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Lower-back and leg pain: Causes and treatments

Reviewed by Dr. Nileshkumar Patel, M.D., M.B.A.

Though often caused by muscle strain and normal wear and tear of the body, back pain may also be a symptom of more serious conditions. In some cases, back pain can extend to other areas of the body, specifically to your legs. When this happens, it’s important to identify the root cause and find a treatment that fits your pain.

What are causes of lower back and leg pain?

Some common causes of lower back and leg pain may include:

Lumbar degeneration and arthritis

This is the most frequent cause of lower back pain that may travel to the buttocks and thighs, but not past the knees. It is not typically associated with numbness or tingling. This type of pain can be due to sacroiliac joint and facet arthritis, as well as tears in the disc and changes at the junction between the disc and the vertebral bone. An MRI or x-ray alone may not give the diagnosis and specialized test blocks may be needed to identify the source of the pain. A qualified pain specialist who understands the full range of diagnostic procedures can help determine the root of the problem. Once a definitive diagnosis is made, specific solutions can be found to fit your pain.

Herniated disk

A lumbar herniated disk is a ruptured disk in your lower back. It occurs when the nucleus, the soft inner portion of the disk is pushed out of your spinal disk through a tear. This can cause severe pain that radiates down your leg.

Sciatica

Sciatica is lower back pain caused by or associated with the sciatic nerve. The sciatic nerve runs from the lower back down the back of each leg. Pain caused by stress on the nerve can affect the lower back, pelvic area, hips, and legs. Symptoms of sciatica pain are often isolated to one leg and include muscle weakness, tingling sensations, and numbness.

Lumbar Spinal Stenosis (LSS)

Lumbar spinal stenosis is a condition in which there is narrowing of the spinal canal. This narrowing, called spinal stenosis, may cause pressure on the sciatic nerve leading to a dull and aching pain in the legs with or without back pain. Pain is usually worsened when standing or walking. You may feel relief when you lean forward or sit. For most people, LSS develops gradually over time and is most common in adults over the age of 60. The pain from spinal stenosis worsens with standing and walking.

Neuropathic pain

The symptoms of neuropathic pain are numbness, tingling, burning pain, with or without hypersensitivity, and allodynia (light touch or cold can cause pain). The type of pain can occur on one side or both sides of your body.

  • Symmetrical painful peripheral neuropathies can occur in the setting of diabetes, small fiber neuropathy, after radiation and chemotherapy, as well as idiopathic (cause cannot be defined). The pain tends to be worse at night.
  • Asymmetric neuropathic pain can occur long after the person has healed from an injury or surgery. It can also be due to entrapment of a peripheral nerve. Symptoms may include burning pain, hypersensitivity, discoloration, and pain from normal stimuli such as light touch or light stroking of the region. In the past this was called reflex sympathetic dystrophy but is now termed complex regional pain syndrome.

What are the treatment options for lower back and leg pain?

According to a report by the US Department of Health and Human Services,1 it is important to have an early, accurate diagnosis and a multidisciplinary approach that is personalized to the specific needs of each individual patient. After a trial of 3 months of conservative options (medications, restorative therapies, and behavioral treatments), if your pain does not improve, seek a pain management consultation from a qualified physician who can give an accurate diagnosis on the source of pain and offer a highly personalized treatment regimen tailored to your specific needs. 

Medication

In minor cases, your doctor may recommend over-the-counter pain medications. Prescription pain medications may help relieve leg and back pain, though they are not always effective. These medications include anti-inflammatory, anti-seizure drugs, anti-depressants, muscle relaxants and others, often used alone or in combination. If symptoms don’t improve after 12 weeks of trial of various pain medications, your doctor may recommend alternative treatment options.

Restorative therapies and alternative therapies

With the right plan, physical therapy exercises can help strengthen the muscles in your lower back and legs to improve posture, relieve nerve pressure, and reduce pain to manageable levels. However, there's no guarantee that physical therapy will be successful since each person’s pain is unique. Be sure to discuss with a professional before starting this type of treatment. Massage, acupuncture, TENS units, heat and cold pack may provide temporary respite.

Behavioral therapies

Mindfulness, coping strategies and cognitive therapies have all been shown to help though access is often limited. Use of app-based therapies, as well as virtually reality-based therapies, may help.

