Leg pain coming from the back is very common and quite frustrating. In order to understand how to treat leg pain it is important to establish what the type of leg pain is and what is causing it.
Medical management for leg pain relief
There are many different types of pain relief which may help your leg pain. Some of the most common types include non-steroidal anti-inflammatories (NSAIDs), analgesics and nerve pain medication.
NSAIDs
Common NSAIDs include aspirin, voltaren, nurofen and ibuprofen, which are available over the counter at Pharmacies. Your GP can also supply prescription anti-inflammatories such as Mobic, celebrex, naproxen or stronger voltaren or brufen tablets. NSAIDs should always be taken under the direction of a pharmacist or your GP.
Analgesics
The most common analgesic used to treat more mild pain is Panadol/ paracetamol, however your GP may be able to prescribe stronger medication such as opioids (eg. Tramadol or codeine)
Nerve medication
Medications used to treat nerve pain act differently to other pain medications as they act more on issues with the nervous systems. Low doses of antidepressants or epileptic medication are commonly seen prescribed for nerve pain (eg. Endep or lyrica).
As leg pain referred from the lower back can be due to a number of reasons. It is important to consult with a health professional to know what medications would be right for you. Pain medications are also commonly used in conjunction with other treatments including physiotherapy or exercise therapy.
Matthew Ash explains some of the evidence around what medication may be best for treating acute low back pain.
Injections:
Corticosteroid injections are another form of pain relief. This time the pain relief is used locally to the source of pain. The steroid is injected into the epidural space of the spine that is irritated to provide a strong anti-inflammatory to reduce irritation within the spine that is leading to leg symptoms.
A common misconception is that this fixes the issue, however the effects of the injection are only short term and therefore it is recommended to use this technique in conjunction with other treatments including physiotherapy.
Surgical management of leg pain
Surgical management is typically utilised in extreme cases or for those who have tried most other treatment options. It is important to know that even though surgery can be a useful option, most people will also require physiotherapy following surgery as the surgery itself will not completely alleviate pain. Consulting with a surgeon will help you decide if surgery is appropriate and what surgical option would be best for you.
Types of surgical options include:
Discectomy/ decompression:
This process involves removing a portion of the disc to allow more space for the lumbar nerves to pass through – with hopes to reduce the irritation of the nerves in the lumbar spine.
Lumbar fusion:
Typically, a more invasive procedure this involves fusing two or more vertebrae together to stop the movement which may be irritating the nerves which pass through.
Lumbar fusion
How can a physio help with leg pain management
Physiotherapy can often be used independently or in conjunction with some treatment techniques mentioned above.
There are many different types of treatments that a physiotherapist can provide and the best option may differ depending on the type of leg pain.
Manual therapy
- Massage and mobilisation.
- Dry needling
Improving movement patterns
- Helping people find comfortable ways to move.
Education
Exercise therapy
- Stretches
- Strengthening
- Neural stretches
Matthew Ash takes you through a neural stretch
- Walking
In order to know what treatment option will be best for your leg pain, it is important to understand what exactly is causing the leg symptoms as some treatments may be more useful than others. It would be beneficial to get assessed by a health professional to determine the appropriate treatment option for you.
References:
https://www.painmanagement.org.au/
https://www.medicinenet.com/cortisone_injection/article.htm
By Samantha Mathews
Physiotherapist Payneham, myPhysioSA
