Managing Low Back Leg Pain: Treatment Options and Strategies

Lower back leg pain depends on specific symptoms and their duration. Can having a better idea of symptoms help individuals inform their medical providers to develop an effective treatment plan?

Low Back Leg Pain

Lower back leg pain, sciatica, and weakness of the lower-extremity muscles are often diagnosed as a herniated (compressed or ruptured) disc. Nerves surrounding the spine are sensitive to irritation and pressure caused by a disc shifting out of position or physical damage to the disc and surrounding area, ranging from mild to severe. This is why it is important to be evaluated by a healthcare provider. Treatment depends on the type of spinal disc herniation and the severity, but getting an early medical evaluation helps ensure optimal outcomes. Non-surgical conservative treatments are often effective, but some cases may require more aggressive treatment, especially if the pain persists.

Spine and Nerves

Spinal discs are the shock absorbers between vertebrae. They consist of a tough outer layer, annulus fibrosis, covering a soft gel core, nucleus pulposus. When a disc is damaged, it can bulge and irritate surrounding nerves. In more severe cases, the annulus fibrosis can weaken and tear, allowing the material to leak and compress the spinal cord or nerves. As the nerves are not functioning properly, abnormal signals may be sent to and from the brain. The most common lower back herniations occur in the lumbar region, where five vertebrae near the base of the spine are classified from top to bottom as L1 through L5. (Dydyk A.M. et al., 2023) Pain resulting from an injury to this part of the spine can be debilitating because it may involve sciatic nerve irritation. Herniated disc causes are generally a combination of age-related degeneration, being overweight/obese, trauma, a sedentary lifestyle, and overloading of the spine. (Cleveland Clinic, 2021)

Symptoms

The most common symptoms include: 

Back Pain

• Caused by nerve irritation, muscle spasms, and inflammation.

Radiculopathy

• Abnormal signaling of the nerves.

Electrical Shooting Pain

• Nerve pressure can cause abnormal sensations, commonly experienced as electric shooting pains.
• For low back herniations, the shocks go down one or both legs.

Tingling – Numbness

• There are often abnormal sensations such as tingling, numbness, or pins and needles down one or both legs.

Muscle Weakness

• Nerve signals may be interrupted, causing lower-body muscle weakness. (Dydyk A.M. et al., 2023)

Bowel – Bladder Symptoms

• These symptoms may signal cauda equina syndrome, a rare condition resulting from a herniated disc between the L5 vertebrae and the first vertebrae of the sacrum.

Diagnosis

Diagnosing a herniated disc as the cause of low back leg pain involves testing sensation, muscle strength, and reflexes. MRI also aids this process (American Association of Neurological Surgeons, 2024). MRIs can often show herniated discs and other abnormalities, especially in older patients.

Treatment

A herniated disc treatment plan is based on patient symptoms, physical examination findings, and imaging results. Most herniated disc symptoms resolve themselves in four to six weeks. Lower back pain is generally treated conservatively through:

• Topical pain ointments or creams for muscle spasms.
• Non-surgical decompression relieves pressure, activates healing, and restores circulation and nutrients.
• Chiropractic adjustments realign the spine and musculoskeletal system.
• Massage loosens the muscles and maintains their relaxation.
• NSAIDs to reduce inflammation. (Cleveland Clinic, 2021)
• Total rest is never recommended, even if movement is challenging,
• Exercise and stretching help avoid muscle degeneration and strengthen the muscles.
• Relaxation techniques and other natural pain therapies can help manage symptoms and restore overall health.
• Pain-blocking injections which can include anesthetics or corticosteroids at the source (Cleveland Clinic, 2021)
• Surgery is recommended only when conservative treatments are ineffective after six weeks, if there is significant muscle weakness from nerve damage, or if motor functions are compromised. (American Association of Neurological Surgeons, 2024)

Injury Medical Chiropractic and Functional Medicine Clinic

Chiropractic therapy is among the more conservative treatment options and may be tried first before proceeding with surgery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other associated medical professionals to integrate a treatment plan to improve the body’s flexibility and mobility and resolve musculoskeletal issues.

Disc Herniation

References

Dydyk AM, Ngnitewe Massa R, Mesfin FB. Disc Herniation. [Updated 2023 Jan 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK441822/

Cleveland Clinic. (2021). Herniated disc. my.clevelandclinic.org/health/diseases/12768-herniated-disk

American Association of Neurological Surgeons. (2024). Herniated disc. www.aans.org/patients/conditions-treatments/herniated-disc/