombophlebitis—an inflammation and clotting of the veins—creates a feeling of heaviness, along with a throbbing or burning sensation below the skin. In its "superficial" form, this disease produces tender skin redness and is not cause for concern. But deep vein thrombophlebitis (DVT) can produce sore, oozing skin ulcers. And a DVT clot that breaks away could be fatal if it lodges in the lungs.
In addition, insufficient blood flow from atherosclerosis (hardening of the arteries) can lead to what doctors call intermittent claudication. A person who has this condition experiences a dull cramping sensation that comes on with exercise (when the muscles require more oxygen-rich blood) and goes away with rest. Intermittent claudication, which is fairly common, usually shows up in the calves but sometimes appears in the upper leg as well. In rare cases, blood flow problems can be caused by a limb-threatening aneurysm (ballooning) in an artery behind the knee.
It's also possible for leg pains to originate somewhere other than in the leg, particularly in the spine. This is called referred pain. "Any abnormality in a disk or the spinal canal—a tumor, an infection—can refer pain to the legs with little or no pain in the back," says Steven Mandel, M.D., clinical professor of neurology at Jefferson Medical College and an attending physician at Thomas Jefferson University Hospital in Philadelphia.
Sciatica is a common type of referred pain. The sciatic nerve runs from the spine down the leg. Just sitting on a hard stool or wearing a tight work belt can pinch the nerve upstairs and produce a stabbing pain farther down the leg.
Also, the leg itself can experience entrapments—constrictions of nerves that produce burning, tingling, numbness or weakness. This kind of pain often shows up in people who sit, squat, stand or kneel for long periods.
Finally, the cause of pain can be in the bone itself. Osteomyelitis, for example, is an infectious bone disorder that can be acutely painful.
Symptom Relief
An aching leg can make you feel like a plow horse bound for the glue factory. Here are some tips to get your gimpy gams back in racing form.
Be attentive to your symptoms. Try to identify what makes your pain worse and what may make it better. Pay particular attention to the kinds of activities that affect the intensity or duration of your pain, advises Michael F. Nolan, Ph.D., physical therapist and associate professor of anatomy and neurology at the University of South Florida College of Medicine in Tampa. If constant or repetitive leg motion is part of your job, consider taking frequent rest breaks.
Chill out with ice. Several days of ice-pack applications is perfect for relieving pain from an injury, says Dr. Micheli. Wrap ice cubes in a towel and apply them to the painful area for 15 minutes at a time, whenever you need relief. Just make sure the pain is from an injury. Ice can aggravate the pain associated with vascular disease, says Robert Ginsburg, M.D., director of the Cardiovascular Intervention Unit at the University of Colorado Health Science Center in Denver.
Try compression. An elastic bandage will relieve pain and swelling from a quad or hamstring pull, says Dr. Micheli. (The quadriceps and hamstrings are muscles at the front and back of the thighs.) For relief from painful thrombophlebitis, compression support stockings do a fine job, says Dr. Ginsburg. These are prescription stockings designed for vascular pain relief. Knee-high support hose from a department store can actually constrict blood flow and increase pain, he says.
Get a leg up. Elevating an injured leg drains the fluids that cause painful swelling, says Dr. Micheli. It can also provide fast relief for the dull, aching heaviness of thrombophlebitis.
Warm away vascular pain. A warm, not hot, heating pad, blanket or other warming device provides fast, soothing relief for thrombophlebitis, says Dr. Ginsburg. Don't use heat on the first three days following an injury, however. It could make swelling worse.
Preventing Leg Pain
If leg pain plagues you on a regular basis, there are several things you might want to try to keep it at bay.
Be heart smart. "The same lifestyle changes that can prevent a heart attack can reduce vascular leg pain," says Dr. Ginsburg. "Give up smoking, stop eating fatty, cholesterol-laden foods and shed some pounds. A regular exercise program, especially a walking program, will re-establish quality blood flow throughout the leg."
Find exercise alternatives. People who have shin splints should cut back on the activity that brought on the pain (usually running) and find less stressful alternatives, like biking or swimming, advises Gary M. Gordon, D.P.M., director of the Running and Walking Clinic at the University of Pennsylvania Sports Medicine Center in Philadelphia.
Work your abs. Sit-ups and other stomach-strengthening exercises can
relieve strain in the lower back, thus reducing referred leg pain, says Dr.
Nolan.
Empty your pockets. Sitting on your wallet can bring on sciatica, says Dr. Mandel. Wearing tight belts and tight pants can also irritate nerves. So pick your pockets and trade in your designer jeans for a pair of comfortable chinos.
Use padding. Cushioned seats or knee pads can lessen the severity of hard surfaces and prevent sciatica and nerve compression, says Dr. Mandel.
See also Calf Pain
