Where does it hurt?
Pain can occur anywhere along your spine, from the neck down. But the most common site of discomfort is in the lower back—the area between the bottom of your rib cage and the bottom of your buttocks. Occasionally it can spread around the hips.
Many people with low back pain will also feel pain in the legs —anywhere from the bottom of the buttocks through the back of the thigh and down to the knee, calf, ankle and foot. The pain is usually in one leg but some people feel it on both sides.
The most important distinction is whether the pain is worse in the back, buttocks or hips (back dominant pain) or in the thigh, calf or foot (leg dominant pain). Back dominant pain is called “referred” pain. This is pain arising in one place, the disc for instance, but felt most intensely at a distance. Leg dominant pain is labelled “radicular” pain and is the result of the direct irritation of a nerve root in the spine. The pain travels along the course of the nerve down the leg. It is much less common than referred pain.
Back dominant pain can be felt in the leg and leg dominant pain can spread to the back. It is identifying the site of the most pain, not just where the pain goes, that makes the diagnosis.
Other common complaints
Along with pain you may also notice tingling, pricking sensations and other funny feelings in the back, groin, genital area, leg or foot. The legs may feel “weak” but this is often just a response to the pain. True weakness is rare and typically affects only specific areas and not the whole leg. Many people complain of stiffness or ‘tightness’ in their back, which goes away once they start moving around. In younger people, prolonged periods of morning back stiffness (more than half an hour) may indicate a more systemic problem.
A quick anatomy lesson
Pain can arise from many structures in your back. These include the bones (vertebrae); the joints between the vertebrae; the discs that serve as cushions between the vertebrae; the ligaments around the spine; the muscles and rarely the nerves themselves. Most of the time, even with x-rays and MRIs, it is impossible to be certain what structure is causing the pain.
What causes back and/or leg pain?
Over 90% of the time back and back-related leg pain is the result of minor mechanical problems, simple ‘wear-and-tear’. These changes can produce severe pain, but they are so small and hard to detect that, in most cases, it’s not possible to find a specific cause for the symptoms. Very rarely back and leg pain can come from a more serious problem, like an infection or an illness, but these cases can usually be recognized and treated.
What’s the difference between acute and chronic back and/or leg pain?
These terms are used by health care providers as a way of describing how long people have been experiencing their symptoms.
- ‘Acute’ is used to describe pain that has lasted for six weeks or less. Acute can also refer to the speed of onset of the pain; pain that starts suddenly. So the term can be a bit confusing. Most back pain is acute, it comes on quickly and it doesn’t last very long.
- ‘Sub-acute’ is used to describe pain that lasts longer than six weeks but less than three months
- The term ‘chronic’ is generally used to describe persistent discomfort that lasts for more than three months with little or no improvement. But it can also be used to describe pain that goes away but comes back again. By that measure, most back pain is chronic.
A typical timeline for recovery
While some back pain gets better in a matter of days, many people with back dominant pain improve over a period of weeks—maybe even months. Patients with true leg dominant pain usually take longer. This means that your life will be affected and you may need to limit certain activities at home and at work. Naturally this can be frustrating but if you are able to do more over time, you’re getting better—even if you still feel pain.
What to expect as you recover
Symptoms can change as you recover. If you’ve been less active for a few weeks or months you will lose some strength and as you try to get back to normal weak muscles can get stiff and sore. These aches and pains can interfere with your recovery and need to be balanced with short periods of rest or the use of simple pain relieving remedies such as those outlined in the Treatments Known to Work section of this website.
The chance of future back and/or leg pain episodes
More than half the people who have had one bout of back pain will experience a recurrence within a year. Mechanical back pain is a problem that can keep coming back but each episode can be successfully managed and there are strategies to minimize the negative impact. And the return of pain does not mean the problem is getting worse. As you may have heard and will hear again, in the back hurt does not mean harm. It is just the same minor mechanical difficulty acting up again.
It’s important to understand that if your symptoms do come back within a few months or years, you are still likely to recover. You should consider the approaches discussed on this website. As a rule if something worked for the last attach and it the recurrence is the same kind of pain then the treatment that helped before will probably help again. Of course the new episode of back pain can be quite different than an earlier attack and so each episode needs to be carefully assessed. If treatments that were helpful in the past don’t seem to be working this time, it may be time to take a different approach.