Causes for leg pain

The characteristics of the pain and the response to medication are useful elements for the doctor to identify the cause of the discomfort in the legs.

How many times do we go to the family doctor or a specialist for a painful disorder – an intermittent twinge, a sharp or deep and continuous pain, a feeling of discomfort – that shows no sign of passing, appeared suddenly and without a defined cause, such as a blow, pregnancy, tiredness due to excessive fatigue, the resumption of the gym and fitness after the holidays, A day of intense skiing or a period of over-work in which you have been for hours in an incorrect posture?

And how can the expert identify any in-depth examinations and the correct treatment, to face – as soon as possible and effectively – our problem?

«There are already known characteristics of the patient that help the attending physician: sex, age, previous diseases, weight, family history, profession, drugs already taken, tests prescribed in the past and so on“, says Giorgio Serino, internist and immunorheumatologist at the IRCCS Policlinico San Donato and the Casa di Cura La Madonnina. “Information that is instead collected by a specialist with the medical history and a cognitive dialogue during the first visit.”

The characteristics of leg pains

In the case of leg pain, the problem just described arises already when we have to locate the discomfort: in fact, when in common language we speak of “leg” wanting to allude to what human anatomy designates as “lower limb”, in fact we indicate the anatomical district between the knee and the ankle.

In order to identify the cause of the pain and therefore the most appropriate medical care for its treatment, it is necessary to undergo thorough investigations, conducted through visits, blood tests and instrumental tests.

But the starting point, fundamental and inescapable, are always some questions related to the symptomatology.

First of all, is the pain generalized or is it felt at a specific point? If the pain is generalized, that is, it does not affect a precise point (a knee, for example), the first important element is symmetry: “If a muscle pain is symmetrical, that is, it affects both lower limbs (but also applies to the arms, the left and right thoracic muscles, etc.) we are almost certainly faced with a systemic problem. If, on the other hand, only a thigh hurts or only a knee or a forearm, localized in-depth questions are usually necessary, in addition to any targeted examinations: did you travel, did you catch cold, did you carry weights, did you start a sporting activity?”.

An element of evaluation of the doctor is also the fact that pain in the limbs or limb is associated or not with other painful symptoms: for example, back pain, which can be an indication of sciatica, ie a pain that from the lumbar area of the spine, or from the buttock, descends posteriorly along the thigh to the foot, caused by inflammation or crushing of the sciatic nerve due to osteoarthritis of the vertebrae, disc disease or herniated disc.

Equally important are the temporal characteristics of the manifestation of pain: “Does it appear only in movement, only by touching the affected area or even at rest, perhaps at night so as to awaken from sleep? Is it spontaneous or is it felt only by stressing the limb?», continues Serino.

This is an important clue, because if the pain in the muscles occurs even at rest, then it means that it has rheumatological characteristics: “Immobility worsens it, and this pain is often accompanied by a feeling of heaviness or “awkwardness”. In the morning, as soon as he gets up and before having made some movement and having “warmed up a little” (typical description), the person is much worse than during the day and struggling with usual activities, at home or at work».

It is also important to investigate any “visible” manifestations that accompany the pain: “That is, if the muscle or the painful part is swollen, swollen, has redness or is warmer than nearby areas or the contralateral part (for example a wrist yes and one no, or both): in these cases the pain is no longer only functional, but has a series of inflammatory components with its own causes”, The expert continues. The swelling of the ankles can have causes “far” from the lower limbs, such as kidney failure, and is therefore a symptom not to be overlooked. “Sometimes you also see muscle bundles moving, and that can be a sign of predominantly neurological pain.”

If the problem is given by varicose veins, typical of those who spend many hours standing, such as shop assistants or pharmacists, or pregnant women, the legs are also swollen, hot in some places, sometimes with a sensation of itching up to eczema.

Serino continues: “Obviously, if the pain affects a joint point of the limbs it is joint pain, but it can also involve a muscle. And then the key question to the patient is: but does the pain feel him as deep or as superficial? Do you feel it when I touch it or when, bending your leg, it moves your joints?”

Causes of muscle pain in the legs

Leg pain often results from muscle trauma, frequent especially in athletes, which can cause, for example, a contracture, a strain or a tear.

Contracture is an involuntary contraction of one or more muscle bundles that are subjected to an excessive workload. Contractures can be confused with cramps, which however represent very different pathophysiological phenomena.

Cramps, in fact, cause a sharp and sudden pain, of greater intensity than that generated by contractures. They mainly affect the thighs, feet and calves at night and are usually caused by a hydrosaline imbalance or insufficient energy intake (which may be due for example to celiac disease, a disease that causes malabsorption of calcium, magnesium and potassium).

Instead, we talk about stretching when the muscle fibers are subjected to excessive stretching, which is often also associated with the appearance of a hematoma, caused by the rupture of the subcutaneous blood vessels (we hear about it especially in relation to the world of running, perhaps attributed to a lack of warm-up).

Finally, the most serious muscle injury is represented by tearing, or the partial or total rupture of muscle fibers.

Contractures, strains and tears all involve the appearance of localized pain to the affected muscle, which can be more or less intense depending on the severity of the trauma or injury.

The response to drugs

«Even the response or not to the drug is an important clue to find out if it is an inflammatory or “tear” pain or contracture,” adds Serino. “Another additional element, the association of pain with a cramp, at rest or in motion, implies its neurological or vascular activation. In these cases, the patient is always asked if he uses supplements or drugs, because some (for example statins, taken for too high cholesterol) can affect pain and muscle cramps. Not to mention, then, diuretics, clofibrate (another drug used in the treatment of hypercholesterolemia), contraceptives and ace inhibitors administered in the treatment of hypertension.

