By Virginia Nsitem

Do you experience low back, hip, or buttock pain that radiates down the leg? Do you have difficulty getting up from a seated position, walking, or sitting for long periods of time? This article discusses the common causes of low back pain associated with pain down the leg.

Lumbar Disc Disease

The lumbar spine has five vertebral bones separated by vertebral discs (shock absorbers of the spine). The discs provide support to the spine during bending, turning, and twisting. As we age, and as the spine is exposed to repetitive stress and trauma, the discs begin to break down and can even bulge or beak open. As the disc degenerate, they lose their fluid and become flatter, and this brings the spinal bones closer together. Bony spurs growths begin to form to stabilize the lumbar spine where the discs have degenerated. The degenerative changes in the spine can develop over time, or begin following a traumatic injury.

Symptoms degenerative disc disease in the low back include:

• Back pain
• Buttock pain
• Pain down the leg pain to the foot
• Numbness and tingling in the leg
• Restricted low back movements (bending, twisting)

Disc Herniation

The shock absorbing discs can become injured, and bulge or break open. This type of disc injury is also called a herniated disc. Some people use the term “slipped disc” to describe a herniated disc. The injured discs can put pressure on the nerves exiting the spine (“pinched nerve”), causing the pain to radiate down the leg to the foot. However, there are some people with these changes that do not experience any pain at all. The amount of pain experienced is sometimes related to the location of the disc injury in the low back. Disc bulges and herniation can be caused by wear and tear on the disc and traumatic injuries.

Symptoms of a disc bulge or herniation in the low back include:

• Back pain
• Muscle spasm
• Sciatica (pain down the buttock and leg to the foot, with numbness)
• Leg numbness and tingling to the foot
• Leg weakness

Piriformis syndrome

The piriformis muscle is a muscle located in the buttock region that attaches to the hip, and lies under the gluteus muscle. It helps with movements such as rotating the hip and bringing the thigh inward. We use the piriformis in activities such as walking and standing on one leg. The sciatica nerve (largest nerve in the body) travels under and through the piriformis muscle.  Muscle spasm or injury to the piriformis muscle can put pressure on the sciatic nerve causing pain down the leg. The pain can be triggered by repetitive movements, sitting for long periods of time, running, or pressure to the buttock and hip area.

Symptoms of Piriformis Syndrome

• Tight muscle in the hip and buttock
• Sciatica-symptoms down the leg (pain and numbness)
• Pain with walking, squatting, or getting up from lying down
• Pain with hip movements
• Difficulty sitting
• Pain that refers to the groin region

Low Back Joint Pain

The lumbar spine spinal bones are connected by joints, called facet joints. These joints help absorb stress and forces in the spine, and work to prevent extreme movements in the low back. These joints can become inflamed from wear and tear, poor posture, and even poor lifting techniques.  If the pain is severe, it can feel similar to pain from a herniated disc.

Symptoms of Lumbar Joint Pain

• Episodes of pain that occur a few times a year
• Pain worse in the morning
• Tenderness in the spine
• Difficulty leaning backwards
• Pain that radiates to the back, buttock and down the thigh to the knee

Sacroiliac Joint Pain

The sacroiliac joints join the spine (sacrum) to the hip bones (pelvis), and works to absorb stress. The joints can become inflamed from repetitive stress, traumatic injuries, and poor posture. It is also common for pregnant women to experience sacroiliac joint pain from loosening of the joints caused by the pregnancy hormones.

Symptoms of Sacroiliac Joint Pain

• Low back and buttock pain, usually on one side
• Pain that radiates down the thigh to the knee
• Difficulty getting up from a seated position, sitting down, and climbing stairs
• Pain worse in the morning, and relieved with exercise
• A feeling of the back buckling

What treatments are helpful?

The first goal before therapy is to diagnose the injury.  Visit your chiropractor for an assessment in order to get a proper diagnosis.  There are other serious conditions that can also cause pain down the leg, and these should be ruled out before you begin your rehabilitation treatments. Your chiropractor may order x-rays, or refer you to your physician for other investigations such as CT scans or MRI studies.  The rehabilitation program will be determined based on the type and severity of your injuries, and may include:

• Treatment with modalities such as LASER therapy, and the use of heat or ice applications to relieve pain and inflammation.
• Chiropractic treatments, joint mobilization, manual traction, and mechanical traction are important features of a rehabilitation program to reduce pain, and restore proper movement and function to the injured areas.
• Massage and acupuncture are complimentary therapies that can reduce pain as you become more active.
• Specific stretching and strengthening exercises help you return to your regular activities at home, work, and recreation. Exercises and stretches help improve your strength, flexibility, posture, and overall fitness level. The exercises prescribed may differ depending on the cause of your low back and leg pain.
• Education on posture, ergonomics, and back supports for specific activities.

Stop the Pain … Before it Stops You!

(Dr. Virginia Nsitem is a chiropractor specializing in laser therapy for muscle, joint, and nerve injuries, and is a Fellow of the Royal College of Chiropractic Sports Sciences in Canada. She may be reached at (905) 275-4993, or by email at totalhealth@bellnet.ca )