Waist and Leg Pains

When we look at the general population, waist and leg pains are quite common and the most common cause of these pains is a herniated disc. Of course, not every back pain is caused by a hernia.
Although leg pain is caused by excessive strain of the muscles in the leg and degenerative changes in bone structures, it can also be caused by referred pain originating from the waist area.

When we look at the causes of low back pain, the most common causes are excessive exertion, anatomical posture disorders, congenital curvatures in the spine, lumbar slippage, calcification, and narrowing of the spinal canal. In addition to these, infections occurring in the lumbar region, various rheumatic diseases and cancers can also be listed.

When Should Someone Experiencing Low Back Pain See a Doctor?

Low back pain that occurs for a short time and gets better within a few days by using simple analgesic medications is not a situation that needs to be worried. However, it would be very useful to get support from a specialist physician for pain that lasts longer than 3 months and seriously affects life. Additionally, if you experience one or more of the alert findings below, your situation should be evaluated by a physician.

History of falling from heights or previous trauma
Low back pain that is severe enough to wake you up at night
Constant pain even at rest
Extreme limitation in daily movements
Feeling of lower back pain as referred pain in the leg
Numbness or tingling sensation in the leg that occurs over time
Paralysis
Urinary and fecal incontinence
malignancy
Excessive weight loss without diet or exercise in the last month

What are the Treatment Methods for Low Back Pain?

First of all, it should be kept in mind that not all back pain is caused by a hernia. Many back pain diseases can be prevented with simple rest, use of painkillers and lifestyle changes. Apart from these, the methods used for treatment are as follows:

Nonsteroidal anti-inflammatory, antirheumatic and muscle relaxant drugs, called pharmacological treatment
Physiotherapy schools such as applying cold or heat to the painful area, laser treatment, and methods of stimulating muscles and damaged nerves.
Using a corset and applying pain tapes in the lumbar region
Massage applications to the painful area
injections
Various exercise apps
Surgical treatment

The treatment methods listed above are generally used, but keeping in mind that the cause of most back pain is mechanical, lifestyle changes are among the rational solutions. Nowadays, the use of surgical methods has decreased considerably, and many low back pain problems have been solved with physiotherapy approaches.

Lumbar Disc Herniation (Herniated Disc)

A herniated disc, one of the most common causes of waist and leg pain, occurs as a result of degenerative changes in the discs between the vertebrae. Since the discs are cartilaginous, the forces applied here or the ruptures that occur will cause herniation over time and dull pain will be felt in the lumbar region. Discs that cannot fulfill their function of providing flexibility to the waist can wear out further and cause chronic low back pain.

Risk Factors for Disc Herniation

Irregular lifestyle, wrong nutrition, smoking and alcohol use
As we get older, the amount of water in the discs decreases and this decreased amount is not replenished.
Overexertion and poor anatomical posture
blunt trauma
Heavy lifting and sudden movements

Diagnosis of Disc Herniation

A patient who goes to the doctor with a complaint of severe back pain is diagnosed with a herniated disc as a result of examination, laboratory tests and radiological imaging methods. In some cases, neurological examination and EMG also help diagnosis.

Disc Herniation Treatment

Simple back pain can be relieved by rest and using painkillers, while some treatment principles are applied for chronic pain.

Disc herniation can be treated by using anti-inflammatory drugs, muscle relaxants, spinal injections and physical therapy methods. If the patient does not respond to all these, surgical treatment should be considered.

In order to prevent a herniated disc before it occurs, making lifestyle changes and avoiding movements that are excessively challenging to the lumbar region are among the correct behaviors.

Degenerative Disc Disease

Degenerative disc disease occurs as a result of the deterioration of disc tissue. This disease, which is completely different from herniation, can be easily recognized by showing symptoms on radiological images.

Reasons include decreased water content in the disc, various infections, smoking, and hereditary predisposition. Among these substances, it is very important to reduce the water content in the disc. Because the decreasing amount of water with aging will lead to easier deterioration of the discs.

The most common symptom of degenerative disc disease is unbearable pain in the waist and legs. These pains do not go away with changing positions or resting. It can lead to very negative daily lives and some psychological disorders in patients.

Treatment

In degenerative disc disease, if low back pain lasts longer than 6 months and there is no response to physiotherapy and steroid injections, surgical treatment may be considered.

The main thing to do is to drink plenty of water in daily life and strengthen the muscles in the waist area to protect against disease. Additionally, overweight patients should be supported to lose weight.

Facet Syndrome

Spinal movement consists of regular coordination of muscles and nerves. We encounter facet syndrome as a result of degenerative changes in the facet joints in the lumbar region. Because this creates weekly mechanical instability, patients will complain of lower back pain. 15-40% of the entire population suffers from facet syndrome.

The main function of the facet joints in the lumbar region is; It is to control the stabilization of the body during flexion and extension movements and to ensure key-lock harmony by preventing any sprain in the discs between the vertebrae. These facet joints cannot provide excessive rotation movements when flexing and can easily degenerate. The amount of load that the facet joints in the spine can carry increases from top to bottom. Since the maximum capacity that can be carried is determined, not overloading will be a good decision for your back health.

How Does Facet Syndrome Occur?

The basis of facet joint syndrome is postural disorders such as traumas that cause degeneration and excessive flexion-rotation movements. This degeneration mostly affects the L4-L5 facet joints. If there is a congenital facet joint anomaly, degenerative changes will occur more easily.

