Leg Pain may be defined as the continuous involuntary, localized, painful muscle contraction and pain in a group of muscles, individual single muscle, and muscle fiber in one leg or both sides of the leg. The pain may be continuous, sudden, throbbing pain, and a few minutes or prolong pain with paresthesia, itching, numbness. The causes are wide varieties of disorders for leg pain such as acute or chronic pain due to nerve root compression, radiating pain, trauma, degenerative pain, muscle spasm due to stroke or road traffic injury in the leg, congenital leg abnormalities. The leg pain may be classified by radicular pain due to spinal nerve root compression, referred back pain either acute or chronic pain that is spread from the back and buttock, ligament joint or spinal disc problem, PLId injury[rx].
Causes of Leg Pain
Cause of the leg pain is described bellow
Lumbosacral disc injuries
Lumbosacral discogenic pain syndrome
Lumbosacral facet syndrome
- Lumbosacral segmental injury
- Somatic dysfunction with mobility deficits
- Spinal instabilities with movement coordination impairments
- A flatback syndrome that is caused by ankylosing spondylitis,
- Lumbago due to displacement of disc spinal disc
- Acute and chronic low back pain associate with (referred) lower extremity pain
- Low back pain associate with strain and strain
Lumbosacral spine sprain
Sacroiliac joint injury and dysfunction
Inferior gluteal artery aneurysm or pseudoaneurysm
Malignancy and tumors
Sciatic nerve injury is the most common
Bleeding with related chronic cognitive problem
- Chronic LBP with associate with generalized pain
- Additional axis-Yes-acute pain, subacute and chronic pain.
- LBP referred to pain aggravated by flexion, slow-onset lasting weeks
- Low back pain referred to pain increase by extension, sudden onset lasts 1–2 weeks
- Leg associated pain due to nerve root compression, and it may increase by flexion, slow onset, lasts weeks
- Abnormal pain behavior, the chronic pattern associated work/sleep/psycho/social issues
Symptoms of Leg Pain
At the early stage of leg pain, the following symptoms may be found in one side with both sides and left side or right leg pain
- Acute and chronic pain in the backside of lag
- Muscle cramping pain during prolonged walking
- Pain may be decreased during the time of rest
- Tingling sensation, itching in the lower leg
- Pain may be aggravated during the night
Numbness or paralysis in one or both legs
Impaired function of the bladder or bowel
- Pain with muscular degeneration may be present
- Spasticity may be formed in both or one side of the leg
Unbearable pain despite treatment
Severe symptoms remain intake for many weeks despite treatment being continued
The tumor is another condition that may cause the leg pain
- The pain sometimes radiates or spreads down to one or both legs.
- Low back pain that is radiating down to below your knee or into the afoot and is called sciatica.
Diagnosis of Leg Pain
Your doctor may advise you to investigate the following test and diagnosis for leg pain in one side or both side leg pain
- History – The most common symptoms of pain, swelling, a tenderness that is diffuse in the whole leg. The character of pain may differ for men and women due to osteoarthritis and the joint swelling is worse with joints and is relieved by rest tell your doctor. Your doctor may ask about the feeling of pain and often associated with, paresthesia, and worse in the morning, and gets better as the day goes on. One side or both side joints pain is also the most common in the leg pain. Synovial hypertrophy and muscle wasting may occur for women in special reason that includes patient history.
- Redness and warmth – Most of the leg pain feel warm during tests or keep tenderness with swelling in a non-traumatic leg pain also suggest inflammation or inflammatory arthritis and infectious septic arthritis. Patients may also complain of the presence of limitations in range of motion in the knee or ankle and can even feel weakness and worm, tenderness, and numbness.
- Inspection – Deformities in both legs are the two most important findings associated with leg pain. Swelling and tenderness, numbness, are important to identify between a joint effusion in the knee, swelling from tenosynovitis, or a localized abnormal mass formation that may be found during ankle movement. Chronic inflammation in diseases like rheumatoid arthritis, osteoarthritis can cause deformities for leg pain and ankle pain
- Palpation – Palpation is the manual test that helps in identifying the specific affected area by the underlying pathological condition. You also feel the pain and muscle spasms with spasticity in the lower or upper knee joints. Dorsal instability is a common sign of joint swelling and effusion. The instability can be also tested by looking for transmission of pressure from one hand placed at one side of the joint to the second hand placed on the opposite side.
- Range of Motion – The doctor or clinicians must test the active range of motion first for rheumatoid arthritis, tendinitis, tenosynovitis, and ligament injury or instability in knee joints. They should be seen if there is any limitation to look for any important impairment. The range of motion tested at the knee is flexion, extension, rotation.
