Author: Adam Felman
Leg pain can be due to trauma or a symptom of a condition. A person can receive treatment based on the specific cause of the leg pain.
There are many causes of leg pain. Causes can relate to the following:
- blood vessels
- soft tissues
The course of treatment depends on the cause of the leg pain. People can often treat leg pain at home, but if the pain is sudden, severe, or persistent, or if there are other symptoms, medical attention may be necessary.
This article examines some common causes of leg pain and treatments.
Fast facts about leg pain
- The causes of leg pain can be musculoskeletal, neurological, or vascular.
- Shin splints and stress fractures can result from repetitive sports, such as running.
- Leg pain can sometimes indicate a serious vascular issue. These can occasionally be fatal, and they require medical intervention.
- People can treat many types of pain at home, but severe or persistent pain can indicate a more serious condition.
Doctors mostly classify leg pain as neurological, musculoskeletal, or vascular, which can overlap.
Conditions include restless legs syndrome, in which the legs twitch uncontrollably, neuropathy or nerve damage, and sciatic nerve pain. Neurological pain can be present even when resting, such as in the arms or legs.
Musculoskeletal pain examples are crepitus, a popping or cracking sound in the knee, or arthritis, a condition that affects the joints in the body.
For example, injuries to the muscle tendon or ligament during a fall would cause musculoskeletal pain.
Cramps, compartment syndrome, and stress fractures are also musculoskeletal issues.
Causes of vascular pain include:
- peripheral arterial disease (PAD)
- deep vein thrombosis (DVT)
- varicose veins
- varicose eczema, discoloration of the skin accompanies the pain
Different causes of leg pain can have similar symptoms. If necessary, getting a correct diagnosis increases the chances of receiving appropriate treatment. Identifying the symptoms and their onset can help find an appropriate diagnosis.
Leg cramps, or Charley horses
Charley horses are transient episodes of pain that can last for several minutes. The muscle — usually the calf at the back of the lower leg — tightens and spasms.
Nocturnal leg cramps are common with a high prevalence in older people.
Many people with PAD are asymptomatic. However, a painful ache or cramp in the leg consistently occurs after the same walking distances, but they often ease on resting.
The key symptom is intermittent claudication. Intermittent claudication causes the blood supply to the leg muscles to become restricted. The resulting lack of oxygen and nutrients causes pain.
- cramp-like muscle pain during exercise or exertion
- pain in the buttocks, thighs, calves, and feet
- pain when walking or climbing stairs
DVT refers to a blood clot in the deep veins of the leg. For example, it can emerge after spending a long time sitting on a long-distance flight.
Vascular problems can be serious. Both PAD and DVT can present without symptoms. People whose lifestyle or medical history leaves them prone to vascular problems in the leg should be aware of possible symptoms.
Symptoms include swelling and a hot, painful sensation on one side of the leg. This sensation may only occur when walking or standing up.
The clot may dissolve on its own, but if the person experiences dizziness and sudden shortness of breath, or if they cough up blood, emergency attention is needed. These could be signs that DVT has developed into a pulmonary embolism or a blood clot in the lung.
Engaging in intense exertion during sports can lead to different types of injury.
Jogging and running can create repetitive impact forces that overload muscles and tendons. Shin splints produce severe, localized tenderness in the muscles and sometimes bone pain commonly felt around the shin bone.
Fractures and stress fractures
Heavy pressure, such as a fall, can lead to fractures. Some fractures are easily visible, with severe bruising, swelling, and deformation. These normally receive urgent medical attention.
Stress fractures are small fractures that can result from repetitive stresses sustained during sports, often when activity intensity increases too quickly, such as in running-intensive sports.
The pain may start earlier during each exercise session and eventually become present all the time.
Achilles tendonitis is a common condition where the large tendon that runs down the back of the lower leg becomes irritated and inflamed.
Acute trauma can lead to sprains and strains. A sprain refers to the stretching or tearing of a ligament.
A hamstring strain or injury is very common in athletes and can lead to an acute pain in the rear of the thigh muscle, usually due to a partial tear.
Sprains and strains usually develop due to inadequate flexibility training, overstretching, or not warming up before an activity. Continuing to exercise while injured increases the risk.
When an injury to the leg results in swelling, dangerous muscle pressure levels can lead to acute or chronic compartment syndrome. This possibly may be due to a fracture or severe bruising.
The swelling causes pressure to build up until the blood supply cuts off from muscle tissue, depleting the muscles of oxygen and nourishment. The pain may be unexpectedly severe, considering the injury.
In severe cases, numbness and paralysis may follow the pain. Permanent muscle damage can result.
Sciatic nerve pain
Sciatica happens when something puts pressure on a nerve, often in the spine, leading to pains that run down the leg from the hip to the foot.
It can happen when a nerve is “pinched” in a muscle spasm or herniated disk.
Long-term effects include strain on other body parts as the gait — the way a person walks — changes to compensate for the pain.
People can resolve many cases of leg pain at home without medical intervention.
Self-help for muscle cramps
If doctors have ruled out the serious causes of cramps, self-help measures may be appropriate.
Pain relief medication will not improve leg cramps as they start suddenly, but stretching and massaging the muscle may help.
To relieve the pain when cramps occur, a person can hold the toe and pull it up toward the body while straightening the leg. They can also walk around on heels until the cramp eases off.
To prevent cramps, a person should:
- Always stretch and warm up before and after exercising.
- Avoid dehydration by drinking 8–12 glasses of water a day.
- Regularly stretch and massage the legs.
Sports injury treatment
Over the years, acronyms to guide the management and treatment of injuries have evolved, including Rest, Ice, Compress, and Elevate (RICE). The most recent rehabilitation treatment is PEACE and LOVE.
- Protect: A person should try to protect the affected area by restricting movement for 1–3 days.
- Elevate: People need to elevate the leg higher than the heart.
- Avoid nonsteroidal anti-inflammatory drugs (NSAIDs): Remedying inflammation with NSAIDs may negatively affect long-term tissue healing and recovery.
- Compress: Apply pressure to the affected area using taping or bandage.
- Educate: Physical therapists should educate people on the benefits of an active approach to recovery.
After the first few days, soft tissues need LOVE.
- Load: A person should exercise and move areas affected by musculoskeletal disorders.
- Optimism: Optimistic expectations link to better outlooks and recovery.
- Vascularisation: Aerobic exercise should start a few days after injury to boost motivation and increase blood flow to the injured structures.
- Exercise: Exercises help to restore mobility and strength early after injury.
Many experts are considering using PEACE and LOVE for treatment. People should consult their doctor if they have questions about which method is right for them.
Drugs such as acetaminophen can help with some pain, but if pain persists for more than 72 hours, a person should seek specialist medical advice.
A person requires medical attention for claudication and other symptoms of vascular disease due to the risk of developing coronary artery disease and cerebrovascular disease, which could lead to a heart attack or stroke.
To reduce cardiovascular risk factors, doctors advise:
- avoiding or quitting smoking
- reducing excess weight
- managing levels of blood sugar, cholesterol, and lipids
- controlling blood pressure
- exercising and following a balanced diet
- reducing stress where possible
A differential diagnosis strategy can help rule out inappropriate causes, narrow the possibilities, and provide timely intervention.
Leg pain has many different causes, and the symptoms often overlap. If they persist, worsen, or make life difficult, the individual should contact a doctor.
A person can receive treatment based on the cause of the leg pain. They can also treat it at home by stretching, massaging, and staying hydrated. At present, doctors treat sports injuries with the PEACE and LOVE protocol.