Leg pain can be caused by poor circulation, sciatic pain, excess exercise or neuropathy. To identify what is causing the pain, the exact location and the characteristics of the pain should be assessed, as well as whether both legs or just one is affected and whether pain improves or worsens with rest.
Normally, leg pain that does not improve with rest can indicate a circulation problem, like peripheral vascular disease. Leg pain that appears upon waking can be a sign of nocturnal leg cramps or of poor circulation. Leg pain that occurs with back pain can be a symptom of spinal problems or compression of the sciatic nerve.
In order to identify the origin of the leg pain, the doctor will likely examine the spinal curvatures and vertebrae. He or she may perform sensitivity testing to evaluate pain, and they may also palpate the abdomen to assess for any concurrent abdominal or pelvic discomfort. Testing that may be ordered includes bloodwork, spinal fluid testing, and imaging (like x-ray or MRI). Based on the results, a diagnosis can be reached and the appropriate treatment initiated.
What causes leg pain?
Some of the pain causes of leg pain include:
1. Muscle or tendon abnormalities
Leg pain that is bone or muscle-related does not follow normal nerve patterns and will generally worsen with movement of the legs. Some abnormalities that can cause pain include myositis, tenosynovitis, a calf abscess or fibromyalgia.
Muscle pain can occur following repetitive physical activity, like after an intense exercise session or after using an uncomfortable shoe. In these cases, pain will generally emerge at the end of the day and many times it is felt as a “leg fatigue.” Another common cause of muscle-related leg pain are cramps that normally happen at night. These can also frequently occur during pregnancy.
Pain in the calf can also be a sign of compartment syndrome, which can lead to intense pain and swelling. Symptoms will emerge 5 to 10 minutes after physical activity and the affected area will remain sore for long periods of time. Pain in the shins can be a result of tendonitis of the anterior tibial tendon, which occurs frequently in athletes and in those who work out intensely (likely long distance runners).
What to do: Take a warm bath and lay down with your legs elevated. This will help to improve blood circulation, which can reduce fatigue. Rest is also very important, but total bed rest is not necessary. You should, instead, avoid intense exercise or heavy physical activity. If tendonitis is confirmed, you can use ice and topical anti-inflammatory ointments to help cure the inflammation more quickly.
2. Joint problems
Leg pain can be related to orthopedic problems like arthritis or osteoarthritis, particularly in older adults. Other symptoms are also present with joint problems, and they can include joint pain and morning stiffness (especially in the first 15 minutes after waking). The pain might not be present every day, but it tends to worsen with physical activity and resolves with rest.
Knee deformity and be a sign of osteoarthritis, while a reddened appearance around the joints is usually a sign of arthritis. Knee pain can also occur, however, after a fall, or with hip injuries or leg length discrepancy.
What to do: Apply a warm compress on the affected joint (e.g. the knee or ankle) for about 15 minutes. You are also advised to consult a doctor or orthopedic surgeon for assessment, as you may benefit from taking anti-inflammatories or engaging in physiotherapy.
3. Vertebral spine abnormalities
When leg pain worsens with spinal movement, it may be a sign of vertebral injury. Stenosis of the vertebral canal can cause a moderate to intense sensation of weight or cramping in the lower back, glutes, thighs or legs while walking. In this case, pain will only resolve when sitting or leaning your torso forward. You may also experience some numbing.
Spondylolisthesis is another possible cause of back pain that radiates to the legs. The pain feels like a heavy weight in the lumbar spine, worsens with walking and improves with rest. A herniated disc may also cause back pain that radiates to the legs. It is associated with a sharp, intense pain that can radiate to the glutes, the back or sides of the legs, to the ankles or to the bottom of the foot.
What to do: Place a warm compress on the area affected with pain to relieve symptoms. Your doctor may advise use of anti-inflammatories and physiotherapy.
4. Sciatic pain
When legs pain is provoked by sciatic nerve abnormalities, pain may be felt in the lower back, glutes and the back of the thigh. You may also experience tingling or leg weakness. Pain may be piercing or sharp, or even electric and sudden, appearing in the lower back and radiating to the lower extremities.
What to do: Place a warm compress in the area affected by pain, and let it sit for about 20 minutes. You should also avoid physical activity or picking up heavy objects. Physiotherapy may also be indicated, in which the physiotherapist may prescribe specific sciatica stretches to help relieve discomfort.
5. Poor blood circulation
Leg pain caused by poor circulation mainly affects older adults. It can occur at any time of the day, but it worsens after prolonged periods in the same position, like sitting or standing for too long. The feet and ankles can also become swollen and purple, which indicates difficulty with blood return to the heart.
A more serious complication is the occurrence of a thrombosis, which occurs when a small blood clot cuts off circulation. In this case, pain is localized to where the clot is (which is most frequently in the calf). There will also be difficulty with foot movement. A thrombosis can occur following surgery or when birth control is used without medical guidance.
What to do: Lying down on your back with your legs elevated for 30 minutes can help, but the doctor may prescribe medications to improve circulation, and may also recommend the use of compression stockings. If you suspect you have a thrombosis, you should proceed immediately to the hospital.
6. Growing pain
Leg pain in children or adolescents can be a result of rapid bone growth, which can occur between the ages of 3 and 10. This is not a serious finding. The pain is usually most felt around the knee, but it can affect the entire leg all the way down to the ankle. Children will more often report pain at night, before going to sleep, or after engaging in heavier physical activity.
What to do: You can place ice cubes in a sock or bag and apply directly to the painful area for 10 to 15 minutes. Caregivers can also massage the affected area with a moisturizing cream or almond oil and encourage the child to rest. There is no need to stop physical activity completely - children should only decrease the intensity of activity or frequency.
7. Leg pain during pregnancy
Leg pain during pregnancy is a very common and normal symptoms. It most commonly occurs at the beginning of pregnancy due to the increased production of estrogen and progesterone, which cause dilation of the leg veins and increase blood volume in the legs. The growth of the baby in utero, as well as the increasing weight of the woman, can also lead to compression of the sciatic nerve and of the inferior vena cava, which can lead to swelling in the legs.
What to do: To relieve this discomfort, you can lie on your back with your knees bent to stretch the spine, and rest with your legs elevated.
8. Lipedema
Lipedema is characterized by the excessive accumulation of fat, which can occur in the legs. Is associated with symptoms like swelling, mild to severe leg pain, leg heaviness or pain in the feet or joints.
Excessive fat accumulation in the legs can be caused by genetic factors, hormonal changes or obesity, for example.
What to do: Treatment should be directed by a vascular surgeon and is aimed at relieving symptoms and improving quality of life. Lymphatic drainage, physiotherapy, wearing compression stockings, physical activity or an anti-inflammatory diet may be recommended.
In more serious cases or when other treatments are not effective, the doctor may recommend liposuction to remove fat and improve mobility or even bariatric surgery in cases of obesity with a BMI above 35 kg/m².
Be sure to check out the most common causes of calf pain and how to treat it.
When to go to the doctor
You are advised to see your doctor when your leg pain becomes very intense, or if you have other symptoms like:
- Leg pain that is localized to one spot and very intense
- Calf stiffness
- Fever
- Very swollen feet or ankles
- Upon suspicion of a fracture
- When you are unable to work
- When you are unable to walk
You should report the intensity of pain you are experiencing, when it started, and what you have done to try to relieve it. The doctor may order exams to help guide the appropriate treatment, which may include physiotherapy or the use of medication.