As a result of disc degeneration, the disc space decreases. As a result, the increase in load on the facets explains the main pathology in this disease. Over time, osteophytes and osteoarthritis may occur as a result of inflammation and may cause pain in the lower back.

The low back pain experienced in facet syndrome has no specificity for this disease. However, the pain is usually bilateral and does not show a radicular spread. The absence of pain in the knees is a guide in terms of diagnosis.

How Should Facet Syndrome Be Treated?

In acute syndrome, bed rest for a few days is recommended using analgesics. It will be beneficial to use a corset in the lumbosacral region. In cases where there is no response to simple analgesics, opioids can be tried. In addition, performing facet joint injection and denervation on suitable patients is also very relaxing. Surgical treatment is preferred in patients who do not respond to these applications, but its reliability is quite low due to lack of adequate follow-up.

Spinal Stenosis (Stenosis of the Spinal Canal)

Spinal stenosis, which generally affects older people in society and occurs as a result of narrowing of the discs between the vertebrae, causes severe low back pain. Since nerves pass through the spinal cord, the main pathophysiology in spinal stenosis occurs as a result of the compression on the nerves as a result of narrowing. The decrease in the amount of fluid with aging causes calcification in the joints, worsening the current situation and causing some neurological problems in patients. It causes numbness and tingling in the legs, causing problems in walking. Patients often say that their complaints increase with exercise and that they only get relief with rest. So how do we understand that there is stenosis in the spinal canal? Spinal stenosis can be easily diagnosed with a simple lumbar X-ray. Degeneration and narrowing are visualized by x-ray, but the most definitive diagnosis is made by magnetic resonance imaging. If necessary, tomography or myelography methods can also be used in advanced cases.

In the treatment of spinal stenosis, methods such as simple analgesics, muscle relaxants and physiotherapy are applied to patients. If the patient’s pain persists, we provide some relief to the back pain complaints by performing transforaminal and intraluminal steroid injections. If, despite all this, the patient continues to experience lower back pain complaints, surgical treatment is performed to relieve the spine by opening the narrow canal.

Sacroiliac Pain​

The sacroiliac region is located between the spine, hips and legs and provides load transfer by balancing the pressure there. Pain in this area is often caused by mechanical problems. The sacrum bone can break as a result of trauma. Sacroiliac pain, a disorder that can often be confused with a herniated disc, generally increases with excessive lifting and bending forward.

Pain felt in the lower back and around the hip is expressed by patients. In its diagnosis, simple radiography, computed tomography and magnetic resonance methods, which are radiological methods, are used. In the treatment of sacroiliac pain, analgesic medications and ice application are the first methods applied to patients. If physiotherapy treatments are not sufficient, steroid injections are made into the sacroiliac areas under local anesthesia. In advanced cases, radiofrequency thermocoagulation therapy is also applied.

Sciatica-Piriformis Syndrome​

Sciatic piriformis syndrome is a disease that occurs as a result of compression of the sciatic nerve, the longest nerve in the body, as it passes through the musculus piriformis. The patient’s standard of living drops considerably and the pain starts from the hip and spreads to the legs. The most prominent feature is a feeling of pain in the hip and numbness and tingling in the legs. Among other causes of lower back pain, hip pain increases with sitting on hard ground and crossing your legs.

The causes of this disease include mechanical trauma to the piriformis muscle, excessive exercise or a sedentary lifestyle, and congenital anatomical disorders. If you are experiencing pain that starts from the coccyx, spreads to the legs, and improves with movement and increases with rest, it would be beneficial to consult a physician.

The disease can be easily diagnosed with simple imaging methods, radiological applications such as magnetic resonance and computed tomography. In the treatment of sciatic piriformis syndrome, various analgesic and muscle relaxant medications can be applied as well as exercises that reduce muscle spasms in the body and strengthen the piriformis muscle. Corticosteroid injection into the area with the help of local anesthesia aims to reduce acute pain. Botox application may be preferred in patients who do not respond to these treatments. Osteopathic manipulative treatment, BTX-A injections and iontophoresis methods applied in recent years also provide very successful results.

Failed Back Surgery Syndrome

As a result of patients’ complaints of low back pain, especially in conditions such as a herniated disc, after surgical treatment, the symptoms do not regress, but rather progress, resulting in failed back surgery syndrome. In the hands of expert surgeons, the rate of experiencing failed back surgery syndrome is 3-5%.

So how do we identify patients who underwent unsuccessful back surgery?

Patients consult doctors again, especially after herniated disc surgery. Recurring hernias as a result of inadequate clearance of the disc space during hernia surgeries cause patients to experience lower back pain later on.
If the surgeon sees more than one hernia during the surgery and only removes the hernia that is causing the problem, after the operation the patient will think that he had a failed surgery because he was not adequately informed.
Patients may also suffer from spinal stenosis along with a herniated disc. If no intervention was made for spinal stenosis during the surgery, the patient will complain of low back pain again after the operation.
Even if the herniated disc surgery is successful, new hernias, spinal stenosis or lumbar slip may occur later.

Due to the reasons listed above, patients may experience back pain again after back surgery. In order to prevent this problem, it is extremely important to have complete patient-physician coordination. Of course, the possibility of unsuccessful application is minimal depending on the experience of the surgeon.