Interventional treatments

If you have severe lower back and leg pain, it may be time to consider other treatment options. At Boston Scientific, we offer treatment options that can be personalized to fit your unique pain. 

Depending on your condition, it may be worthwhile to explore alternative options such as radiofrequency ablation, spinal cord stimulation (SCS) therapy or the Vertiflex™ Procedure†.

Spinal Cord Stimulation Therapy (SCS)

SCS therapy is a procedure that uses an implanted device to deliver mild electrical impulses to your spinal cord. This interrupts the pain signals that your nerves send, which can help prevent you from feeling the pain.

The Vertiflex™ Procedure†

The Vertiflex Procedure is a clinically proven, minimally invasive solution that is designed to deliver long-term relief from leg and back pain associated with lumbar spinal stenosis (LSS).

Radiofrequency Ablation (RFA)

Axial non-radicular lower back and buttock pain can arise from specific structures. Your pain doctor may perform a test block to precisely delineate the source of the pain, and then follow up with radiofrequency ablation (RFA) of the affected nerve. Patients who respond well to RFA can expect pain relief that lasts from six to 12 months.2-4 

When should I consider seeing a doctor about my pain?

Persistent leg and back pain are often symptoms of more severe medical conditions. In some cases, pain may improve within a few days, but some conditions can cause debilitating pain for weeks at a time.

If you begin to experience regular, daily pain or worsening symptoms, seek immediate medical assistance. Discuss treatment options with your doctor to ensure that your treatment needs are met with the right pain management solution. To get started, you can use our physician locator to find a pain specialist near you.

Wondering which of our pain management solutions may be right for you?

Take this quick quiz and find out. ⟶

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†Superion™ Indirect Decompression System

Reference: 1. U.S. Department of Health and Human Services (2019, May). Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations. Retrieved from U. S. Department of Health and Human Services website: https://www.hhs.gov/ash/advisory-committees/pain/reports/index.html 2. MacVicar J, Borowczyk JM, MacVicar AM, Loughnan BM, Bogduk N. Cervical medial branch radiofrequency neurotomy in New Zealand. Pain Med. 2012;13(5):647-654. 3. Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine. 2000;25(10):1270-1277. 4. Govind J, King W, Bailey B, Bogduk N. Radiofrequency neurotomy for the treatment of third occipital headache. J Neurol Neurosurg Psychiatry. 2003;74(1):88-93.

Indications for Use: The Boston Scientific Spinal Cord Stimulator Systems are indicated as an aid in the management of chronic intractable pain of the trunk and/or limbs including unilateral or bilateral pain associated with the following: failed back surgery syndrome, Complex Regional Pain Syndrome (CRPS) Types I and II, intractable low back pain and leg pain, Diabetic Peripheral Neuropathy of the lower extremities, radicular pain syndrome, radiculopathies resulting in pain secondary to failed back syndrome or herniated disc, epidural fibrosis, degenerative disc disease (herniated disc pain refractory to conservative and surgical interventions), arachnoiditis, multiple back surgeries. The Boston Scientific Spectra WaveWriter™, WaveWriter Alpha™ and WaveWriter Alpha™ Prime SCS Systems are also indicated as an aid in the management of chronic intractable unilateral or bilateral low back and leg pain without prior back surgery.

Contraindications. The Spinal Cord Stimulator systems are not for patients who are unable to operate the system, have failed trial stimulation by failing to receive effective pain relief, are poor surgical candidates, or are pregnant.

MR Conditional symbol

Boston Scientific’s ImageReady™ MRI Technology makes safe MRI head scans possible. Patients implanted with the Precision Spectra™ or Spectra WaveWriter™ Spinal Cord Stimulator Systems with ImageReady™ MRI Technology are "MR Conditional" only when exposed to the MRI environment under the specific conditions defined in the applicable ImageReady™ MRI Head Only Guidelines for Precision Spectra™ or Spectra WaveWriter™ Spinal Cord Stimulator Systems.

MR Conditional symbolBoston Scientific’s ImageReady™ MRI Full Body Technology makes safe MRI scans possible. The Precision Montage™ MRI, WaveWriter Alpha™ and WaveWriter Alpha™ Prime SCS Systems with ImageReady™ MRI Full Body Technology are “MR Conditional” only when exposed to the MRI environment under the specific conditions defined in the applicable ImageReady™ MRI Full Body Guidelines for Precision Montage™ MRI or WaveWriter Alpha™ and WaveWriter Alpha™ Prime Spinal Cord Stimulator Systems.

