Leg pain can have a number of different causes, some related to disease process and a lot to mechanical sources. Among the most common mechanical reasons for pain is entrapment of the fifth lumbar (L5) nerve.
Anatomy: The spinal cord puts out nerve branches that correspond to each bony vertebra. The nerve related to the lowest vertebra (L5) is particularly vulnerable to being pinched at different locations because of its course through bone, muscle and other soft tissues.
Symptoms: The universal symptom is pain, but it may take different forms.
Spinal stenosis: L5 nerve is pinched where it exits the spine and is often associated with one-sided pain in the low back or buttock and weakness or tingling. Usually related to age and arthritis.
Sciatica: Nerve is compressed by inflammation of the Piriformis muscle as it passes through the muscle. Typically pain is ‘lightning-like’ and will radiate down the back or outside of the thigh or calf.
Soft tissue: There are several locations where L5 can be pinched, including the gluteal fold, behind the knee and near the ankle. This kind of impingement will often cause pain, numbness, tingling, or even weakness to parts of the leg that are below the injury.
Treatment: Physical therapy is usually the first treatment for this kind of pain and may even relieve it completely. Other options include osteopathic manipulative therapy, steroid injections, and anti-inflammatory medications. So If you’ve got leg pain, come see Dr. Dave Carfagno at Scottsdale Sports Medicine to help you get back to 100%.
F. Ashton Taylor, MS4, MWU AZCOM
Dave Carfagno, CO, CAQSM Scottsdale Sports Medicine
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Rutkove, Seward, MD, ‘Overview of lower extremity peripheral nerve syndromes’, UpToDate, Dec 22, 2014.