Practitioner: “Can you please describe your problem for me?”
Patient: “Yes. I have this Chronic Lower Back Pain that if it triggers, I can feel in my leg(s) as well. I start work from 9am, the pain will start crawling in after an hour of sitting, and then I can feel the pain down into my leg(s) after that. But, if I stand up and walk around a little bit, the pain will ease. This is why I have been putting treatment off for so long.”
Does this sound familiar?
The question is why does the LBP sometimes follow with leg pain? If the LBP is already a pain in the backside, why does the leg pain love to join the party?
If we look into the User’s Manual for the human body – lower body in particular, the question can easily be answered.
The difference between disc origin and muscular origin is if the pain travels below the knee. This is the reason why most practitioners are critical to the pain below or above the knee. If the pain travels below the knee, it is suggested to be disc lesion. If the pain does not travel below the knee, it is suggested to be muscular-related. Unfortunately, there is a User’s Manual 1.1 that specifies that each person is unique, and there could be an occasional case where the above situation differs.
Studies have shown that younger patients experience more discomfort in a sitting position due to increased disc pressure, but gain relief by standing up and walking (Souza, 2014). Whereas older patients have trouble when walking or standing due to gravity pull with a compressive effect that applies pressure onto the posterior (back) aspect of the region (Souza, 2014).
The patient sometimes describes the pain only in one leg or both legs at the same time. The difference between the two is disc-related pain for one leg and stenosis-related (narrowing) leg pain for both legs.
Pain below the knee is suggested to be caused by a disc lesion; chiropractic treatment usually has a beneficial effect and is able to achieve a good result.
Pain above the knee is suggested to be muscular-related. A trigger point is a term used to describe a tender area of the body that is irritated by a particular muscle group and has created a referral pattern to another area of the body. An example such as, an iliopsoas trigger point can cause referral pattern down to the front of the thigh, a piriformis trigger point can cause referral pattern down to the back of the thigh, or a Tensor Fascia Lata (TFL) can cause referral pattern down to the side of the thigh. These three muscles are located either deep inside our lumbar region or on the side of our hip region, which can mimic LBP. If by adding trigger point patterns into the equation, we have a lower back pain associated with leg pain/discomfort symptom.
Therefore, finding a practitioner with the advanced ability to diagnose this is essential to determine which type of treatment is most suitable for the patient. Once the partitioner is found, it would be wise to stick with them. If the partitioner provides effective treatment, plus a strong ethical view, it is considered hitting the jackpot.
Written by David Hsu
Dip Remedial Massage, Bachelor Rn. Diploma Osteopathy (Canada)
Souza, T. (2014). Differential Diagnosis and Management for Chiropractors. Burlington: Jones & Bartlett Learning, LLC.