Tag: back pain

Why You Are Having Leg Numbness

“I’m having numbness down my leg and no one seems to know why!” she barked out frustratingly over the phone.  I hear similar complains from high level athletes and desk jockeys almost on a weekly basis.

80% of the population suffers from low back pain within their lifetime and numbness or pain down the leg is a common symptom.  Finding the reasons for the nerve involvement is almost as difficult as treating this injury.

Bulging lumbar disc, herniated disc, bone spurs, spinal stenosis, scar tissue, piriformis muscle syndrome and nerve entrapment are just a few of the possible sources of leg numbness.

Understanding Leg Numbness

If you have static on your home telephone, where could the problem be located?  Your puzzled look is justified.  The truth is that the “lesion”, as we say in sports medicine, can be in the headset of your phone, the wire going to the wall, the jack in the wall, the wire in the wall, the connection on the telephone pole, on and on.  The truth is that the source of the problem could be anywhere between your ear and the microphone in the phone of the person on the other end of the phone call.

Although the distance is significantly shorter, much of the same can be said about the numbness down your leg.  The pressure on your leg nerve can be located anywhere from within the spinal cord to within the leg itself.

It’s important for the readers to understand that when pressure is placed on a nerve, typically the initial symptom is numbness.  If greater pressure is applied to any part of a nerve and more of the inner nerve is impaired, leg pain and weakness in the pattern where that nerve travels can result.

This is the reason why a doctor will implement a variety of tests including reflex tests, manual muscle tests, pin-prick tests and range of motion assessments while comparing each of the results to the opposite leg.  Understanding the exact type and location of the symptoms is the first step to determine where the lesion is located and, ultimately, how to treat the leg numbness.

Signs & Symptoms of Leg Numbness

  • Numbness and/or pain can extend anywhere from the low back to the toes.
  • Low and mid-back spasms often accompany leg numbness.
  • A sharp “stabbing pain” in the low back region can initiate symptom.
  • can be initiated by a sharp “stabbing pain” in the low back region.
  • The intensity of the symptoms and even how far down the leg the numbness travels is often worsened with prolonged sitting and with the transition from sitting to standing.
  • A sense of hip and leg weakness is common with leg numbness related to nerve pain.

Professional Treatment for Pain Down the Leg

  • Contact your orthopedic physician for a thorough exam.
  • Get off your feet as much as possible to decrease the pressure on your lumbar spine and associated nerve structures.
  • Lying on your back on a firm surface with pillows under your knees is often the best position to rest and sleep.
  • Low back massages, PAINFREE hamstring stretches and lumbar icings will help to minimize localized spasms and pain.
  • While lying on your back with knees bent and feet on the floor, slowly use your arms to pull each knee to your chest while exhaling.  Alternate each leg for 5 reps then 5 reps with both legs together while keeping your head and shoulders relaxed and resting on the ground.
  • Progressive crunches with firm exhale with your feet on the ground along with no low back pain or any increase in leg numbness.
  • Strong emphasis on core stability, hamstring flexibility, sound body mechanics and maintaining a lordotic (sway-back) curve position of the lumbar spine with all activities.
  • Progressive return to activities while avoiding setbacks that would initiate the pain>spasms>more pain cycles.

Asking the Questions a Pro Athlete Would Ask

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. What is the source of my leg numbness?
  2. Can you show me on a model or picture exactly what my low back looks like and what is contributing to my leg numbness?
  3. Do I need to have an MRI to determine the status of the discs in my lumbar spine?
  4. Am I at risk for permanent numbness and/or weakness in my hip and lower extremity?
  5. Do I need surgery or can I avoid surgery with a very aggressive low back therapy program?
  6. In your opinion, who are the best low back physical therapists in town?

Elite Sports Medicine Tips from Mike Ryan for Leg Numbness

  • No Low Back Pain? – With leg numbness, the actual low back pain may be minimal.
  • Centralization – Simply stated, the less numbness/pain in the leg the better.  The farther the symptoms extend down the leg, the greater the pressure on the lumbar nerve.  That’s not good.  Centralization is when the pain moves out of the lower extremity and into the lumbar spine.  That’s better.
  • Disc 101 – Only the outer rim of the disc has nerve fibers so if you’re damaging them, you will never know.  Avoid a slouched posture and keep the curve in your low back and your discs may be nice to you.
  • Un-Clear Mechanism – Sometimes it obvious but often pain down the leg “just happens” and it will take a specialist to determine why.
  • Take The Blinders Off – Look at the big picture.  Hip injuries, poor sleeping surfaces, childhood injuries and bad shoes can all be reasons for back injuries so step back and evaluate all the factors.

Tips For Getting Relief From Sacroiliac Joint Pain

If you experience pain when twisting at the waist or bending over, you may be suffering from Sacroiliac joint pain. The two sacroiliac joints are often not recognized or appreciated by most people because of their “bigger brother” located next door:  the lumbar spine.  Meanwhile, the true importance of the SI joints cannot be understated.  When these joints become symptomatic you will quickly realize their contributions to your normal motion.
These joints are the only two bony connections between the entire lower spine and the pelvis and lower extremities.  Think about that for a minute: that means all the weight of your spine, shoulders, head, arms and anything you are holding in your arms has only two small joint surfaces to technically bare the forces of all that weight in the SI joints!  That is just one reason why any disturbance of the sacroiliac will be painful and considerably impair your ability to perform normal movements without pain.

Found on the backside of the pelvis just above the large and strong buttocks or gluteus maximus muscles, the two SI joints can be located when examining just below the beltline on the back of the pelvis.  There you will feel one bony pump on each side approximately 4 to 6 inches apart.  Those bony landmarks are called the posterior superior iliac spines (PSIS) and the sacroiliac joints are located just inside of the PSIS.  Often these landmarks are tender to touch and swollen.

