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Leg Pain


Low back pain and lower extremity (leg and/or buttock) pain are two distinct entities, in need of discussing. The cause and treatments of low back pain differs from when there is extremity (radiating buttock and leg) pain accompanying it.

Lower extremity (buttock, leg, calf) pain, which radiates from the low back, is usually the result of pressure on a nerve.  The pain is in the same area as the distribution, which the nerve supplies.

The cause, incidence and treatment of low back pain VS lower extremity pain must be distinguished, as they represent different pathologies. When the extremities are involved, such extremity pain is referred to as "radicular pain." This refers to pain that radiates or shoots down the leg, from the low back into the buttock, leg or calf.

Radiating pain results from the pinching of a nerve, and the pain pattern radiates along the distribution of the nerve.

Nerve Distribution

Each nerve from the lumbar spine has a characteristic distribution as follows:

Motor function to muscles called “myotome”

Sensory distribution to the skin called “dermatome”

Reflex , as when the doctor hits your knee to elicit a knee jerk reflex.

Dr. Skala is trained in identifying which nerve is responsible for each of the sensory, motor and reflex functions and can determine the nerve or nerves that are involved during your physical and neurologic evaluation. This is part of the data Dr. Skala uses to arrive at an accurate diagnosis in each and every case.

Low back pain, on the other hand, is not due to the pressure on a nerve root, as lower extremity pain is, but is more of a mechanical pain, due to strain and sprain of the ligaments and tendons of the low back, and due to degeneration or damage of the disk space and facet joints which hold the spine together.

Lower extremity (buttock, leg, calf) pain, which radiates from the low back, is usually the result of pressure on a nerve.  The pain is in the same area as the distribution, which the nerve supplies.


The following conditions can cause radicular pain in your leg and must be ruled out by Dr. Skala prior to consideration for non invasive non surgical spinal decompression.


This is the term used to reflect narrowing between the joints of the spine. The space in the spine joint is much smaller, or closed up. This narrowed condition, or closing up, causes "pinching" on the nerves within the spinal canal.

Spinal nerves supply movement, sensation and function of organs in the lower extremities. When these nerves are pinched within the canal, loss of function of the bowel, bladder and sexual activities as well as pain can be caused, radiating down to the lower extremities. The pain is generally worse when in a standing position or when walking due to the effects of gravity. When standing, there is more pressure on the nerves, but when bending over or sitting, the structures are opened, the ligament is stretched, resulting in decompression of the nerves


Simply means that one vertebra has slipped forward of another. It generally results from a "break" in the bone section that helps the vertebra to stay connected to each other (technically known as the pars interarticularis), but can also result from degenerative changes in the joints holding the bones together. This condition can cause low back pain, and can also cause lower extremity (buttocks, leg and calf) pain when the slipped vertebrae pinches the nerve(s).

Compression Fractures

There is a fracture called the compression fracture, which arises from constant pressure, build up or sudden pressure builds up. They are usually quite painful, can occur for a variety of reasons. First, and most obviously, trauma. Certainly, injuries such as motor vehicle accidents or falls can cause fractures. Osteoporosis, which is weakening of the bones due to loss of calcium, can predispose the bones to fracture. If the bones are weak, then it doesn't take much stress to fracture them. Cancer can also weaken the bones. Some types of tumors will actually eat away at the bone, causing mild or severe degrees of bone weakness.


This is an endemic problem in this country and one that is ever increasing. It is a disease with a very common cause of bone fractures. Roughly 28 million people in the United States are affected, and women are more significantly affected than men. 50 percent of women and 13 percent of men will suffer from fractures as a result of osteoporosis. When bone is weak, it doesn't take much pressure to cause it to fracture. Events of minor trauma, even picking up a heavy object the wrong way, may cause fractures of weak bone. This is the reason they are termed “compression” fractures. The fracture can occur from only mild pressure (compression), since then bone was already weak.

Arthritis (osteoarthritis and rheumatoid arthritis)

This refers to degeneration of bones and joints and it can occur anywhere in the body, including the spine. Many believe that a certain degree of arthritis is part of the normal aging process. Degeneration of the joints, including any associated narrowing of the openings through which the nerves travel (foramina), is also thought by many to occur as a result of aging. However, with the effects of aging combined with other predispositions as being over weight, having heart or respiratory problem which keep people from exercising, inactivity, injury, accidents, overexertion, strenuous movement, dietary factors, predispositions as smaller canal shape and stress, it’s no wonder why we are a society suspect to back pain. That’s where decompression comes in to reverse all the physical effects of degeneration, disc bulge and hernia, stenosis, even arthritis and stress.


This is the term used to describe an infection of the vertebra of the spine. The most common occurrence comes as a result of previous spinal surgery. An infection may also travel from other infected organs (such as kidneys or bladder) through the blood. While it is relatively uncommon, patients with diabetes, or other diseases affecting the immune system, are at a higher risk.


This is a term used to describe an infection of the disc. It is most often seen only in patients with immunodeficiencies.


This is the condition known as “softening” of the bones in the body. Its primary cause is a deficiency of calcium and phosphorus. This can be corrected by supplementation therapy, vitamin D, calcium and medication.


When there is cancer of the spine, it is usually what is termed “metastases” or a cancer in the spine that has spread from other parts of the body (metastases). Common causes are breast and prostate cancers. Some cancers, such as multiple myeloma, can originate within the spine. Typically, lying down or bending forward does NOT relieve the low back pain associated with cancer of the spine.

Referred Organ Pain

Some organs as the gall bladder, kidneys, prostate or conditions thereof as kidney infections, ulcers, gallstones, prostate disease can cause pain in the low back that is referred from the organ sites.


This is a relatively new condition, often a diagnosis given to some patients who experience low back pain and aching joints. It is characterized by a diffuse non-descript pain accompanied by fatigue and often presents difficulty with sleeping. Science is attempting to distinguish it from a syndrome, versus a specific disease. There is no standard radiographic evidence to define it and often it accompanies an emotional component.

Reflex Sympathetic Dystrophy (RSD)

RSD is an ill defined source of pain, experienced as both a painful and often burning sensation in an extremity, often minor in nature. While the exact cause is not clearly understood, it often responds to a selective nerve blockade of the sympathetic nervous system. RSD is usually brought on by a trauma of some sort, perhaps even contains an emotional component.


There are two types of claudication that can be responsible for leg pain.

Vascular claudication: Insufficient blood supply to the legs (arterial insufficiency). It is brought upon by walking.

Neurogenic claudication: Pain in the lower extremities brought upon by walking. This is often caused by pressure upon the spinal nerves within the spinal canal, usually the result of the gravity effects causing the disc and weakened ligaments to bulge into the nerves when standing.

Both types of pain must be distinguished from other causes of lower extremity pain. The major difference between these two is that merely standing (even without walking) causes neurogenic claudication but not vascular claudication. Vascular claudication can be brought on even when not standing.

Take the first step to a healthier and better life:
call Dr. Richard K. Skala today!


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