What is causing my leg pain?

Leg pain is a common complaint that we see as Chiropractors. There are lots of different causes for this, some easier to identify than others. But did you know that the pain can originate and refer from lots of different areas of the body. This is where it can get a little more confusing… So let me shed some light on this common, but often puzzling symptom.

Local Pain

Yes, let’s start with the glaringly obvious. Leg pain can indeed come from the leg. This can be foot, ankle, calf, knee, hip or thigh pain. It can originate from your joints, ligaments, muscles, tendons or bones, among other causes. It can be caused by repetitive strain, overuse, wear and tear, trauma, change in activity or lifestyle, biomechanics and many other things.

Treatment for this type of complaint will vary. It will depend on the extent of the injury, what tissues are involved and what is causing it. But overall, treatment will likely involve identifying what is hurting, why it is hurting, making temporary or long term adaptations to allow for healing and prevent re-injury, treating the injury itself AND that pesky underlying cause.

Referred Pain

Sometimes, however, the pain does not come directly from the area you feel it. So, for example, you may feel pain in the leg when there is no injury or abnormality in the leg itself. This can be caused by referred pain. Referred pain can have a number of causes. This can include nerve irritation or compression (which I will cover later). It can also be due to convergence of different nerves at various points throughout their path.

Pain occurs when a signal is sent from a nerve in a certain body part, to the brain, and the brain then creates a pain signal. Nerves follow a very complex path up through the spinal cord and into the brain where they are registered in different areas. Their path includes lots of crossing over, merging, separating and synapsing. So, when nerves eventually reach the brain, they may not consist of exactly the same nerve fibres that they started with and the exact body part which that nerve represents can be ambiguous. When the brain then creates a pain sensation, it may not know exactly where the “problem” is, and the pain can be felt in areas not specific to the injury or abnormality itself.

There are a few body parts which can commonly cause referred pain in the leg.

The Sacroiliac Joint

Also known as your pelvic joint or the joint between your sacrum (at the bottom of the spine) and your ilia (pelvis bones), the sacroiliac joint can cause referred pain down the back of the leg, usually only down to the knee level. This can be caused by a sprain injury to the joint, hypermobility or stiffness.

Treating this will involve rest and rehabilitation if it is a new injury, to avoid further aggravation. Mobilising the joint if it is restricted, treating the muscles around the joint and usually strengthening those muscles to help keep the pelvis strong and happy.

The Hip Joint

Another possible cause of referred pain to the leg is your hip joint. There are lots of injuries which can occur within the hip joint. Such as a fracture, labral (cartilage) tear and ligament or joint capsule injury. There may be longer standing abnormalities within the hip joint such as dysplasia or femoroacetabular impingement (these are both types of abnormality in the shape of the joint itself), hypermobility or wear and tear.

Other hip-related abnormalities which can refer into the leg, some more commonly than others, include tendon injuries, the iliotibial band (ITB) and bursitis. This is definitely not a conclusive list so I hope you are beginning to see how broad and extensive this topic really is!

Muscular Referral

Another type of referred pain can be muscular, often due to trigger point referral. A trigger point is a local area of overly-contracted muscle which can be painful and tender. Trigger points often have unique referral patterns all over the body. A common area to cause pain referring to the leg is your glute muscles. So, having tightness or trigger points in your glutes can also cause leg pain.

To help with this, there are lots of soft tissue techniques which can effectively release contracted muscles and trigger points. However, muscles do not tighten for no reason. It may be because the muscle is weak and needs more strength. There may be restriction or hypermobility in the joints which that muscle works with. There may be a factor in your lifestyle which is repetitively irritating that muscle, or there may be a compensatory pattern which is causing that muscle to be overused. For this reason, treatment is rarely as straightforward as using only soft tissue techniques. It can be helpful to look at the whole body and picture.

Neurological Referral

The other type of referred pain, as mentioned earlier, is neurological pain. This is when you feel pain, or quite often tingling or numbness along the course of a nerve due to a compression or irritation of that nerve higher up in its course. Most nerves travel from the brain, down the spinal cord. They leave the spinal cord at their specific level and then travel out to their assigned body part. However, they have to navigate through narrow channels, muscles, wrap around bones, pass under tendons… So you can see how many areas there are for these sensitive structures to potentially run into some bother.

Luckily our nerves can withstand plenty of normal movement and stretching within the body. However, occasionally they can become compressed due to tightening of muscles or narrowing of the channels that they pass through. This can cause referred pain elsewhere along the course of the nerve, depending on where it is heading.

Some common areas which can cause nerve pain in the leg include:

The Lower Back

The nerves that exit your spine in the lower back will travel down to the legs. As they exit the spine, they travel through a passage which is a common area for compression or irritation. This can occur due to a disc herniation, age-related changes in the spine or other space occupying abnormality.

But it is important to note that nerve irritation at any point is not always caused by physical compression. It can be caused by chemical irritation due to inflammation nearby. This will cause the nerve to be affected by the inflammatory chemicals in the area and cause similar irritation as if the nerve were compressed. Inflammation nearby can be caused by abnormalities in the little joints in your spine, discs and any other injury to the spine. Inflammation can also be amplified by physiological or psychological stress. If you are highly stressed in your life or other factors such as your diet or sleep are below par, then you can cause the same chemical irritation, causing the same symptoms.

As you can imagine, treatment for this type of pain will vary widely. It will likely include appropriate manual treatment, such as soft tissue techniques, mobilisations and spinal manipulation. Then it is really important to address any lifestyle factors or muscular weaknesses which may be contributing. This is to allow for the best chance of long-term resolution.

The Glutes and Piriformis

Sometimes known as piriformis syndrome or deep gluteal syndrome, this is when the sciatic nerve becomes compressed within the buttock region as it passes through or past the piriformis muscle. And much like trigger point referral, this is often treated by addressing the cause of the tightness in the muscle.

If you are feeling a little overwhelmed, or maybe even less sure about what may be causing your leg pain, you are not alone. It is an interesting but expansive topic with lots of potential causes. So, if you are experiencing leg pain and would like some help identifying what is causing it and how best to help it, book in to see your Chiropractor.

At the clinic we are able to do a full assessment, give you a thorough explanation and closely guide you through the best way to help your pain and have you functioning as well as possible!