Causes of Lower Back and Thigh or Lower Leg Pain

Low back pain that radiates down your thighs or legs can have several different causes. For instance, central lower back pain is often due to muscle strain while lower back pain that travels down the front of the thigh is usually caused by a pinched nerve. Sciatica is another common reason for pain in the back and thigh.

Low back and thigh pain can affect one or both sides. It may stop above the knee or go all the way to your foot.

This article examines the causes, symptoms, and treatments of lower back and thigh pain.

Anatomy of Your Spine

The lumbar spine, also known as the low back, is composed of five bones called vertebrae that are stacked one upon another. Between the bones are soft, spongy discs. Your spinal cord runs down the center and nerves split off from it and exit between vertebrae.

Many nerves originate in the low back and travel down through the buttocks or legs. Some types of low back pain involve those nerves and cause pain along their entire length.

Hip joints—which include muscles, tendons, and ligaments—attach to the lumbar spine, giving it both mobility and stability.

By monitoring where you feel the pain and understanding how your pain changes, you can help your healthcare provider or physical therapist diagnose and find the best treatments for you.

Here are the most common symptoms of problems coming from the low back:

Central Low Back Pain

Central low back pain is usually caused by small disk bulges or muscular strain in the low back. This type of low back pain usually responds to gentle stretches and postural correction.

Central Low Back Pain With Pain Down Both Legs

This is very typical of a condition called spinal stenosis. This condition occurs when the spinal canal is too narrow and the nerves that travel down the legs are compressed.

The common presentation of stenosis is low back and leg pain that worsens with walking and is often relieved with sitting or bending forward at the waist. Research shows that physical therapy can effectively treat spinal stenosis and should be considered before any surgical intervention.

One-Sided Lower Back Pain Only Above the Thigh

This pain presentation is usually due to muscular strain and should readily respond to postural correction and gentle stretching. A small bulging disc may also cause this type of back pain.

Degenerative arthritis may cause bony overgrowth around a joint in your spine, which may also pinch a spinal nerve, leading to pain in your back or buttock.

One-Sided Lower Back Pain With Thigh Pain

Usually, pain that travels down the thigh is due to a pinched nerve. Nerves can be pinched by either a bulging or herniated disc, an arthritic facet joint, or an overgrowth of bony material, such as a bone spur. Pain may or may not be accompanied by numbness or tingling in the thigh, and muscle weakness may also be present.

One-Sided Lower Back Pain With Pain In the Lower Leg or Foot

Pain that travels from the low back to the lower leg is called sciatica. Many consider this to be the most severe presentation of low back pain. The pain may or may not be accompanied by numbness or tingling. This is usually caused by a pinched nerve from a lumbar disc, an arthritic joint, or a bone spur.

Treatments for Low Back and Leg Pain

Treatment for low back and leg pain depends on the underlying cause:

• Muscle strain may be treated with rest, hot and cold compresses, abdominal-strengthening exercises, and gentle low back stretches. More severe muscle strains may be treated with steroid injections to relieve pain.
• Spinal stenosis may be treated with physical therapy to strengthen back, stomach, and leg muscles, NSAID medications, steroid injections, acupuncture, or surgery to remove bone spurs.
• Arthritis pain may be relieved with NSAID medications, steroid injections, and physical therapy. Surgery is an option for some people who do not achieve pain relief with more conservative treatments, and may involve decompressing the spinal cord to release entrapped nerves.
• Piriformis syndrome may be relieved with hip stretches and strengthening exercises, heat application, acupuncture, and steroid injections. Surgery to remove a portion of the piriformis muscle or its tendon is an option when conservative treatments are inadequate.
• Pinched nerve pain may be relieved with NSAID medication, rest, physical therapy, low back stretching and strengthening exercises. If these options do not help, an oral corticosteroid, or injected steroid treatment should relieve the pain.

Sciatica usually heals on its own with enough rest. In the meantime, you can help relieve sciatica-related low back and leg pain by:

• Taking a nonsteroidal anti-inflammatory (NSAID) medication, such as ibuprofen
• Applying heat or cold compresses to painful areas
• Doing low-impact exercises, like yoga, pilates, or swimming (movement increases circulation and helps reduce inflammation)

About 10% of people with sciatica have what's known as a lumbar discectomy to repair a herniated disc. This is the most common surgery done in people with sciatica, but about 40% of people who get it report persistent pain post-surgery.

Summary

Low back and leg pain may be related to nerves, muscles, tendons, or bones. Sciatica and muscle strains are two of the most common causes. It can be related to spinal stenosis, arthritis, a pinched nerve, or a condition called piriformis syndrome, which is particularly common in pregnant people.

Treatment depends on the underlying cause, and may involve a combination of NSAID medications, hot and cold compresses, physical therapy, and low-impact exercises like yoga. When conservative treatments are not enough to relieve pain, steroid injections or surgery may be an option.