Warnings. Patients implanted with Boston Scientific Spinal Cord Stimulator Systems without ImageReady™ MRI Technology should not be exposed to Magnetic Resonance Imaging (MRI). Exposure to MRI may result in dislodgement of the stimulator or leads, heating of the stimulator, severe damage to the stimulator electronics and an uncomfortable or jolting sensation. As a Spinal Cord Stimulation patient, you should not have diathermy as either a treatment for a medical condition or as part of a surgical procedure. Strong electromagnetic fields, such as power generators or theft detection systems, can potentially turn the stimulator off, or cause uncomfortable jolting stimulation. The system should not be charged while sleeping. The Spinal Cord Stimulator system may interfere with the operation of implanted sensing stimulators such as pacemakers or implanted cardiac defibrillators. Advise your physician that you have a Spinal Cord Stimulator before going through with other implantable device therapies so that medical decisions can be made and appropriate safety measures taken. Patients using therapy that generates paresthesia should not operate motorized vehicles such as automobiles or potentially dangerous machinery and equipment with the stimulation on. Stimulation must be turned off first in such cases. For therapy that does not generate paresthesia (i.e. subperception therapy) it is less likely that sudden stimulation changes resulting in distraction could occur while having stimulation on when operating moving vehicles, machinery, and equipment. Your doctor may be able to provide additional information on the Boston Scientific Spinal Cord Stimulator systems.  For complete indications for use, contraindications, warnings, precautions, and side effects, call 866.360.4747 or visit Pain.com. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

Indications for Use: The Superion™ Indirect Decompression System (IDS) is indicated to treat skeletally mature patients suffering from pain, numbness, and/or cramping in the legs (neurogenic intermittent claudication) secondary to a diagnosis of moderate degenerative lumbar spinal stenosis, with or without Grade 1 spondylolisthesis, having radiographic evidence of thickened ligamentum flavum, narrowed lateral recess, and/or central canal or foraminal narrowing. The Superion™ Interspinous Spacer is indicated for those patients with impaired physical function who experience relief in flexion from symptoms of leg/buttock/groin pain, with or without back pain, who have undergone at least 6 months of non-operative treatment. The Superion Interspinous Spacer may be implanted at one or two adjacent lumbar levels in patients in whom treatment is indicated at no more than two levels, from L1 to L5. Contraindications, warnings, precautions, side effects. The Superion Indirect Decompression System (IDS) is contraindicated for patients who: have spinal anatomy that prevent implantation of the device or cause the device to be unstable in situ (i.e., degenerative spondylolisthesis greater than grade 1), Cauda equina syndrome, or prior decompression or fusion at the index level, scoliosis or spinous process fractures, osteoporosis, infection, allergy or reaction to any metal or implant or a high Body Mass Index. Avoid strenuous activity for 6 weeks after surgery, contact your physician if there is fluid leaking from your incision, if you have pain, swelling or numbness in your legs or buttocks or if you fall. Refer to the Instructions for Use provided on www.vertiflex.com for additional Indications for Use, contraindications information and potential adverse effects, warnings, and precautions prior to using this product. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

Indications for Use: The Boston Scientific Radiofrequency Generators, associated Radiofrequency Lesion Probes and RF Cannula are indicated for use in procedures to create radiofrequency lesions for the treatment of pain or for lesioning nerve tissue for functional neurosurgical procedures. The Boston Scientific RF Injection Electrodes are used for percutaneous nerve blocks with local anesthetic solution for radiofrequency lesioning of peripheral nerve tissue only. The Boston Scientific LCED and Stereotactic TCD Electrodes are indicated for use in radiofrequency (RF) heat lesioning of nervous tissue including the Central Nervous System.

Warnings: The Boston Scientific RF devices may cause interference with active devices such as neurostimulators, cardiac pacemakers, and defibrillators. Interference may affect the action of these active devices or may damage them. For appropriate guidance, consult the instructions for use for these active devices. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

§The physician locator tool identifies pain management specialists in your area who have met certain qualifying criteria and are experienced with one or more of Boston Scientific pain management therapies. All treatment options should be discussed thoroughly with a pain management specialist.