Why do I have back and leg pain?

Back pain is an extremely common condition, with around 80% of people experiencing it at some point in their lifetime. It can equally affect men and women, ranging in intensity from a mild ache lasting a few days to intense, chronic pain lasting for weeks at a time. Though often caused by muscle strain and normal ‘wear and tear’ of the body, back pain may also be a symptom of more serious conditions. In some cases, back pain can extend to other areas of the body, specifically to your legs.

What causes the condition?

In a number of cases, there’s no obvious reason for back pain (non-specific back pain) and it's not anything serious. It’s often due to a sprain or strain to a muscle, tendon or ligament.

Back pain can be caused by a range of factors, including:

• Lifting something that’s too heavy for you
• Twisting awkwardly
• Poor posture
• An injury such as a sprain or strain

What are the typical signs?

Symptoms commonly associated with back and leg pain:

• Burning sensation
• Tingling
• Being sore to the touch
• Limited mobility

There are a number of causes of back and leg pain, these include:

• Sciatica: Also called nerve root pain, sciatica is responsible for around one in 20 cases of lower back pain. It happens when there’s irritation to the nerve that passes from your spinal cord down to your leg (the sciatic nerve). It’s sometimes known as a trapped nerve. Symptoms of sciatica include lower back pain and leg pain, and sometimes also tingling and numbness from your lower back and buttocks down your leg to your feet
• Prolapsed or slipped disc: Discs are fluid-filled cushions that sit between each vertebra in your spine and act as a shock absorber. If it’s damaged, it can leak out and put pressure on the spinal cord and surrounding nerves. A slipped (also called herniate or prolapsed) disc can cause sudden and severe lower back pain. It can be triggered by various things, such as awkward bending, heavy lifting or vibration (from driving or some hand-held power tools)
• Spinal stenosis: Where your spinal canal becomes narrowed, causing the nerve tissue nearby to become compressed and inflamed. It can cause pain, numbness and weakness in your back and legs. Weakness while walking that’s relieved when you sit down is a common symptom
• Cauda equina syndrome: A rare but serious condition caused by pressure on the nerves at the very base of your spinal cord. It causes pain and also bowel and bladder problems. Symptoms usually start and progress quickly, and it needs urgent treatment to avoid permanent damage.

Additional, less common, conditions related to back pain are:

• Arthritis, including osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. All can cause back pain and stiffness due to inflammation of joints in your spine
• Tumours
• Infection
• Pressure from structures that are near the spine

How is it diagnosed and treated?

Diagnosis

Your consultant will discuss your symptoms with you and perform a medical examination, which may be followed by an X-ray or MRI scan.

Treatment

Non-surgical treatment: This can involve a variety of techniques including physiotherapy, as well osteopathy and chiropractic treatment. Other pain management techniques can vary from advice on painkilling medication to more invasive painkilling techniques such as steroid injections into the spine. Injection therapy will depend on the cause of the pain, your consultant will advise you on this.

Surgery: It depends on the cause of your pain, but generally this will only be considered by your consultant when there is neurological compression giving rise to sciatica or claudication. In rare cases there may be a role for lumbar fusion for severe back pain caused by specific conditions such as single-level disc degeneration, spondylolisthesis (slipped vertebra) or post-discectomy back pain.

Recovery

This depends on the type of treatment you’ve had. The average stay in hospital is one to two nights and by discharge, you should be mobilising freely and able to climb a flight of stairs. Full soft tissue recovery normally takes about six weeks.

When can I return to normal activities?

• Work - this depends on your individual employment and lifestyle, however if your job mainly involves sitting then an approximate guide is around four weeks post-surgery. If you have a more active role, your consultant will be able to advise you on a suitable period of time, however it could take up to two months.
• Driving – usually about two weeks.
• Exercise – usually just walking for six weeks, then low impact exercise 6 to 12 weeks.