Main causes of back and leg pain
The spinal nerves form nerve trunks. The largest of them is the paired sciatic nerve, which leaves through the gluteal region into the lower extremities. With osteochondrosis, hernia or protrusion of the intervertebral disc, spondylosis and other diseases, the spinal cord roots that form the sciatic nerve may be pinched. The result is swelling, inflammation, poor circulation and lack of oxygen in the pinched spinal nerves, which causes sharp and severe pain in the back and legs
along the course of the sciatic nerve.
Shpidonov Gennady Stanislavovich
Neurologist
Rostov State Medical University (neurology)
10 years of experience
Radicular syndromes
The described phenomena in medicine are called radicular syndrome (radiculopathy) - this is a complex of neurological symptoms that occurs when the spinal nerves are pinched or irritated. Pain in the back and limbs
often occurs with intervertebral hernia, protrusions, and other diseases of the spine.
With radicular syndrome, pain is accompanied by various neurological symptoms. In addition to pain, sensitivity disorders are possible - patients complain of numbness, tingling, burning sensation on the skin. Reduced pain sensitivity. The skin is cold even on the hottest day. With advanced radicular syndrome, atrophy and weakness of the muscles of the lower extremities may be observed. But the most striking symptom remains pain along the nerves, the intensity of which varies from mild aching to unbearable.
Let us consider the variants of radicular syndromes and the causes of their occurrence separately.
Sciatica (sciatica)
Sciatica is called chronic pain in the lower extremities, most often arising from protrusion/hernia of the 5th lumbar/1-2 sacral vertebrae. The nature of pain in the acute period is described by patients as burning, shooting, boring, pulling. The pain spreads along the sciatic nerve, through the buttock, the outer surface of the thigh and lower leg, to the back of the foot. Increased pain is provoked by turning, bending the body, lifting weights, being forced to stand for a long time, and cold weather. With sciatica, there may be no pain in the spine itself.
The intensity of pain depends on the location of the intervertebral hernia, and to a lesser extent on its size. A characteristic sign is that pain occurs on one side, less often on both sides.
Shooting pain in the lower back (lumbago, lumbodynia)
Lumbago is an acute, sudden pain in the lower back. Most often, the cause of lumbodynia is osteochondrosis or protrusion/hernia of the intervertebral disc. Unlike sciatica, pain is localized at one point, in the projection of the affected segment of the spine. The provoking factor is lifting weights, physical activity, and a draft blowing through the lower back, especially after hard work.
A characteristic symptom is a forced position; attempts to straighten the lower back lead to increased pain. The reason is a sharp spasm of the back muscles that occurs in response to severe pain. The duration of an attack of pain with lumbodynia can vary from several minutes to days and even weeks. Rest and a firm bed may relieve pain in some patients.
Lumbalization and sacralization
Lumbarization and sacralization are anomalies in the development of vertebrae in the lumbosacral spine. During lumbarization, the first and/or second vertebra of the sacral spine in the process of development takes on the shape characteristic of the lumbar vertebrae, while maintaining mobility (normally, the vertebrae of the sacral spine completely fuse by the age of 18, forming the sacrum or sacrum). With sacralization, the 5th and/or 4th lumbar vertebrae in the process of development take on the characteristics of the vertebrae of the sacral spine and fuse with it into one whole.
Both anomalies lead to disruption of the biomechanics of the spine and improper distribution of loads. Often sacralization and lumbarization are accompanied by other anomalies (split vertebral arches, flattening of vertebral bodies). All this leads to the development of spinal osteochondrosis, provokes the formation of hernias and protrusions, which in turn cause lumbago and sciatica.
Shpidonov Gennady Stanislavovich
Neurologist
Rostov State Medical University (neurology)
10 years of experience
Pinched sciatic nerve (lumboischialgia)
Infringement of the spinal nerves forming the sciatic nerve, as mentioned above, is a consequence of osteochondrosis, hernias and protrusions of the intervertebral discs. And most often this condition is accompanied by both acute pain in the lower back (lumbago) and sharp, nagging pain along the sciatic nerve in the legs (sciatica). This condition is called lumboischialgia.