Supplements, in particular saline (potassium in particular), can also be therapeutic, especially if accompanied by a diet rich in fruit and vegetables and plenty of liquids. Some muscle pain in the legs, in fact, can be due to particularly demanding physical exercise: for example, cramps can be a consequence of dehydration in those who practice intense physical activity or during the hot season.

Causes of leg pain in young and old

A particular pain in the lower limbs is what sometimes affects adolescents in the growth phase: “They are not very frequent, but between 12 and 16 years there may actually be symmetrical pains that affect some areas of bone growth, and therefore are described as deep. In the opposite span of life, that is in old age, osteoporosis, by modifying the structure of the bone, can cause pain, especially at the vertebral level, and in subordination to the hip or long bones (femurs and humerus) and is due to microscopic fractures caused by certain movements or climatic changes. However, it is a very localized pain and much more acute than muscle pain.”

Leg pain: osteoarthritis or arthritis?

“Patients often use the two terms synonymously, but between the two pathologies – both can also cause leg pain – there is a substantial difference.”

Arthritis is an acute inflammatory phenomenon that affects the joint capsule and therefore all the tissues that make up the joint joint. Inflammation can be provoked by trauma, infection or pathologies such as gout, rheumatoid arthritis, arthritis that accompany immunological diseases. Usually the joint is red, swollen (that is, with edema) and with a feeling of heat. The competence lies with the rheumatologist.

If, on the other hand, the joint hurts, but there are no clear signs of inflammation, then it is arthritic pain, that is, a mechanical pain from wear, sometimes with an osteoporotic component: the joint is no longer lubricated, and therefore the articular heads, sliding one over the other with friction, cause pain: in this case, the competent expert is the orthopedist.

“While osteoarthritis responds well to a pain medication and not to an anti-inflammatory – explains Serino – arthritis responds very well to an anti-inflammatory or cortisone, but not as well as a painkiller. Distinguishing these aspects is very important even before prescribing in-depth examinations, such as x-rays».

Even “distant” arthritic phenomena can also cause leg pain: for example, cervical osteoarthritis. This chronic pathological condition, in fact, begins with pain localized along the cervical, neck stiffness, headache, nausea and limitation of mobility and can determine (although in rather rare cases) low back pain, pain in the lower limbs, movement disorders and loss of bladder control, due to excessive compression of the cervical and spinal cord.

When it’s the fault of the circulation

A further cause of pain in the lower limbs is a circulatory disease. “In this case, the main characteristic is that it is a painassociated with a cramp and “exhaustion”: that is, the more the person tries to move and walk, the more the pain increases and forces rest. Vascular pain, unlike muscle or arthritic pain that continues even if the patient stops, draws relief from immobility. But the moment you start walking again, it resumes as before.”

The pain can therefore derive from peripheral arterial disease (among the most common reasons, high cholesterol, which is the cause of atherosclerosis, ie the formation of plaques that obstruct the passage of blood), also recognizable by the so-called intermittent claudication (a form of lameness that causes difficulty in walking), accompanied by a burning sensation, and cold feet, which can go as far as arterial occlusion and therefore requires a timely visit to an angiologist and vascular surgeon. Intervention equally necessary in case of thrombophlebitis, ie an inflammation of the wall of a vein associated with a thrombus, ie a blood clot, called deep vein thrombosis if it concerns the deeper veins, precisely and not the superficial ones. Symptoms are warmth and pain in the affected area, redness, swelling and sometimes fever.

Anxiety and fibromyalgia

Anxiety causes a condition of generalized discomfort, which can also reverberate on the muscles. “In the neuronal sphere the main painful problem is fibromyalgia: although included in rheumatological diseases, it has a large component that derives from the nervous-emotional system. Anxiety and depression interfere with muscle pain which is therefore called “myofascial”: it affects the muscle and the fascias that wrap around the muscle and end in the tendons, and the pain concerns precisely the insertion of the tendon into the bone (enthesis). The person is always in tension in these points of the body and does not loosen it even when he sleeps: this rheumatological pain is not by chance treated with anti-inflammatories, but above all with a therapy based on antidepressants, which, even at very low doses, resolve contracture pains also due to “simple” stress that does not yield even when you sleep».

For everyone, pain from anxiety or fatigue can benefit from “sweet” remedies: from yoga to walks to swimming, from gymnastics to stretching and meditation exercises, physical activities that allow you to release tension and relax the nerves, without necessarily resorting to drugs.

There are those who wake up with leg pain in the morning, for problems related to poor sleep quality (restless legs syndrome, insomnia, micro-awakenings).

What exams to do?

Once it has been established that the causes of pain are contracture and non-inflammatory, which concerns the muscle and not a joint, confirmation of the diagnosis is achieved with the prescription of targeted examinations.

Giorgio Serino concludes: “Blood tests are necessary to look for the presence or absence of “inflammation indices”: rheumatoid factor, ESR, C-reactive protein. If the problem is articular, however, the situation is investigated with radiological examinations (x-rays, CT scans, ultrasounds, etc.). If the patient is over 45-50 years old and is a woman or more than 60-65 if a man or there are food deficiencies (in particular calcium, due to exclusion from the diet of dairy products, typical of many very young women), a MOC serves to highlight a picture of osteoporosis. If there is a circulation problem supposedly, the ad hoc examination is the arterial and venous Doppler. Finally, if the pain is associated with skin sensations such as the disappearance or excess of sensitivity in some fingers or tingling, an electromyography can also be prescribed that evaluates the muscular potentials, that is, the electricity released by the muscle and therefore the peripheral neurological structure».