Leg Pain Treatment and Different Presentations
Leg pain is a common complaint that can affect people of all ages and lifestyles.
Whether it’s a dull ache, a sharp stabbing sensation, or a persistent throb, leg pain can significantly impact someones daily activities and quality of life.
A lot of these “pain down the leg” presentations get often misdiagnosed or thrown under the diagnosis of “sciatica”.
In this blog post, we’ll explore some of the most common causes of leg pain and our recommended treatment option in each case.
*Seek your doctor immediately if you experience pain and/or numbness down both sides of back of your legs.
Identifying the Type of Leg Pain
The nature and location of the leg pain can provide important clues about its cause or origin. It can save time and help the therapist get to the source of the issue a lot quicker if you take some time to properly feel the pain, the type of pain, where it’s located as well as whether there is any particular action that aggravates it or a particular time of the day where it’s more intense.
Here are the most common 3 types of pain:
- Cramping pain.
- Sharp, shooting.
- Dull, aching.
As per it’s location:
- Local pain: Felt in one focused area.
- Referred pain: Pain radiates over a bigger area.
Actions that might aggravate the pain. Ask yourself, is there anything that makes it worst?:
- Movement. If so, what movement?
- Prolonged periods of inactivity
- Rolling in bed
- Getting up from sitting
- Going up or down the stairs
- Bending the knee
- Worst after exercise
As per time of the day:
- Worst at night
- Worst in the morning
- Worst at the end of the day
Most musculoskeletal related “pain down the leg” presentations we see in clinic are cause by Trigger Points.
Trigger points are hyperirritable spots in the skeletal muscle or fascia that can cause pain, tenderness, and dysfunction. They are often described as “knots” in the muscle tissue.
They can develop due to muscle overuse, injury, stress, poor posture, or prolonged inactivity.
Trigger points can cause local pain and referred pain to other areas of the body.
They are typically identified by symptomatology and through physical examination and palpation by a specialist soft tissue therapist.
Understanding and addressing these points can be crucial in effectively treating various causes of leg pain.
Let’s break down the most common Trigger Point pain patterns we find in clinic.
Break down of the most common musculoskeletal causes of upper leg pain (thigh) we see in clinic on a regular basis (not including the knee!)
Lets categorise them by location.
PAIN AT THE FRONT OF THE THIGH
The main one here has to be the Iliopsoas, both due to the frequency this muscle group is involved in pain at the front of the thigh and also because many therapists believe it’s a special one.
- ILIOPSOAS:
This muscle is known as a “hidden prankster”, it serves important functions, often causes trouble and pain and it’s hard to access!
The Iliopsoas is a really deep muscle group, it attaches to the lower back (at the front of the spine rather than back), the pelvis (ilium bone) and into the leg (femur). It’s the only muscle in the body that crosses through from upper body to lower body.
It consists of two parts:
- The psoas: Originates from the lumbar spine (lower back) and runs down through the pelvis onto the leg.
- The iliacus: Originates from the inner surface of the ilium (hip bone) and joins the psoas in its way to the leg.
Some therapists and treatment modalities believe this muscle group to be the muscle of the “soul” due to its myofascial connections with the diaphragm and its role in breathing patterns.
The psoas is also closely connected to our fight-or-flight response, as it flexes the body into a protective fetal position when we’re stressed or threatened.
While the concept of the psoas as the “muscle of the soul” isn’t scientifically proven, it highlights the complex inter-connection between our physical body and emotional processing which is already backed by science.
- ADDUCTORS:
Next on the list are the Adductor muscle group.
Located medially in the thigh they play a crucial role in movement and stability of the leg.
These muscles can be a source of pain and injury, particularly in athletes or individuals who perform activities involving frequent changes in direction or lateral movements. Strains or tears in the adductor muscles are common in sports like football or martial arts.
These muscles can radiate pain down the leg at the front and front-medial portion of the leg in the following patterns:
- Adductor Longus and brevis (first image)
- Adductor Magnus (2nd image). Tps in his muscle can cause pain in the genitals, which can be quite scary.
PAIN AT THE LATERAL THIGH
The most common one here has to be Gluteus minimus.
- GLUTEUS MINIMUS:
Gluteus minimus is the smallest and deepest of the three gluteal muscles located in the buttocks. Despite its size, it plays a crucial role in hip stability and movement due to its deep location.
Trigger Points in this muscle can cause often intense and very dramatic pain down the lateral hip area and into the leg.
Something so small can cause such trouble!
Trigger Points on this muscle are very common amongst runners due to overuse and weakness but they are also frequent in sedentary lifestyles were the hip isn’t mobilised enough.
- TENSOR FASCIAE LATAE:
The Tensor Fasciae Latae (TFL) is a small but important muscle located on the outer side of the hip.
It originates in the outer surface of the ilium (hip bone) and inserts into the iliotibial band (IT band) which travels all the way through the lateral side of the thigh into the lateral side of the knee.
Pain pattern: Trigger points in the TFL can cause pain along the outer thigh, sometimes extending down to the knee.
Trigger Points in this muscle are very common amongst athletes and runners.
QUADRICEPS GROUP:
The quadriceps group consists of four muscles located at the front of the thigh: rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius. These muscles work together to extend the knee and flex the hip.
Trigger points in the quadriceps can cause pain patterns that vary depending on which specific muscle is affected:
- Rectus Femoris: Pain can be felt at the front of the thigh and sometimes extends to the knee.
- Vastus Lateralis: Pain typically radiates down the outer part of the thigh (image 1)
- Vastus Medialis: Pain is often felt on the inner thigh and around the knee (image 2)
- Vastus Intermedius: As the deepest of the four, its trigger points can cause a deep ache in the thigh (image 3)
Quadriceps trigger points are common in athletes, especially runners and cyclists, as well as individuals who spend long periods sitting or have poor posture. Treatment often involves a combination of stretching, strengthening exercises, and manual therapy techniques.
PAIN AT POSTERIOR THIGH
- GLUTEUS MINIMUS
Again!
This small muscle is located deeply into the buttock area.
Although more frequently Trigger Point referred pain from this muscle is felt locally into the buttock, pain often radiates and it’s often felt down the back of the leg, mimicking sciatica.
When the muscle becomes tight or spasms it can potentially compress the sciatic nerve (which travels underneath it and occasionally through it). This can lead to pain, tingling, or numbness in the buttocks and down the leg. Due to its close proximity with the sciatic nerve Trigger points in the Piriformis can be particularly annoying and it’s important to address them.
Common causes of Piriformis-related pain include:
- Prolonged sitting or standing
- Overuse from activities like sports
- Trauma to the buttock area
- Postural patterns
References:
Travell, J.G. (n.d.). Travell and simons’ myofascial pain and dysfunction. Lippincott Williams.
Fairweather, R. and Mari, M.S. (2015). Massage fusion : the Jing method for the treatment of chronic pain. Edinburgh: Handspring Publishing.