walking pain, legs hurt

Four conditions for leg pain causes that can affect you when walking

When walking is supposed to be good for you, why do you have to suffer with leg pains? And what causes the pain in your legs when walking? Fitness experts used to stress the benefits of heavy-duty aerobic exercise — the kind that makes you breathe hard and gets your heart going. But the message changed to moderation after a number of studies showed that physical activity that’s far less taxing is also associated with lower rates of heart disease, some cancers, and several other illnesses — if it’s done regularly. Plain old walking usually tops the moderate-intensity exercise list because it’s easy, convenient, and free, and it requires minimal equipment — a comfortable pair of shoes. The trouble is that walking isn’t so easy for everyone. Indeed, the leg pain is agony for many. And forget the «brisk» pace of three to four miles per hour advised for health and fitness. With age — and occasionally without it — a number of conditions can result in leg pain after walking and make walking difficult. Some are very familiar, such as arthritis that makes knees and hips creaky; others, such as peripheral artery disease, aren’t. This article looks at four nonarthritic conditions that cause leg pain and may affect walking, and some ways to treat and manage them — no need to limp and bear it!

Why do my legs hurt? Leg pain causes and conditions

We’re discussing these conditions that may cause leg pain separately, but people may have two or more of them at the same time, which complicates diagnosis and treatment. 1. Peripheral artery disease Peripheral artery disease is a form of atherosclerosis, the same condition that leads to most strokes and heart attacks. Fat- and cholesterol-filled plaque narrows arteries, and blood clots can collect on the plaque, narrowing them further. In peripheral artery disease, the arteries affected by atherosclerosis tend to be the ones that supply the leg muscles. The risk factors are similar to those for heart disease and stroke: smoking, high cholesterol levels, high blood pressure, and especially diabetes. The classic symptom is cramping, tight pain that’s felt in muscles «downstream» from the narrowed artery. It can occur in the buttocks, thigh, calf, or foot, but occurs most often in the calf. The pain tends to come on with walking, gets worse until the person stops walking, and goes away with rest. Similar to angina, the pain caused by peripheral artery disease comes from working muscle cells that are «starved» for oxygen because of obstructed blood flow. The medical jargon for this kind of pain is intermittent claudication, from the Latin claudicatio for limping. Many people with peripheral artery disease have other sorts of pain, though. Sometimes their legs are heavy, or they tire easily. And it’s common for people to cut back on their activity level without realizing it, which can mask the problem. Signs of peripheral artery disease include a diminished pulse below the narrowed artery, scratches and bruises in the lower leg that won’t heal, and pale and cool skin. The diagnosis usually depends on the ankle-brachial index, which compares the blood pressure at the ankle to the blood pressure at the arm. They’re normally about the same, but if there’s a blockage in the leg, blood pressure will be lower in the ankle because of low blood flow. A picture containing clothing, underwear Description automatically generated Arteries narrowed by atherosclerosis leave leg muscles starved for oxygen. Peripheral artery disease by itself can be serious and debilitating, but it may also serve as an important warning of even more serious trouble. Atherosclerosis in the legs often means there’s atherosclerosis elsewhere, and people with peripheral artery disease are six to seven times more likely to have a heart attack, stroke, or transient ischemic attack than people without it. A peripheral artery disease diagnosis should prompt a concerted effort to rein in cardiovascular disease risk factors. Walking hurts, so a «just do it» attitude about exercise isn’t helpful. But researchers have found that tightly structured, supervised exercise programs can help people increase the amount they can walk before their leg pain kicks in. These programs usually involve walking ’til it hurts (which may be only for a few minutes), resting ’til the pain goes away, and then walking again. These walk-rest-walk sessions are most effective if people do them for about 30 minutes at least several days a week. Low dose aspirin (75 mg to 81 mg) is often recommended to reduce the risk of heart attack and stroke. Clopidogrel (Plavix), another drug that makes blood clots less likely by making platelets less sticky, is an alternative for people with aspirin allergy. Cilostazol (Pletal) may help some people walk longer distances without pain. Serious cases of peripheral artery disease can cause leg pain even when the person isn’t walking. This «rest pain» most often occurs in the feet. Even more serious are cases when the condition leads to tissue death and gangrene. If peripheral artery disease is serious, or isn’t improving with exercise and medication, doctors can reopen the blocked artery with angioplasty or use part of a blood vessel from elsewhere in the body to reroute circulation around the blockage. But the track record of these revascularization procedures is mixed, and some studies suggest that the results from a structured exercise program can be as good, or even better. 