Introduction
Leg pain is a term used to mention a wide variety of conditions. Pain happening at any site in the lower limbs is included in it. There can be a lot of causes and conditions that can be related with leg pain. Pain in any part of the leg is a common symptom of trauma or disease. Traumatic causes include sports injuries. Other causes can relate to the blood vessels, nerves, muscles, joints, soft tissues, or bones. Leg pain can often be treated at home, but if pain is sudden, severe, or persistent, or if there are other symptoms, medical attention may be necessary.
The course of treatment depends on the cause of the leg pain.
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 problems. These can occasionally be fatal, and they require medical intervention.
- Many types of pain can be treated at home, but severe or persistent pain can indicate a more serious condition.
Pain occurs when nerves respond to stimuli such as high levels of pressure, high or low temperatures, and chemicals, which can be released by tissue damage.
Injury sustained during a sports game or in an accident is normally acute and traumatic. The person can often identify the cause.
Pain in any part of leg
Nature, severity and duration of the pain depend upon the cause of the pain. It can be sharp/dull, numbing, tingling, burning, radiating/non-radiating, or aching.
It can also be acute, meaning sudden and short term, or it can also be chronic and persistent. Severity can be mild or severe.
Leg pain can mostly be classified as neurological, musculoskeletal, or vascular, or these can overlap.
Musculoskeletal pain: Examples are crepitus, recognized by a popping or cracking sound in the knee, or arthritis, that affects the joints in the hip, knee, or ankle. If a muscle, tendon, or ligament is strained, the pain will be musculoskeletal.
Night cramps, compartment syndrome, and stress fractures are also musculoskeletal problems.
Vascular pain: Causes include peripheral arterial diseas(PAD), Deep vein thrombosis (DVT), Cellulitis, infections, Varicose veins, and varicose eczema, where pain is accompanied by discoloration of the skin.
Neurological pain: Conditions include restless legs syndrome, in which the legs twitch uncontrollably. Neuropathy, nerve damage, and sciatic nerve pain also present with neurological pain in the leg. Neurological pain can be present even when resting.
Pathophysiology
The pathophysiology solely depends upon the cause of leg pain.
Some sports injuries build up over time, such as repetitive strain injuries and stress fractures. Traumatic injuries can also become long-term and worse if the individual if not properly treated.
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Different causes of leg pain can have similar symptoms, too.
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 goes into spasm.Cramps are more common at night and in older people.
Peripheral Arterial Disease
PAD can cause pain in the leg due to poor circulation. Without treatment, it can be fatal. The main symptom is intermittent claudication.
Intermittent claudication causes the blood supply to the leg muscles restricted. The resulting lack of oxygen and nutrients causes pain.
Claudication involves:
- a cramp-like muscle pain during exercise or exertion
- pain in the buttocks, thighs, calves, and feet
- pain when walking or climbing stairs
The cramps recur after the same walking distances, and they often ease on resting.
DVT
DVT causes one type of leg pain and can become a blood clot on the lung if not quickly treated.
DVT refers to a blood clot in the deep veins of the leg. It can emerge after spending a long time sitting down, for example, on a long-distance flight.
Symptoms include swelling and a hot, painful sensation on one side of the leg. This 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, it is a medical emergency. These could be signs that DVT has developed into a pulmonary embolism, or a blood clot in the lung.
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.
Shin splints
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, localised tenderness in the muscles, and sometimes bone pain commonly felt around the shin bone.
The shin pain cannot be explained by an obvious cause such as a fracture.
Fractures and stress fractures
Heavy pressure on the bone like a blow can lead to fractures. Some fractures are easily and immediately 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 the intensity of activity increases too quickly. There is no single injury, and the fractures are small. The pain can start at an earlier stage during each exercise session, and eventually become present all the time.
Popliteus tendinitis
This produces knee pain during downhill running. It is caused by inflammation of the popliteus tendon in the knee joint.
Hamstring strain
Acute trauma can lead to sprains and strains. A sprain refers to a stretching or tearing. A strain is an injury to the muscles or tendons.
Often associated with running, a hamstring strain can lead to acute pain in the rear of the thigh muscle, usually due to a partial tear.
Sprains and strains usually develop because of inadequate flexibility training, overstretching, or not warming up before an activity. Enough rest is essential for a complete recovery.
Compartment syndrome
When an injury to the leg results in swelling, dangerous levels of pressure in the muscles can lead to acute or chronic compartment syndrome.
This could be due to a fracture or severe bruising.
The swelling causes pressure to build up until the blood supply to muscle tissue is cut off, depleting the muscles of oxygen and nourishment. The pain may be unexpectedly severe, considering the injury.
In severe cases, early pain may be followed by numbness and paralysis. Permanent muscle damage can result.