Localization of pain in the back and legs
The localization of pain in the lower back and lower extremities depends on the location of the protrusion or herniation of the intervertebral disc. There are lateral, central (horizontal hernias) and internal (Schmorl's hernia) herniations of the intervertebral disc.
Pain radiates to right leg
Pain radiating to the right leg occurs with a lateral or horizontal herniation of the intervertebral disc that occurs on the right. In this case, the right spinal nerve is pinched, and the pain, accordingly, will radiate to the right leg.
Pain radiates to left leg
Pain radiating to the left leg occurs due to hernias/protrusions of the left half of the intervertebral disc.
Pain in the lower back and lower back
Isolated lower back pain of the lumbago type occurs with a central location of a hernia or protrusion, strictly at 12 o’clock. In this case, the hernial protrusion is directed into the spinal canal; there is no pinching of the spinal nerves in the intervertebral foramen, as occurs with lateral hernias. Because of this, there is no pain radiating to the legs. The source of pain is the posterior longitudinal ligament of the spine stretched by a hernia.
Physiotherapeutic treatment
Lumbar massage is an effective method of combating pain.
Physiotherapeutic procedures reduce pain, improve blood circulation, and restore metabolic processes.
If there are no contraindications, doctors prescribe:
- acupuncture;
- electrophoresis with lidase;
- D'Arsonval;
- acupuncture;
- massages;
- mud.
All procedures are carried out in courses, repeated every month. For persistent pain in the lumbar region, it is recommended to wear an orthopedic bandage that supports the base of the spine, relieving point pain in the buttock. For the same purpose, you can wear a regular warming belt. The area of pain should be rubbed with ointments with a warming effect.
Consultation with a neurologist / Egor 1463 views December 1, 2020
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Answers from doctors ComplainYulia Safronova, December 1, 2020 Narcologist, Neurologist, Psychiatrist What are you currently taking for treatment? Getting ahead, December 1, 2020 Client Julia, Nimesil, if a load is ahead, 3 months of arcoxia 60mg, glucosamine+chondroitin, ointment, I am on the rug of Lyapko Safronovoi Safronov, December 1, 2020, neurologist, psychiatrist tried a pregabalin according to the treatment with the treatment with the treatment of monitorialpathic pains. December 2020Client Yulia, no ComplainEgor, December 1, 2020Client Yulia, Immard was still drinking ComplainYulia Safronova, December 1, 2020 Narcologist, Neurologist, Psychiatrist Start with 75 mg at night for 3 days, then 75 mg 2 times a day for 3 days, then 75 mg in the morning and 150 .at night for 3-4 days and then 150 mg 2 times a day for 2 weeks ComplainRegina Fakhrutdinova, December 1, 2021 Neurologist Hello! Did a neurosurgeon consult you about hernias in the spine? When was your last treatment and what did you receive? Complain Egor, December 1, 2020Client Regina, the last treatment was basic from a rheumatologist 4 months ago (indicated in the previous answer). I saw a neurosurgeon. I will attach a photo to the question. ComplainRegina Fakhrutdinova, December 1, 2021 Neurologist Have you tried therapeutic blockades in the knee and lumbar region? ComplainRegina Fakhrutdinova, December 1, 2021 Neurologist Didn’t they prescribe you Carbamazepine? Or gabapentin? Complain Egor, December 1, 2020Client Regina, haven’t tried it. Not prescribed ComplainRegina Fakhrutdinova, December 1, 2021 Neurologist You can try therapeutic blockades in the knee joint and lumbar sacral region; give good effects. Among the drugs, gabapentin 300 mg at night for 3 days, then 300 mg 2 days for 14 days Complain Yana Potekhina, December 1, 2021 Neurologist Hello. Have you taken tests such as C reactive protein (CRP), rheumatic factor, ASLO? Complain Egor, December 1, 2020Client Yana, passed in July 2021 - negative