Orthopedic Leg Pain: Musculoskeletal and Neurological
Pain Management for Musculoskeletal and Neurological Orthopedic Leg Pain
Orthopedic Leg Pain: Musculoskeletal and NeurologicalAdmin2023-04-03T09:53:27-04:00
Orthopedic leg pain is a common symptom of trauma or disease, such as sports injuries, accidents, and diabetes. However, other causes of leg pain can relate to nerves, muscles, joints, soft tissues, and bones. Even blood vessels in the leg can cause pain.
Orthopedic leg pain can be the result of a musculoskeletal (bone, muscle and joint), neurological (nerves), or vascular (blood vessels) disorder.
Orthopedic leg pain can be constant or intermittent. It can develop suddenly or gradually and affect the entire leg, or just a specific area like the knee. The pain can be stabbing, sharp, or dull and produce an aching or tingling sensation.
Some leg pain can range from merely annoying to a mild nuisance. However, severe leg pain can be debilitating and affect the ability to walk, bear weight on the affected leg, or perform simple everyday activities.
Pain that affects bones, muscles, ligaments, and tendons is musculoskeletal pain. It can be acute (having a rapid onset, with severe symptoms) or chronic (long-lasting). Musculoskeletal pain can be localized to just one area, or widespread.
There are varying symptoms and causes of musculoskeletal pain. Some of the more common types are:
“Tunnel” syndromes. Any musculoskeletal pain that is the result of nerve compression, generally caused by overuse. The disorders include carpal tunnel syndrome, cubital tunnel syndrome, and tarsal tunnel syndrome. The pain tends to spread along the path supplied by the nerve and may produce a burning sensation.
Fibromyalgia: This is a condition that may cause pain in the muscles, tendons, or ligaments. The pain is usually in multiple locations and can be difficult to describe. Fibromyalgia is generally accompanied by other symptoms.
Bone pain. Usually, a deep, penetrating, or dull pain that is typically the result of an injury. The pain may be the result of a sprain, fracture, or tumor.
Joint pain. Joint injuries and diseases usually produce a stiff, aching, “arthritic” pain. The pain can range from mild to severe, and often worsens when the joint moves. The joints may also swell. Joint inflammation (arthritis) is a common cause of pain.
Muscle cramp or pain. Often less intense than bone pain, however, muscle pain can still be debilitating, as with a sudden, tight, intense lower leg pain that can quickly get worse. Muscle pain can be the result of an injury, an autoimmune reaction, loss of blood flow to a muscle, infection, or even a tumor. The pain can also include muscle spasms and cramps.
Tendon and ligament pain: Tendon and ligament pain are often caused by injuries, including sprains. This type of musculoskeletal pain can become more intense when the affected area is stretched or moved.
Though orthopedic leg pain may be a problem that originates in the legs, often times the actual cause of the pain is a problem with the nerves in the lower back (neurological).
The sciatic nerve and lumbar nerve are a major cause of neurological pain in the legs. Neurological pain is often described as a sensation of “pins-and-needles” or “numbness.” In some cases, there may be persistent weakness. In cases of sudden, unpredictable weakness, the patient’s description may be that their leg just “gave out.”
Nerves can also be damaged by high blood sugar levels that can cause diabetic neuropathy, a common complication of diabetes. Diabetic neuropathy can cause pain in the legs along with numbness and reduced sensation in the lower legs.
What Causes Orthopedic Leg Pain?
Most leg pain results from wear and tear, overuse, injuries to the bones or a joint, or damage to muscles, ligaments, tendons or other soft tissues (musculoskeletal). Some types of leg pain can be traced to lower spine problems which result in an irritated or damaged nerve (neurological).
Damage to muscle tissue can come from normal daily wear and tear, or as a result of trauma from an accident. Any sudden jerking movements, falls, fractures, sprains, or dislocations can cause musculoskeletal pain. Other causes of pain include postural strain, repetitive movements, overuse, and prolonged immobilization. Changes in posture or poor body mechanics may bring about spinal alignment problems and muscle shortening, therefore causing other muscles to be misused and become painful.
There are more than 100 different types of nerve damage. Neurological pain can be present even when resting. The primary cause of neurological pain originates in the lower back, where nerves branch out from the spine to provide function to the muscles in the leg, ankle, and foot. The following are just a few of the possible causes of leg pain originating from nerve damage:
Autoimmune diseases. A variety of different types of autoimmune diseases (like multiple sclerosis) can produce symptoms of nerve pain and nerve damage.
Cancer. In some instances, cancerous masses may push against or crush nerves. Some types of chemotherapy and radiation can also produce nerve pain and nerve damage.
Compression/trauma. Anything that results in trauma or compression of nerves can result in nerve pain and nerve damage.
Degenerative Disc Disease. As we age, our intervertebral discs lose their flexibility and allow small movements, which can cause pain from the disc that may radiate into the leg (referred pain).
Diabetes. Up to 70% of people with diabetes suffer from nerve damage, which becomes more likely as the disease progresses. Diabetes most often affects sensory nerves, causing burning or numbness.