2. Chronic venous insufficiency Like peripheral artery disease, chronic venous insufficiency is a condition of poor circulation, but it involves the veins and the blood’s return trip back to the heart and lungs. Our arteries are springy and help push blood along, but our veins are relatively passive participants in circulation. Particularly in the legs, it’s the muscles surrounding the veins that provide the pumping power that drains the vessels near the surface of the skin and then push the blood up through the «deeper» vessels that travel toward the heart. Tiny valves inside the veins even out the pressure and keep the blood from flowing backward. In people with chronic venous insufficiency, the valves are damaged, so blood tends to pool in the legs and feet instead of traveling «north» to the heart. It’s often a vicious cycle: if the valves aren’t working, pressure from the blood collecting in the veins increases, so the veins stretch out. As a result, the valves don’t close properly, so even more blood flows backward, adding pressure. The most common symptom is swollen feet and ankles. Persistent fluid accumulation in the legs can also lead to inflammation of the skin (dermatitis), skin ulcers and an increased risk of skin infection (cellulitis). Legs may feel achy or heavy. And when people walk, they may feel an uncomfortable tightness in the legs. Damaged valves in veins happens commonly with chronic venous insufficiency. The symptoms from chronic venous insufficiency can be helped by lying on your back and using a pillow to elevate your legs so blood flows downhill to the heart. If you’re sitting for long periods, pointing your toes up and down several times can flex the vein-pumping leg muscles. Compression stockings that squeeze harder at the ankle than at the knee can be very effective at reducing swelling and discomfort. For the stockings to work, they must be much tighter than the «antiembolism» stockings people routinely wear in the hospital. But because they are so tight, people often have a hard time getting them on. Washing a new pair can help. Some people coat their skin with talcum powder or wear thin, regular stockings underneath. There are no specific medicines to treat venous insufficiency. Surgical procedures have improved significantly over the years. Nowadays varicose vein therapy has moved very far away from the old-fashioned saphenous vein stripping. That procedure involved making an incision in the groin and leg, inserting a stripping device into the vein, and pulling the vein out of the body. It usually required general anesthesia, an overnight hospital stay and weeks of recovery. Today, physicians usually close the vein permanently rather than remove it. They use one of several minimally invasive techniques, performed through catheters inserted into the veins under ultrasound guidance. These treatments are performed in outpatient settings under local anesthesia, and the patient can walk immediately after treatment. 3. Lumbar spinal stenosis Stenosis (pronounced ste-NO-sis) is a medical term for any kind of narrowing. Spinal stenosis can occur anywhere along the spine as a result of the vertebrae, the disks between them, or their supporting structures impinging on the tube-like spinal canal that holds the spinal cord and the roots of the nerves that branch off of it. Pain comes from the mechanical pressure, and perhaps also from the pinching off of blood flow to nerves. The lumbar region of the spine consists of the five large vertebrae that form the small of the back. When spinal stenosis occurs in the lumbar region, lower back pain can be a symptom but often it’s the legs that are affected. The pain can resemble the pain caused by peripheral artery disease: cramping tightness that increases with walking, although it’s often felt in the thigh rather than the calf. The legs may also feel weak and numb. In the past, the leg pain caused by lumbar stenosis was called pseudo-claudication because it was unrelated to blocked arteries, and doctors didn’t understand that it could be caused by spinal problems. Now the preferred medical term seems to be neurogenic (which means originating from the nervous system) claudication. Vertebrae, disks, and other parts of the spine impinge on the spinal cord and nerves branching off of it. The diagnosis starts with discussion of symptoms and medical history. One important clue is whether the pain eases when the back is curved forward or flexed. That posture tends to take pressure off the lumbar region, and it’s the reason some people with lumbar spinal stenosis find it easier to walk when leaning on a grocery cart or a walker. An MRI or CT scan will often be ordered to confirm a diagnosis, but imaging studies shouldn’t be used to make one. Many people have spinal stenosis that shows up on an imaging study but doesn’t cause any symptoms. Treatment usually begins with physical therapy and exercises aimed at strengthening back and abdominal muscles. Pain relievers may help. Corticosteroid injections into the spine may provide temporary reduction in pain, but they are not a long term solution. If the pain persists, surgery is an option. The most common procedure is a laminectomy, which involves cutting away part of a vertebra to create more space for the spinal cord and nerves. Bone spurs and portions of the disks and facet joints can also be removed to relieve pressure. 4. Diabetic neuropathy People with diabetes are prone to nerve damage, or neuropathy. Exactly why is uncertain. High blood sugar levels may damage the tiny blood vessels that supply nerves with oxygen and nutrients. Diabetes may also deplete the body’s store of neurotrophic peptides, chemicals that normally repair and regenerate nervous tissue. Blood vessels (shown in red) that supply nerve cells can be damaged by high blood sugar. Diabetic neuropathy affects the upper and lower legs in different ways. In the upper leg, the pain from a damaged nerve can come on suddenly and be felt in just one leg. In the lower legs and feet, where it is more common, the symptoms are typically numbness or tingling, and are usually felt about equally in both legs. The numbness often dulls painful sensations, so sores on the feet go unnoticed and get worse. Diabetic neuropathy can make walking difficult, but leg pain may improve with exercise. People with diabetes can reduce their chances of developing neuropathy by keeping their blood sugar down. It’s less certain that tight blood sugar control is helpful once nerves have been damaged. Still, it’s an important goal for many other reasons. Pain relievers, tricyclic antidepressants (amitriptyline, desipramine, duloxetine), and anticonvulsants (carbamazepine, gabapentin, pregabalin) are used to control the burning and tingling sensations from neuropathy.
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Sore Muscles? Don’t Stop Exercising

