Leg Pain (cont.)
What Causes Leg Pain?
Trauma is the most obvious cause of leg pain. Falls, near falls, and twisting injuries can damage bones, muscles, and joints of the leg or a combination of all three. Back pain, due to injury, can inflame the sciatic nerve and cause sciatica. This is a pain that radiates down the leg that follows the path of one of the many nerve roots that leave the spinal cord and make up the sciatic nerve. Sciatic pain usually begins in the back and radiates to the buttock and into the thigh.
Overuse injuries may cause pain and can be thought of as multiple minor traumatic injuries to muscles, tendons, and joints that occur over a longer time span.
- Fractures: When referring to a bone, the terms fracture, broken, and cracked all mean the same thing: The integrity of the bone has been compromised. The most common symptom is pain that occurs because the nerve endings located in the fibrous tissue lining of the bone, called the periosteum (peri=surrounding +osteum=bone), have become damaged and inflamed. As well, the muscles surrounding the bone go into spasm and intensify the pain.
- Stress fractures: Some fractures occur because of repetitive small traumas to a specific area of the body. March fractures describe a fracture of one or more of the metatarsal bones in the foot (the long bones at the base of the toes) that are caused by overuse that fatigues the bone. The name comes from the fact that they are found in soldiers who are forced to march long distances as part of their training.
- Shin splints are an overuse injury to the tibia or shinbone. This condition is also known as tibial stress syndrome. Running, jumping, and dancing are the most common causes. Microscopic fractures occur in the tibia, causing pain and swelling. If the person continues to exercise and disregards the pain, a shin splint can progress to completely break the bone.
- Sprains and strains: A ligament injury is called a sprain and occurs when the ligament fibers are stretched, or partially or completely torn. Muscles and tendons can also be stretched or torn, causing a strain. Both sprains and strains result in swelling and inflammation that causes pain. Sometimes a sprain or strain can occur at the location where the structures attach to bone, and a small fleck of bone can be pulled off at the insertion of the muscle, tendon, or ligament. This is called an avulsion fracture but often is treated in the same manner as a strain.
- Bursitis: There are small, fluid-filled sacs that cover large bony prominences and allow tendons to slide across the bone. Bursitis, or inflammation of the bursa sac, may occur with overuse or injury, like a direct blow. Two bursas in the leg that may commonly become inflamed are the trochanteric bursa that covers the bony prominence of the femur on the outside of the hip and the ischial bursa that covers part of the pelvic bone where we sit.
- Bleeding: Injuries can also cause bleeding into tissues and joints. Since blood, like any fluid, cannot be compressed, the swelling causes a significant amount of pain as the pressure increases. Blood is also very irritating to the surrounding tissues when it leaves blood vessels and causes pain by its presence alone.
- Compartment syndrome is a medical emergency. It describes the situation in which excessive swelling occurs within the sections or compartments of the leg that contain muscles. This may cause increased pressure within the compartment that is greater than the blood pressure generated when the heart beats. Blood supply is cut off within the compartment, causing pain, numbness, and an inability to move the foot or ankle. This is a true surgical emergency, requiring opening of the compartments and relieving the pressure within to restore blood supply and prevent permanent disability. One of the hallmarks of the diagnosis is the finding of pain out of proportion to physical findings. The diagnosis is confirmed by measuring pressures within the compartment.
Picture of the muscle and nerve anatomy of the leg
Medically Reviewed by a Doctor on 9/11/2017
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