- Special tests – It is called the manual test that is in excluding causes of knee joint rheumatoid arthritis and other than arthritis in a patient with leg pain in one side or both side with the associate condition.
- Muscle jark test – It is a manual test for right and left side leg pain. In here your doctor may use a hammer to test reflex in tendons or muscle. The test indicates the muscle and nerve with tendon pain positive or not.
- Laboratory tests – Leukocytosis is one of the most important tests for leg pain right side or left side osteoarthritis and rheumatoid arthritis that supports the possibility of infection and bone-related disease. Blood cultures, urine examination, or other possible primary sites of bone infection that obligatory when a septic infectious in the knee joint with right side or left side leg pain is being considered for examination. The and elevated inflammatory condition markers like ESR or CRP include suggesting an infectious or inflammatory disease condition of the left side or right side legs pain.
- Electrolyte Test – It an important test to investigate the electrolyte means the micronutrient, sodium, potassium, magnesium, zinc, iron, folic acid, vitamin B complex are available in the body or not. It may decrease in over sweating, not drink enough water, bad food habits, low carb in your daily meal plan and may cause muscle cramps in right side or left side leg pain.
- Rheumatoid factor and anti-CCP – cyclic citrullinated peptide antibodies test should be increased if there is clinical abnormality for osteoarthritis and rheumatoid arthritis, and radiating pain in the left side or right side leg pain is found.
- A serum uric acid level – It is often considered by clinicians and doctors when gout, pseudogout is suspected, but it is not a reliable and dangerous condition as it may be spuriously elevated or high in acute inflammatory conditions or if the true gout attack or not.
- Radiographs of the joint – Conventional x-ray and radiography is the most widely used imaging modality and allows for the detection of bone fractures, osteoporosis, and abnormal pathologies condition like fracture, osteoporosis, erosions, osteonecrosis, osteoarthritis, or a juxta-articular bone tumor, neoplasm. Characteristic features of in leg pain in one side or both side leg pain include marginal osteophytes formation, joint space gradually narrowing, muscle spasms, wasting subchondral sclerosis formation, and cysts.
- CT Scan – High contrast ct scan is more effective to diagnose leg pain in the right side or left side with rheumatoid arthritis. Ti also helps to detect the abnormal tendon, ligament, cartilage, muscle and osteophyte, synovial fluid. It also helps to identify the bone tumor, necrosis, abnormal joint condition, etc.
- MRI – It is called magnetic radical or resonance imaging is also helpful to find the bone conditions, abnormal tendon, ligament, cartilage, muscle problem and osteophyte, synovial fluid in joints, nerve entrapment. It also helps to identify the bone tumor, necrosis, abnormal joint condition, etc. It is the final stage test to confirm that all joint abnormality.
- Bone scintigraphy – It is the most important test to diagnose bone cancer, neoplasm, fractures, necrosis of bone, and joints. It also helps to identify the tendon, sprained ligament, cartilage, muscle spasm.
- Muscle Biopsy – Muscle biopsy is basically done to investigate abnormal congenital problems such as dutchmen muscular dystrophy, myasthenia graves, hemophilia, etc. A small part of the cell or tissue is collected from the leg and send to investigate other abnormalities.
- Nerve Conduction velocity test – It a special test for leg pain on both sides or right and left side leg. It is the procedure where test the sensation of the peripheral nerve stimuli to send the central nervous system means brain. It helps to identify the nervous system problem from the central to the peripheral cell.
Treatment of Ankle Arthritis
Non-pharmacologic treatments of leg pain
- PRICE – Meaning
- Protection – In ankle osteoarthritis or rheumatoid arthritis and acute or chronic injury with leg right and left side legs pain. Protection means the save the legs from further injury and dislocation, sprain, strain. It can be done by the tapping process or adhesive bandage.
- Rest – After an injury from the lag are keep in rest for some time today to prevent injury and accelerate the healing. It is an excellent manual process to protect ankle joints.
- Ice – The application after acute injury is helpful for the healing process of ankle joints, and leg. It basically constricted the peripheral blood vessel that helps to prevent edema, swelling, or accumulated water. It can be used alternatively by ice and heat therapy at the same time.
- Compression – It is the most important manual technique to protect the swelling, effusion and keep the tendon, ligament, cartilage from injury, and keep intake and regenerate the joint cartilage.
- Elevation – Elevation is the process to prevent swelling, edema, and fluid accumulation in the right side and left side leg pain. Your doctor may advise you to elevate the legs at the same position of the heart horizontally. The leg must be elevated just a small high comparing to the heart position in sleeping times.