Drug side effects and toxic substances. Various substances taken intentionally or unintentionally can cause nerve pain and nerve damage. Toxic substances that may be ingested accidentally, including lead, arsenic, and mercury, may also cause damage to your nerves.
Herniated Disc. A disc herniation can put pressure on an area under a nerve root resulting in pain that can radiate down the sciatic nerve and throughout the leg and into the foot.
Infectious disease. Certain infectious diseases can affect the nerves in your body. These conditions include Lyme disease, the herpes viruses, HIV, and hepatitis C.
Nutritional deficiencies. Deficiencies of specific nutrients, including vitamins B6 and B12, may produce symptoms of nerve pain and nerve damage, including weakness or burning sensations. Nutritional deficiencies can be the result of excessive alcohol ingestion or develop after gastric surgery.
Spinal Stenosis. Low back spinal nerve roots become compressed from enlarged joints in the spinal column. Spinal stenosis usually occurs in elderly patients.
Spondylolisthesis. A condition that occurs when a vertebra in the spine slips forward over the next, lower vertebra, causing instability that can lead to a nerve being pinched or inflamed and cause leg pain.
What are the Symptoms of Orthopedic Leg Pain?
There are many causes of orthopedic leg pain, and the symptoms often overlap.
Musculoskeletal Pain Symptoms
Symptoms of musculoskeletal pain depend on whether an injury or overuse causes the pain, and if it is chronic or acute. People may complain that their entire body aches. Sometimes, the muscles twitch or burn. Symptoms vary from person to person, but the typical symptoms are:
A localized or widespread pain that can worsen with movement.
An aching or stiffness of the entire body.
A feeling that the muscles have been pulled or overworked.
A sensation of “burning” in the muscles.
If the pain is the result of a fracture or significant bone injury, the symptoms include severe bruising, swelling, and deformation. Pain from smaller stress fractures may begin only with exertion, but may eventually become present all the time (chronic).
If the pain is from an injury to muscles, ligaments, or tendons, the pain can be related to a:
Cramp (Charley Horse), a transient episode of pain that can last for several minutes. The muscles tighten and go into spasms.
Severe localized tenderness and pain (shin splint). Sometimes, this bone pain is commonly felt around the shin bone.
Neurological Pain Symptoms
Nerve damage can produce a wide variety of symptoms that depend on the location and type of nerves affected. 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. Sometimes described as a searing pain that may radiate from the low back or buttocks down the leg. The pain may be intermittent, shooting from the lower back down the leg and occasionally into the foot. Burning pain is fairly typical when a nerve root in the lower spine is irritated. It is often referred to as sciatica.
Leg numbness or tingling. The feeling of the leg or foot “falling asleep.” The patient is not able to feel pressure, or hot or cold. The numbness can be nearly continuous, making it difficult or almost impossible to walk or drive a car.
Weakness (foot drop) or heaviness. Leg weakness or heaviness interferes with normal movement. People often describe a feeling of having to drag their lower leg and foot. Patients with foot drop are unable to walk on their heels, flex their ankles, or walk with the usual heel-toe pattern.
Constant pain. This type of pain is typically felt in the buttock area and may occasionally radiate into the leg. This type of pain is usually described as “nerve pain,” versus an aching or throbbing pain. Typically, it is present on only one side of the body, and may be called sciatica or lumbar radiculopathy.
Positional leg pain. Leg pain that dramatically worsens in intensity when sitting, standing, or walking can indicate a problem with a specific part of the low back. Finding more comfortable positions is usually possible to alleviate the pain.
The symptoms of nerve pain depend on the type of nerve affected. Damage to motor nerves can produce symptoms that include:
Sensory nerve damage may produce:
Tingling or prickling.
Positional awareness problems.
In some instances, people with nerve damage have symptoms that indicate damage to more than one type of nerve. The patient may experience weakness and burning in the legs at the same time.
For most leg pain symptoms, an accurate diagnosis of the underlying cause of problems is an essential first step in effective treatment.
How is Orthopedic Leg Pain Diagnosed?
The doctor will conduct a thorough physical examination before making a final diagnosis. Also, a review of the patient’s medical history will help find possible causes of the pain, such as a workplace or sports injury.
An accurate diagnosis of leg pain requires the patient to provide an accurate description of the pain and the symptoms. Clear, descriptive terms that help lead to an accurate diagnosis include:
The position or path of the pain if it radiates down the leg.
The position of the body or leg when the pain occurs.
The sensation the pain causes (e.g., aching, tingling, shooting, or burning pain).
The frequency of the pain (e.g., occasional, becoming more frequent, or constant pain).
A description of what makes the pain feel better or worse.
In some cases, to help determine the underlying cause of the pain, a doctor may perform diagnostic exams such as laboratory tests and X-rays. These may include:
Blood tests to confirm a diagnosis, such as rheumatoid arthritis.
X-rays to take images of the bones.
CT scan for a more detailed look at the bones.
MRI scan to see soft tissues such as muscles, cartilage, ligaments, and tendons.
Based on the findings from the examination and the results of the tests, the doctor should be able to diagnose the cause and type of pain, which is important in developing a treatment plan.
How is Orthopedic Leg Pain Treated?