Complain Egor, December 1, 2020Client Yana, ASLO is antistreptolysin 0? If so, then the indicator was 400 (I was sick when I took this test) added a photo of the test for staphylococcus (10^4) ComplainYana Potekhina, December 1, 2020 NeurologistComplainNatalya Belyakova, December 1, 2021 Pediatrician, Therapist, Massage TherapistComplainEgor, December 1, 2020Client Natalya, rheumatic factor and c reactive protein is negative. Antistreptolysin 0 - 400 (at the time of the test I was sick) attached file with analysis for saphylococcus (10^4) ComplainEgor, December 1, 2020Client Natalya, I do gymnastics and stretching daily ComplainNatalya Belyakova, December 1, 2021 Pediatrician, Therapist, Massage TherapistComplainNatalya Belyakova, December 1, 2021 Pediatrician, Therapist, Massage Therapist didn’t offer to remove Baker’s cyst? Is there stiffness in this joint? Osteopath, if you choose, only based on reviews. This should be a doctor with a certificate in osteopathy, and not a massage therapist with the habits of a chiropractor. Complain Egor, December 1, 2020 Client Natalia, did not offer. None of the doctors even paid attention to her. This joint hurts less and I don’t feel any stiffness. As for the osteopath, I understand. ComplainNatalya Belyakova, December 1, 2021 Pediatrician, Therapist, Masseur You have ordinary dystrophic changes in the joints like gonarthrosis. But including conduction pain, if you remove problems with the spine, then later it will be clear what kind of pain is caused by inflammatory problems in the joints themselves. ComplainEkaterina Kisel, December 1, 2021 Neurologist, TherapistComplainNatalya Nikulina, December 2, 2021 Neurologist Hello! Taking into account all the examinations, blockades in the joints and lower back with hormones and anesthetics are indicated. It is good to take a course of prolotherapy - it helps restore the ligamentous apparatus. Among the examinations - a test for urogenital infections (exclude reactive arthritis). Similar questions on the topicRedness at the tips of the fingers1 answerMarch 5, 2019Anna, SamaraQuestion closedDizziness56 answersSeptember 11, 2019Ekaterina, MoscowQuestion closedGallstones14 answersAugust 31, 2020Natalia, TutaevQuestion closed What should I do if I haven’t found the answer to my question?
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- Lower back pain, radiating to the buttock and leg: reasons, how to treat
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Lower back pain radiates to the leg and buttock - a complaint that doctors hear quite often. This unpleasant phenomenon can significantly limit a person’s ability to live a full life. But what is much more important is that such pain is only a symptom. It is necessary to eliminate the root cause that provokes the appearance of painful sensations.
Types of severe back pain that radiates to the legs
The nature of pain during hernias/protrusions of the lumbosacral region greatly depends on the location of the hernia, the individual characteristics of the patient (diameter of the intervertebral foramina, diameter of the spinal canal, age and severity of degenerative changes). The size of the hernia can also affect the severity of pain.
Drawing, burning, shooting pains in the back and legs are characteristic of the acute period of the disease, immediately after the onset of an attack of lumboischialgia. They are poorly relieved by analgesics, and may last 1-2 weeks before improvement.
Aching pain in the back and legs is often chronic and can last for years if the patient neglects a visit to a neurologist or treatment. Periodically, there may be periods of exacerbation associated with physical activity or heavy lifting.
Shpidonov Gennady Stanislavovich
Neurologist
Rostov State Medical University (neurology)
10 years of experience
Diagnosis of pathology
Pain can indicate a variety of diseases. Therefore, it is useless to relieve this symptom with tablets, ointments or manual therapy until its real cause is identified.