Sciatic nerve pain
Sciatica happens when pressure is put 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 compressed by a herniated disc
Long-term effects include strain on other parts of the body as the gait changes to compensate for the pain.
Ovarian cancer
Ovarian cancer can lead to pain and swelling in the legs.
Diagnosis
Physical examination
X ray
CT scan
MRI scan
Many cases of leg pain can be resolved at home, without medical intervention.
Self-help for muscle cramps
Cramps, or Charley horses, can be alleviated by stretching and massaging the leg.
If serious causes of cramps have been ruled out, self-help measures will be enough.
Painkillers will not improve leg cramps, because they start suddenly, but stretching and massaging the muscle may help.
To relieve the pain when cramps occur:
- Hold the toe and pull it up towards the body, while straightening the leg.
- Walk around on heels until the cramp eases off.
To prevent 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.
Sports injury treatment
Minor sports injuries, such as leg sprains and strains can be treated with RICE:
- Rest: to prevent further injury and allows healing time to reduce swelling.
- Ice: to reduces swelling, inflammation, and pain. Applied for up 20 minutes wrapped in a cloth, not directly on the skin.
- Compression: use an elastic bandage, firmly but not tightly wrapped, to reduce swelling and pain.
- Elevation: lift the leg above the level of the heart so that gravity assists with draining, to reduce swelling and pain.
Drugs such as acetaminophen or NSAID’s can help with some pain, but if pain persists for more than 72 hours, specialist medical advice is needed.
A return to activity should be graduated in its intensity, to build up flexibility, strength, and endurance safely.
Circulatory problems
Medical attention is needed for claudication and other symptoms of vascular disease, because of the risks possible like a heart attack or stroke.
To reduce cardiovascular risk factors, people are advised to:
- avoid or quit smoking
- do moderate exercise, as recommended by a doctor
- manage levels of blood sugar levels, cholesterol, and lipids
- control blood pressure within normal limits
- adhere to antiplatelet therapy to reduce blood clots, if indicated
- Exercise and a healthful diet are beneficial. Those who have a treatment plan for a cardiovascular or other condition should follow it carefully.
Prognosis
Prognosis depends upon the cause of leg pain. In simple cases like dehydration the prognosis is good when the person is hydrated well. But in neurological and other complicated pains, treatment is needed and the prognosis varies vividly depending upon the age of the patient, severity of the disease etc.
Complications
The complications of leg pain depend on the underlying disease, disorder and condition. Mild leg pain due to overuse usually responds to rest, ice, and over-the-counter anti-inflammatory medications. However, untreated leg pain due to serious conditions, such as deep vein thrombosis (blood clot) or peripheral artery disease, can lead to permanent damage and life-threatening secondary complications.
Some of the more serious complications of leg pain due to deep vein thrombosis, peripheral artery disease, and spinal stenosis include:
- Loss of limb (amputation)
- Permanent nerve damage
- Pulmonary embolism (blood clot in the lung)
- Stroke
Disease & Ayurveda
Paadaruka
Nidana
Dhaatukshaya(degeneration)
Aavarana (obstruction to channels in the body)
Purvaaroopa
Not mentioned
Samprapti
Due to the causative factors Vaata gets vitiated and gets lodged in the muscles, bones, joints and adipose tissue in the leg causing the pain.
Lakshana
Paadaruk – Pain in the leg
Divisions
Not mentioned
Prognosis
Saadhya when the disease is new
Krichrasadhya when the disease is chronic
Chikithsa
Samana
Lepana with soolaharadravyas
Parisheka with warm soolaha-sothahara dravyas
Upanaha with Vaataharadravyas
Sodhana
Sneha (Anhyanga)
Sweda (Potalisweda)
Vasti
Virechana
Raktamokshana
Daahakarma
Commonly used medicines
Sahacharadi kashayam
Rasnerandadi kashayam
Kaisoraguggulu
Guggulutiktakaghrutam
Brands available
AVS Kottakal
AVP Coimbatore
SNA Oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Rest
Warm compresses or hot water packs
Ice packs
Stretching exercises
Massaging
Pain killers (Over the counter medicines)
Diet
- To be avoided
Drink enough liquids. Ensure enough hydration.
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha and cause obstruction in channels
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from very hot & cold climates.
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid climbing of stairs.
Yoga
Vigorous exercises are not allowed in painful conditions.
Only stretching, moderate walking, and mild cardio exercises are advised. Also, specific yogacharya including bhujangaasana, salabhasana, vajrasana is recommended. Caution must be there to consider the range of movement and flexibility.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Salabhasana
vajrasana
Bhujangasana
exercises for leg pain
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.sciencedirect.com/topics/medicine-and-dentistry/lower-limb-pain
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