Novus Spine & Pain Center specializes in orthopedic leg pain management and treatment for both musculoskeletal and neurological leg pain.
Musculoskeletal Pain Treatment
Musculoskeletal pain is best treated by treating the cause. The treatment will vary depending on whether the pain is bone, muscle, ligament, tendon, or joint pain. For some acute musculoskeletal pain, manual therapy, or mobilization techniques have been shown to speed recovery. In most cases, medications such as nonsteroidal anti-inflammatories (NSAIDs) may be used to treat inflammation or pain. Other treatments may include:
Acupuncture or acupressure techniques.
Exercise that includes muscle strengthening and stretching.
Heat or cold applications.
Injections with anesthetic or anti-inflammatory medications in the area of pain.
Osteopathic manipulation (a system of treatment designed to achieve and maintain health by restoring normal function to the body).
Physical or occupational therapy.
Reduce stress through relaxation and biofeedback techniques.
Reduce workload and increase rest.
Strengthening and conditioning exercises.
Using a splint to immobilize the affected joint and allow healing.
Patients with musculoskeletal disorders, such as fibromyalgia, may be prescribed medications in low doses to increase the body’s level of serotonin and norepinephrine (neurotransmitters that modulate sleep, pain, and immune system function).
Musculoskeletal leg pain that is not the result of a broken bone can be resolved at home, in many cases without medical intervention. Also, painkillers will not improve leg cramps, because the pain begins suddenly. However, stretching and massaging the muscle may help.
If serious causes of cramps have been ruled out, self-help measures can be appropriate. When a leg cramp strikes, try one of these measures to relieve the pain:
Gently stretch the muscle by standing on the cramping leg.
Massage the muscle.
Flex the foot of the cramping leg.
Grab the toes of the cramping leg and gently pull them toward you.
Walk around on your heels until the cramp eases off.
Place an ice bag on the cramp.
Take a warm bath.
To prevent leg muscle cramps:
Always stretch and warm up before and after exercising.
Avoid dehydration by drinking 8 to 12 glasses of water a day.
Regularly stretch and massage the legs.
Neurological Pain Treatment
In many instances, nerve damage cannot be cured entirely. However, various treatments can reduce the symptoms. Because nerve damage is often a progressive condition, it is essential to see a doctor when the symptoms first appear to reduce the likelihood of permanent damage.
Often, the first goal of treatment is to address the underlying condition that’s causing the nerve pain or nerve damage. These include:
Regulating blood sugar levels in diabetic patients.
Correcting any nutritional deficiencies.
Changing medications if drugs are causing nerve damage.
Physical therapy or surgery to address compression or trauma to nerves.
Medications to treat autoimmune conditions.
Additionally, the doctor may prescribe medications aimed at minimizing the nerve pain. These may include:
Certain anti-seizure drugs.
Complementary and alternative approaches may also help alleviate nerve pain and discomfort. These include:
Is It Possible to Prevent Orthopedic Leg Pain?
There are simple things you can do at home to help prevent musculoskeletal leg pain:
Stretch during the day and before bed. Focus on the calf and foot muscles.
Drink plenty of water.
Move around during the day to exercise your feet and legs.
Wear comfortable, supportive shoes.
Sleep under loose covers, especially if you sleep on your back.
And that old advice about eating bananas for leg cramps? It’s true. The potassium helps.
If you have frequent and severe leg cramps, talk to your doctor. You’ll want to make sure there’s not a health problem causing the pain.
Your doctor might prescribe medication; however, drugs don’t always work for leg cramps, and they can cause harmful side effects. The anti-malaria drug quinine, for example, was once used for leg cramps, but doctors and the FDA no longer recommend it because the side effects include severe bleeding.
These simple tips may not only help in relieving neurological leg pain, but can also help prevent more serious problems and protect overall health. Some of these strategies may even trigger the body’s natural painkillers, having the added benefit of making you feel better.
Control diabetes. If you have diabetes, keep blood sugar under control. Normal blood sugar levels are the best possible treatment for diabetic nerve pain.
Exercise regularly. Exercise releases natural painkillers called endorphins. Activity also promotes blood flow to the nerves in the legs and feet. Researchers believe regular exercise may create a long-lasting expansion in blood vessels in the feet, nourishing damaged nerves back to health.
Pamper your feet. Nerve pain usually means impaired sensation, making injuries and infections more likely. Reduce the risk by examining your feet daily, wearing comfortable shoes, and seeing a podiatrist regularly.
Soak it away. A warm bath might be the easiest, and least expensive, home treatment for nerve pain. Warm water temporarily increases blood flow to the legs and can help ease stress as well.
Avoid alcohol. Heavy alcohol use is toxic to nerves and can make nerve pain more intense. There’s no magic number for how many alcoholic beverages you can have and still avoid nerve pain, but some experts advise four drinks or less per week.
A full night’s rest. Nerve pain can worsen at night, disrupting sleep and making it more difficult to cope with pain. Develop good sleep habits. Limit afternoon caffeine intake and have a consistent bedtime that allows for eight hours of sleep.
Novus Spine & Pain Center
Novus Spine & Pain Center in Lakeland, Florida specializes in treating orthopedic leg pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.