When you think about lower back pain (LBP), you might envision someone hunched over, clutching their lower back. We have all experienced back pain at some point, and we can probably recall how it limited our movements during the acute phase of our last back pain episode. However, when lower back pain comes with different symptoms, like tingling or shooting pain down one leg, it can be both perplexing and concerning. Let’s take a closer look at the anatomy of the low back to better understand where these symptoms come from.
In the front of the spine, closer to the inside of your body, you’ll find the large vertebral bodies and shock-absorbing disks that support about 80% of your weight. Toward the back of each vertebra, there are the spinous and transverse processes that connect to the muscles and ligaments in your back. Between the vertebral body and these processes are tiny bony pieces called the pedicles. The length of these pedicles partially determines the size of the openings through which the nerves exit the spine.
When the pedicles are short (often due to genetic factors), the exiting nerves can get compressed due to the narrowed openings. This is known as foraminal spinal stenosis. This compression usually occurs later in life, especially when osteoarthritis and degenerative disk disease further crowd these “foramen” where the nerves exit the spine.
Similarly, short pedicles can also narrow the “central canal” through which the spinal cord travels up and down the spine from the brain. Later in life, the combined effects of the narrow canal, along with disk bulging, osteoarthritic spurs, and ligament thickening or calcification, can result in “central spinal stenosis.” Symptoms related to spinal stenosis (whether foraminal or central) often involve difficulty walking, with a gradual increase in tingling, a heavy or crampy feeling, and sometimes aches or soreness in one or both legs. The tingling in the legs linked to spinal stenosis is referred to as “neurogenic claudication,” and it must be distinguished from “vascular claudication,” which feels similar but is caused by inadequate blood flow to the legs, rather than nerve issues.
In younger individuals, tingling in the legs can be caused by a bulging or herniated lumbar disk, or it may be referred pain from a joint, usually a facet or sacroiliac joint. The main difference in symptoms between nerve-related and joint-related leg tingling is that nerve pinching from a problematic disk is located in a specific area of the leg, such as the inside or outside of the foot.
In other words, the tingling can be traced fairly specifically in the leg. Tingling from a joint is often described as a deep, “inside the leg,” generalized achy-tingling that can affect the entire leg or foot or may stop at the knee, but it’s more challenging to pinpoint as it’s less specific in its location.
If these symptoms sound familiar, get in touch with us and we’ll help create the right treatment plan for you.