How to diagnose persistent leg pain
Persistent leg pain: Is it because of the blood vessels or Sciatica
The word often banded around for leg pain is ‘sciatica’. Most people will have heard of this term or heard a friend or work colleague discussing their Sciatica. They are normally referring to leg pain that feels a little nervy or radiates down the leg. The problem is that people use this familiar term all too easily. It is often mis-used for the wrong condition. This can lead to the wrong treatment or advice being served and unfortunately no improvement being seen.
We think that the term ‘sciatica’ is used so often for several reasons. It is also quite often the common reason for leg pain as it usually occurs alongside low back pain, is one of the most common conditions affecting 20 to 60 year olds every year and so cases of Sciatica are common. But, it can become the ‘go-to’ easy diagnosis to be reached and all too often leg pain is not fully or thoroughly assessed to exclude other causes before this diagnosis is reached and treatment started. The most frustrating thing is to be treated for something and no improvement be seen because the wrong diagnosis has been reached too early. Importantly we also know that mis-diagnosis and incorrect conclusions are a large factor in creating persistent pain and chronic pain as dis-trust in the professionals producing this diagnosis grows and worry the patient.
We also know that diagnosing Sciatica is an easier conclusion to come to as physiotherapists and other health professionals come across it much more often and symptoms are easier to pick up. In contrast, conditions such as vascular compromise is harder to diagnose and less common. This means that medical professionals need to be on alert for these less common conditions when diagnosing otherwise they risk falling into the mis-diagnosis trap. Knowing what some of the more common signs and symptoms of vascular leg pain are will help you to identify to your health care practitioner the full picture and will help ensure you know what to look out for.
Here are some of the signs and symptoms to observe:
1) Who is more likely to get vascular leg pain?
Problems with the artery in the front of the thigh and groin area (the External Iliac Artery) is more common in people that do cycling and skating. We think this is because of the position they adopt for their sport. They have to bend over at the hip a lot for long periods of time, possibly irritating or compressing the vessels at the front of the thigh. This can lead to altered flow in the pipes (blood vessels) that stirs up the flow and creates thickenings in the walls which with time can narrow the pipes. This means that the amount of blood that can flow through the pipes to the leg is limited and so oxygen and nutrition to the tissues is limited. It is unsure what the exact cause is but it is likely to be more because of thickening in the vessel walls (endofibrosis). People who do a lot of running and jumping such as footballers as well as the elderly are more prone to vascular problems in the calf area due to problems affecting the popliteal artery in the calf. Again, cause is uncertain but it is likely due to excessive plantar-flexion (toe pointing with running or jumping) in footballers or due to plaque build-up (atherosclerosis) in the elderly.
2) What does it feel like?
Here is where it gets tricky as the signs and symptoms of vascular problems often do feel like Sciatica. Some of the more, vascular symptoms are swelling in the lower legs and feet, a feeling of shoes or footwear feeling ‘too tight’ or that the legs are heavy and ‘difficult to move’. There may be sensations of pins and needles or numbness in the legs but unlike sciatica which does sometimes follow a particular pattern in the legs where the nerve supplies (known as dermatomes), the pins and needles or numbness from vascular problems does not follow this known pattern as the sensation comes from the blood vessels instead of the nerves.
3) When do the symptoms occur?
One of the clearer signs that the problem you are experiencing might be vascular is if there is a clear pattern to when the symptoms you are experiencing start and stop. If we think back to the point I raised above about the blood vessels becoming clogged up and so less total blood is able to flow through them, we can start to imagine the picture. Lets take an elderly gentleman who takes a 60 minute walk with his dog every morning. He starts to notice that at 45 minutes into his walk he almost always starts to develop a nagging calf pain. Once he sits down and takes a rest the symptoms almost immediately ease and he can start off again for another 45 minutes (if he has rested fully for 10-15 minutes). The symptoms don’t start again until he gets to around 45 minutes in again. A clear pattern of on and off. This is characteristic of vascular problems as the gentleman’s leg tissues (muscles, bones and nerves etc) can cope for 45 minutes with the amount of blood they are getting. Once 45 minutes of walking activity has been done, then tissues reach a stage when they are not receiving enough regular blood flow to be able to perform their work effectively. They complain about it with pain and symptoms.
Once the gentleman stops the activity, then quickly and almost immediately the blood flow is enough to supply the tissues with the right amount of oxygen and nutrition again and pain and symptoms stop. On and off. This is a good point to assess in yourself with your symptoms prior to seeing a health professional. You can relay this information to them to help them make an accurate diagnosis for you. Another good example, is that people report being fine walking, but once they reach a hill or incline they notice that as soon as their effort or heart rate increases that their symptoms start quickly and consistently.
Having a think about these three points will allow you to consider if there might be a vascular element to your symptoms. If you think some of this might be relevant to you, then make sure you discuss it with a health care professional. Excluding or including this diagnosis can really help to ensure your symptoms are managed quickly and effectively.
Specialist MSK Physiotherapist