How to Fight Back Against Leg Pain

There are many conditions which can cause leg pain, such as disease in the joints, back problems, compression of nerves, or irritated ligaments that cause pain to the legs, and disorders that affect the nerves themselves (see neuropathy article on pages 3). Another cause of leg pain can be peripheral arterial disease (PAD).

PAD is also known as atherosclerosis, poor circulation, or hardening of the arteries. PAD worsens over time at variable rates in each individual, depending upon the area of circulation effected and one's health and family history.

Many folks who have PAD have no symptoms or have symptoms which masquerade as something else. One of the more common complaints is leg pain.

If you are having frequent leg pain—especially leg pain that stops you from doing the things you enjoy—do not dismiss it as simply evidence that you are aging. The leg pain associated with PAD occurs in the muscles rather than in the joints like the pain of arthritis. It is not numbness and tingling like the pain associated with back dysfunction. It is not burning pain in your lower legs and feet like diabetic neuropathy. It is not searing pain running down the back of your thigh like sciatica.

Leg pain from PAD likely occurs after you have been walking a bit. Early on, you may notice that the pain resolves fairly quickly when you stop exercising. After you rest a few minutes, you may be able to walk some more, probably for about the same amount of time you walked initially before the cramping occurs. This pattern of cramping is called "intermittent claudication" and it is one of the hallmark signs of PAD.

When you complain to the doctor about your symptoms, he or she may test the circulation in your extremities using a simple, non-invasive test known as the ankle-brachial index (ABI), which is a reliable means for diagnosing PAD. The ABI test involves measuring the blood pressures in the arms and the legs using a small ultrasound device known as a Doppler. A drop in the leg blood pressure is a sign of PAD.

The single most effective treatment for mild to moderate PAD that causes claudication is exercise. You may be wondering, if the primary complaint associated with PAD is pain when exercising, how are you going to exercise to improve your condition. It's very important that you start out slowly with exercise carefully measured to improve, but not aggravate, your disease. As you use your muscles, they will improve in strength and you will be able to walk farther with less pain.

To be effective, you must work to a level of moderate pain, stop after 8-10 minutes, and then rest until the pain goes away. Then, start walking again with moderate pain for 8-10 minutes, and then rest again. This cycle of pain and rest is repeated until you can complete about 50 minutes of total walking time. For most health conditions, the advice is to stop when you feel pain. However, for PAD, the advice is to walk with some pain because this is the stimulus for improvement. These are general guidelines, so be sure to discuss any treatment programs, including recommendations for exercise, with your health- care provider.

For more information about PAD or to download a walking log, please visit www.vdf.org or call 866-PAD INFO.

About the Author: Jackie Randa, DPT, OCS is a physical therapist who operates a small outpatient clinic in Barstow, CA.