Delayed onset muscle soreness is common after exercise and usually means your muscles are getting stronger. Starting a workout program can be challenging. Making the time to exercise, creating a balanced routine, and setting goals are hard enough, but add to that the muscle soreness that comes with adapting to that regimen, and it may be difficult to stay on track. Chances are, you won’t be leaping out of bed to get to the gym when it hurts to hold your arm up to brush your teeth. After participating in some kind of strenuous physical activity, particularly something new to your body, it is common to experience muscle soreness, say experts. «Muscles go through quite a bit of physical stress when we exercise,» says Rick Sharp, professor of exercise physiology at Iowa State University in Ames. «Mild soreness just a natural outcome of any kind of physical activity,» he says. «And they’re most prevalent in beginning stages of a program.» Exercise physiologists refer to the gradually increasing discomfort that occurs between 24 and 48 hours after activity as delayed onset muscle soreness (DOMS), and it is perfectly normal. «Delayed onset muscle soreness (DOMS) is a common result of physical activity that stresses the muscle tissue beyond what it is accustomed to,» says David O. Draper, professor and director of the graduate program in sports medicine/athletic training at Brigham Young University in Provo, Utah. To be more specific, says Draper, who’s also a member of the heat-responsive pain council, delayed onset muscle soreness occurs when the muscle is performing an eccentric or a lengthening contraction. Examples of this would be running downhill or the lengthening portion of a bicep curl. «Small microscopic tears occur in the muscle,» he says. The mild muscle strain injury creates microscopic damage to the muscle fibers. Scientists believe this damage, coupled with the inflammation that accompanies these tears, causes the pain. «The aches and pains should be minor,» says Carol Torgan, an exercise physiologist and fellow of the American College of Sports Medicine, «and are simply indications that muscles are adapting to your fitness regimen.»

