What Ails You: How to fight back against leg pain

About half the folks who come to see me complain of leg pain. There are many conditions which can cause leg pain. Disease in the joints, back problems, compression of nerves or irritated ligaments that refer pain to the legs and diseases that effect the nerves themselves. Today we are going to talk about peripheral arterial disease (PAD).

Peripheral vascular disease (PVD) refers to disease in the blood vessels. Now while disease affecting the blood vessels can certainly cause problems in the heart and brain, we are talking today about specific problems with your arteries.

Genetics plays an important role in whether or not you will develop vascular disease. You can’t do anything about your genes, but there are other factors which you can control.

Quit smoking.

Lose weight.

You knew those were coming, didn’t you?

Diabetes has the potential to rob you of your limbs and your sight long before it robs you of your life. I know it’s challenging, but you absolutely must pay attention and do everything you possibly can to keep your diabetes under control.

The same goes for your blood pressure.

One of the most obvious causes of blood vessel problems is high cholesterol. We talked recently about plaques of cholesterol collecting in the blood vessels like rocks alongside a creek. Behind the plaques, blood pools. Beyond the plaques, blood flow may be restricted or blocked. If you have tried for three months to control your cholesterol with diet and exercise without success, talk with your doctor about medical management. There are several good medications which can lower your cholesterol dramatically.

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

If you are having leg pain frequently — 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 happens 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.

If your disease is more severe, you may have noticed that wounds on your feet or toes may heal more slowly than you expected, but if you also have diabetes, this sign can be misleading. You may also notice that one leg is markedly cooler than the other. Don’t judge by whether you brain says the leg is cooler or not. When you touch each leg, you will notice the skin actually feels cooler on the painful leg. You may or may not notice changes in the color of the leg.

When you complain to the doctor about your symptoms, he may test for circulation in your extremities by taking your blood pressure around each ankle comparing it to the blood pressure in your arms. Your blood pressure will be somewhat lower in your legs, but should be the same in both legs. Normal ankle pressure is about 90 percent of arm pressure With severe narrowing in the arteries, the pressure in your legs may be only 50 percent of that in your arms.

If your blood pressure indicates a problem, your doctor may order other tests like Doppler or Ultrasound imaging, CT scan or angiography.

Folks with PAD are at significant increased risk for stroke and heart attack yet they are often undiagnosed. For this reason, it is imperative that you not put off talking to your doctor about your concerns.

The single most effective treatment for PAD is exercise. I know you are wondering if the primary complaint associated with PAD is pain when exercising, how are you going to exercise to improve your condition? This is where your physical therapist comes in. 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 and they improve in strength, they will grow new blood vessels which improves their circulation and which decreases your pain.

You must alternate periods of exercise with adequate periods of rest so that you stop exercise before the pain begins and resume again as soon as possible, but not before your muscles have a chance to recover. Even if you are unable to attend physical therapy regularly, make an appointment with your therapist to discuss an appropriate exercise program.

For a small number of patients with advanced or particularly persistent disease, surgery may be indicated. In these minimally invasive procedures, a stent is placed in the blood vessel to hold it open. A stent is a tiny, wire mesh cylinder. Your surgical options are more appropriately discussed with your doctor, but do try conservative treatment first. Surgery or not you are going to have to make certain lifestyle changes to improve your disease.

ABOUT THE WRITER:

Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at jranda@aol.com.