- Physiotherapy – It is one of the most common and effective non-pharmacological treatments in the world. It has a variety of treatment module to erase acute and chronic pain. It is especially helpful in muscle spasticity, spasms related to hand and shoulder or backs pain. Inflammatory and noninflammatory pain is treated by ultrasound, MRI, Shortwave, microwave, wax therapy, IRR, laser therapy, interferential current therapy.
- Exercise – Different types of exercise may be done under the supervision of a physiotherapist or healthcare provider. It falls into the active range of motion, tapping, isometric movement, active range of movement, or passive range of motion, active-assisted exercise or passive assistants exercise.
- Stretching – It is one of the most helpful treatments to reduce muscle pain, spasm, spasticity, leg muscle cramping, and leg pain in the right side or left side that is gradually increasing due to old age and not perform daily workouts or activities.
- Bracing – It is one of the most important self-help devices that is used in a leg fracture, rheumatoid arthritis, osteoarthritis and, maintaining proper joint position, reducing swelling, improve posture and maintain the range of motion exercise.
- Acupuncture – It is the China-oriented acute and chronic treatment system where are needle is used to stimulate the pain receptor to reduce pain. It is also helpful in some spasticity formation pain, stroke, hemiplegia, and chronic rheumatoid arthritis pain in leg pain in one side leg pain or both side leg pain.
- Diet – Diet may be normal or according to the doctor mentions food you can take for you, such as papaya, banana, potato, nuts, lemon, citrus fruits, cereal, seasonal fruits, and drink of water. In your daily routine meal must have plenty amount of magnesium, calcium, iron, zinc, folate, vitamin B complex, Vitamin A, Vitamin C, and vitamin D, etc.
- NSAIDs – It is considered to be the fast-acting nonsteroidal anti-inflammatory drugs (NSAIDs) as including acetylsalicylate, naproxen, ibuprofen, indomethacin, and etodolac, ketorolac in pain is acute. Aspirin is also an effective anti-inflammatory for ankle osteoarthritis, rheumatoid arthritis, leg pain when used at high doses, due to the decrease or inhibition of prostaglandin synthesis. It is also called one of the oldest NSAIDs used for multiple joint pain. NSAIDs work by inhibiting cyclo-oxygenase to prevent the synthesis of prostaglandins, prostacyclin, and thromboxanes. It has also some side effects of aspirin at high doses when used are including tinnitus, hearing loss, and gastric intolerance.
- Muscle relaxant – It is important for patients with chronic muscle spasms, wasting, and muscle cramping releasing drugs. The drugs are tolperisone HCL, eperisone, baclofen, dantrolene, etc. The drug increases the blood supply with oxygen and nutrition to the affected joint.
- Nerve relaxant – It is basically used to reduce neuropathic pain, inflammation, nerve root entrapment, myalgia, neuralgia, and fibromyalgia. Your doctor may prescribe gabapentin, pregabalin, vitamin B1, B6, B12, etc. Major side effects are abdominal pain, nausea- vomiting.
- Calcium & vitamin D3 – It basically takes to improve bone health and healing fractures or any kinds of pain, and osteoporosis, osteonecrosis. Your doctor may prescribe to take calcium and vitamin D3 supplementation to prevent bone erosion, thinning of the bone, and muscle pain. In scientific study show that normal men and women needed calcium 1200miligram and vitamin D3 500 milligrams in a day.
- Vitamin B1, B6, and B12 – It is essential for neuropathic pain management, pernicious anemia, with vitamin b complex deficiency pain, paresthesia, numbness, itching with diabetic neuropathy pain, myalgia, etc. A side effect may be nausea- vomiting, abdominal pain, cramping
- Corticosteroid injections – Corticosteroids to healing the nerve inflammation and clotted blood in the joints that are accumulated in the joint. The injections may provide temporary pain relief anywhere from days to several months. With repeated injections, several times the patient may experience a more permanent improvement in their symptoms.[rx] The steroid injections are typically used in severe conditions when normal treatment can not respond.[rx] Common side effects muscle cramping, increase metabolism, dry mouth, vertigo, blurred vision.
- Dietary supplement – Especially seasonal fruit vitamin B complex, vitamin b12, omega-3 fatty acid, antioxidants, spirulina, cord liver oil, avocado, soybean unsaturated fat, fish oil etc to remove general weakness & improved health by reducing pain.
- Injections – For patients with severe pain, especially leg pain, steroid injections may be a reasonable treatment option to reduce chronic ankle and leg pain. The injections are effective in helping to reduce pain and increase a patient’s functional mobility and increase the range of motion. If a steroid injection does work to relieve the patient’s pain, it can be done up to three times per year. Injections your doctor injects triamcinolone into the affected joint and tendon to give you temporary relief from the pain and inflammation.