Even Bodybuilders Get Them

No one is immune to muscle soreness. Exercise neophytes and body builders alike experience delayed onset muscle soreness. «Anyone can get cramps or DOMS, from weekend warriors to elite athletes,» says Torgan. «The muscle discomfort is simply a symptom of using your muscles and placing stresses on them that are leading to adaptations to make them stronger and better able to perform the task the next time.» But for the deconditioned person starting out, this can be intimidating. People starting an exercise program need guidance, Torgan says. «The big problem is with people that aren’t very fit and go out and try these things; they get all excited to start a new class and the instructors don’t tell them that they might get sore,» she says. «To them they might feel very sore, and because they aren’t familiar with it, they might worry that they’ve hurt themselves. Then they won’t want to do it again.» Letting them know it’s OK to be sore may help them work through that first few days without being discouraged.

Ease Those Aching Muscles

So what can you do to alleviate the pain? «Exercise physiologists and athletic trainers have not yet discovered a panacea for DOMS,» says Draper, «however, several remedies such as ice, rest, anti-inflammatory medication, massage, heat, and stretch have been reported as helpful in the process of recovery.» See what amino acids are made of and how they’re used to help decrease muscle fatigue. Stretching and flexibility are underrated, says Sharp. «People don’t stretch enough,» he says. «Stretching helps break the cycle,» which goes from soreness to muscle spasm to contraction and tightness. Take it easy for a few days while your body adapts, says Torgan. Or try some light exercise such as walking or swimming, she suggests. Keeping the muscle in motion can also provide some relief. «Probably the most important thing is to have a cool-down phase after your workout,» says Draper. Right before finishing, include 10 or so minutes of «easy aerobic work such as jogging or walking followed by stretching.» At Brigham Young, Draper has been researching the use of heat remedies to treat muscle soreness. In clinical tests, a portable air-activated heat wrap — in this case a product called ThermaCare — applied directly to the skin was beneficial to subjects. «When muscle temperature is increased, blood flow increases, bringing fresh oxygen and healing nutrients to the injured site,» he says. «This increased blood flow also helps to wash away the chemical irritants responsible for pain.» While sore, don’t expect to set personal records. Most likely, during a bout of DOMS, your exercise potential will be out of reach, says Draper. Delayed onset muscle soreness usually affects only the body parts that were worked, so perhaps you can work other muscle groups while letting the fatigued ones recover. In a nutshell, don’t beat yourself up. Just take it easy. «Since there’s a loss in muscle strength, athletic performance won’t be at peak levels for a few days,» says Torgan, «so it’s best to plan a few days of easy exercise to prevent further muscle damage and reduce the likelihood of injury.»

Don’t Get in a Rut

It’s also a process of muscle conditioning. Torgan says delayed onset muscle soreness also has a «repeated bouts» effect. «If someone does an activity, they will be inoculated for a few weeks to a few months — the next time they do the activity, there will be less muscle tissue damage, less soreness, and a faster strength recovery.» This is why athletes often cross-train and vary their routines to continue to challenge and develop their muscle strength. It is important to distinguish the difference between moderate muscle soreness induced by exercise and muscle overuse or injury. «If soreness prevents you from performing daily activities associated with living and work, then that is too much soreness,» Draper says. «It can psychologically deter someone from continuing a workout program.» Both Draper and Torgan stress that soreness is not necessary to see improvements. «There are all kinds of different little roads that your muscles can take to get stronger,» says Torgan. Regardless of whether you’re sore, there are still improvements occurring in your muscles during exercise. However, moderate muscle pain might go a long way to keeping someone on the path to fitness. «Soreness can serve as encouragement in a workout program because people like immediate results. Muscle doesn’t visibly [grow] overnight; nor does your time in the mile drop from eight to six minutes,» says Draper. «So something like soreness can give people encouragement that they are in fact working the muscle.»


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