To determine the factor causing such discomfort, doctors use a variety of methods. First of all, this is, of course, a visual examination of the patient, palpation of the diseased area, as well as an oral questioning about the nature of the pain and accompanying symptoms. Based on this, the doctor draws conclusions about which examination methods are best prescribed to the patient.
The most frequently prescribed examinations:
- General blood and urine tests. This research method allows you to check biological fluids for the number of bodies responsible for inflammation and pathogenic processes in the body.
- A group of blood tests for the various components contained in it. We are talking about a biochemical study, as well as checking the presence of various pathogenic bodies in the blood.
- X-ray diagnostics. This research method is the main one in diagnosing diseases associated with the musculoskeletal system. It allows you to examine the joint in detail for the presence of osteophyte damage.
- Taking rheumatic samples. Such a study allows you to accurately determine the presence or absence of rheumatism.
- Proteinogram.
- MRI and CT. These types of diagnostics allow you to examine the ligaments and muscles in detail and identify inflammation and other problems present in them.
- Checking the patency of blood vessels.
- Diagnosis of tendon reflux.
The type of diagnosis required in a particular case is chosen by the doctor. However, if a specialist suspects that the cause of discomfort does not lie in diseases of the bones and joints, he may prescribe other tests and examinations. For example, he will ask you to donate blood to determine the amount of sugar in it.
Diagnosis of the problem
It is very important to consult a doctor before starting treatment. Indeed, due to the wide range of possible causes of discomfort, it is impossible to independently determine the disease that caused it.
How is back and leg pain diagnosed?
The first stage of diagnosing the causes of back pain radiating to the legs is a consultation with an experienced neurologist. Radicular syndrome can be diagnosed during a routine neurological examination. A characteristic sign is the positive Lasègue symptom, which consists of increased pain in the leg when it is raised up while lying on the back. It is also called the spinal cord root tension symptom.
A neurological examination also reveals other disorders - decreased sensitivity of the skin to pain, absence or blurred reflexes, atrophic phenomena, weakness of the muscles of the lower extremities. To confirm the diagnosis, it is best to use magnetic resonance imaging of the lumbosacral spine.
Prevention
Pain in the hips, buttocks and lower back can be prevented by following certain preventive measures. Prevention will help maintain a healthy lifestyle and normal muscle tone. To do this, just follow two recommendations:
- Exercise regularly. This could be swimming, yoga, running or fairly productive exercise. Care should be taken when choosing active sports, as the pain may worsen during productive running or jumping.
- Taking chondroprotectors - drugs based on glucosamine and chondroitin sulfate, which stimulate the process of regeneration of joints and cartilage, prevent bone tissue destruction and have an anti-inflammatory effect.
The most common chondroprotectors include drugs such as Artron Complex, Teraflex, Dona, Structum and others.
How to relieve back and leg pain
A short course (2-3 days) of nonsteroidal anti-inflammatory drugs, or NSAIDs, can be used to relieve back and leg pain. Drugs in this series have the ability to fight inflammation and can relieve pain of various origins. When the sciatic nerve is pinched, they have average effectiveness. It is strictly forbidden to take NSAIDs for more than 5 days due to the high risk of complications such as stomach ulcers and gastric bleeding. Rest and a firm bed may relieve pain in some patients. However, for others, these measures may lead to increased pain. You should try to find the optimal position in which the pain becomes less severe. Wearing an orthopedic corset can also be effective - it relieves pain by unloading the diseased spine, acting as a muscular frame.
How to treat back pain that radiates to your legs
During the period of acute pain, it is recommended to rest, take painkillers, as well as drugs that eliminate spasms of the back muscles. After the acute pain subsides, physiotherapy, massage, and therapeutic exercises are prescribed, which are included in the rehabilitation program for all patients with diseases and injuries of the spine.
Shpidonov Gennady Stanislavovich
Neurologist
Rostov State Medical University (neurology)
10 years of experience