The sacrum is a larger triangle shaped bone that is positioned below the lumbar spine and between the two SI joints.

Why is SI Joint Difficult to Treat?

SI joints are vital connections that allow three-dimensional motion of the pelvis, hips and low back.  Motions such as twisting, bending and squatting are great examples of how the SI joints naturally assists the function of the entire lower extremity, pelvis and low back.  In conjunction with the one pubic symphysis, located at the front of the pelvis, painfree function becomes effortless.

Understanding the sacroiliac joint motion and pathologies is not easy.  Because of the complexity of the anatomy and movement patterns of the SI joint and low back, the evaluation and treatment of sacroiliac dysfunctions is still controversial.

SI joint dysfunction is a sports medicine term that is often used when describing various injuries involving the SI joint. A biomechanical problem that creates physical symptoms in the SI joint and surrounding tissue,  typically the problems of this dysfunction can be related to the sacroliliac joint being too still (hypo-mobile) or loose (hyper-mobile).  Because of the complexity of the SI joint and the joints above and below the pelvis, too little or too much movement of the SI joint will create pain and physical limitations.

Signs & Symptoms of an SI Joint Injury

  • Various levels of pain in the low back below the beltline and off to either side of the midline.
  • Discomfort and slight swelling noted with palpation of the area just medial or inside to the PSIS above the buttocks muscles.
  • Commonly associated with excessively tight hip flexors and hamstring muscles.
  • A sense of the pelvis “being off” or “rotated on one side” with activity.
  • With severe or chronic conditions, radiating pain can be experienced into the lateral low back, buttocks region, groin and lower extremity.
  • Restricted movement with extreme flexion, extension and/or rotation.
  • An increase in symptoms after prolonged period of time in a soft chair or bed.
  • Movements related to a combination of low back and hip rotation such as putting on socks, twisting in bed and getting out of a car tend to create a catching sensation in the low and lateral back below the beltline.
  • A leg length discrepancy is common as either a cause or a result of a sacroliliac joint dysfunction.
  • There may be tenderness on palpating of the ligaments that surround the joint.

Treating Sacroiliac Pain

  • You’ll want to rest the low back, pelvis, hips and upper legs in a prone (face down) position with ice on the low back and posterior pelvis.  You should also avoid prolonged sitting, soft beds and chairs, activities that create symptoms and any one-legged positional movements.  In addition, three ways you can reduce or eliminate your pain are to seek:
  • Massage and soft tissue work to relax the hip flexors, groin muscles, lateral hip rotators, back extensors and hamstrings.  Massage techniques vary greatly and the benefits for sacroliliac pain cannot be understated.
  • Progress with a core-stabilizing program that improve both the strength and the function of the entire abdominal region.  The objective here is to perform stabilizing exercises that address the needs of the athlete without creating any symptoms in the SIJ, low back or hips.  Progress as tolerablable.
  • A biomechanical evaluation to determine if a muscle imbalance, leg length discrepancy, poor flexibility or other factors are contributing to the SI joint dysfunction.

Questions to Ask to Eliminate SI Joint Pain

Especially because the treatment of SI joints are so difficult to treat, it’s vital you receive clear direction on how to safely treat your pain.  Here are the questions a saavy professional athlete with sacroliliac pain will ask his sports medicine specialist to ensure he can safely return to his sport as quickly as possible:

  1. Are you certain of the diagnosis?
  2. Do I need an MRI to rule out any disc, nerve or bony pathology that is contributing to this injury?
  3. What are the warning signs with this injury that will tell me that my back injury is getting worse?
  4. What can I expect with this injury for the next 2, 4 and 6 weeks?
  5. Who do you consider to be the expert lumbar spine and pelvis rehab specialist in this area?
  6. Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Sports Medicine Tips For Your SI Joint Pain

  • The Patient is Usually Right – You’re the patient and it’s your back so listen to yourself!  Sure the doctors and sports medicine specialists have some pretty cool diplomas on the wall and a lot of initials after their name but no one knows your low back like you do.  Trust your insight.
  • SI Joint Phobia – I’ll let you in on a secret that many in the sports medicine world do not like to admit:  The sacroiliac joint is not understood by a majority of doctors and for good reason.  It’s confusing and very complex and unless you work with it first hand every day, most will “shotgun it” with a little of this and a little of that. Therefore, it’s helpful to seek out a specialist with experience in this area before you schedule an appointment.
  • Body Mechanics WILL Make the Difference – Look at the way you move doing the little things like tying your shoes or picking up the newspaper.  If you’re losing your lordotic curve or sway-back curve, you’re loading both your SI joints and your low back.  Excess stress at either location is a bad thing.  Maintain that curve doing everything and chances are your SI joint will allow you to do what you want to do.
  • Ice is Your Friend – I know, I know…here we go again…Ice hurts but it’s exactly what you need for this injury.  Sure, Ice will make your back stiffer and that will require some additional time to warm-up.  But ice will decrease inflammation and pain which are two key steps to recovering from any back injury.  The Pro’s will tell you that ice is their best teammate.  Stop avoiding this extremely beneficial remedy and do what you know you need to do…ICE and lots of it.
  • Find the Source – A hyper mobile sacroiliac joint is often related to a traumatic episode to the low back or an alignment problem elsewhere when compared bilateral.  Get with a specialist who can find the source of the problem to determine if the sacroiliac pain is merely a symptom.  Orthotics, chiropractor care or more aggressive core stability are just a few of the options to be considered.