Demystifying Leg Pain vs. Back Pain

Because the nerves in the spinal column eventually travel down the legs, pain in one of these regions is often related to a problem in the other. Since many patients are unaware of the close relationship between leg and back pain, they often fail to recognize the true source of their pain or how their pain should be treated.

In this Polaris Mythbuster, Dr. Max Steuer clarifies some of the common misunderstandings patients have about leg pain versus back pain.

Max Steuer, M.D. of Polaris Spine & Neurosurgery Center in Atlanta, Georgia.

Myth #1: Spine surgeons primarily perform surgery on patients who are experiencing back pain.

Reality: Spine surgeons perform surgery most often on patients who are experiencing leg pain.

While many people think that spine surgeons are spending their time curing back pain, the truth is that, at least with the low back, surgeons most often trying to cure leg pain, usually caused by a pinched nerve.

“If the patient knows they have a problem with their back,” explains Dr. Max Steuer of Polaris Spine & Neurosurgery Center, “you can see how a patient would come in with back pain and think, I need back surgery. Thus, the patient coming in with back pain may be pushing for back surgery faster than it’s really needed. From our perspective, it’s just the opposite; if they’re having back pain, we’re going be more cautious with proceeding surgery, whereas if they’re having persistent nerve pain or leg pain, that may be more likely to be a surgical repair.”

The patients most likely to have surgical intervention are the ones where the nerve pain or leg pain is more prominent than the low back pain in general. There’s a greater risk of permanent nerve damage if it is allowed to continue without surgical correction.

TAKEAWAY: Don’t assume that your leg pain or weakness is contained to that area; it may stem from a nerve issue in the lower back, requiring treatment from a spine doctor.

Myth #2: Most back pain must be corrected by surgery.

Reality: Many back problems can be corrected without surgery.

“There are some patients that have their back pain as their greatest manifestation of a problem, and we end up doing a lumbar fusion on them,” says Dr. Steuer. “However, that is the exception that proves the rule.”

At Polaris, we prefer to pursue conservative measures like physical therapy, medications or injections for low back pain before considering surgical intervention.

TAKEAWAY: Back pain, particularly in the lower back, is not an automatic sign of a need for surgery. In fact, surgery is usually the last resort if non-invasive treatments don’t resolve the pain.

Myth #3: Pain, weakness, or numbness of the leg automatically points to a nerve issue requiring immediate surgery.

Reality: Nerve pain in the legs may also be corrected non-surgically.

Determining whether a patient needs surgery depends on a careful diagnosis of the problem. It takes three things to come to a diagnosis:

1. Listening to the patient’s history to see exactly how all this developed
2. Doing a very accurate physical exam to see what correlates, to see if there’s a sensory deficit, weakness or motor deficit
3. Imaging, which can involve both X-rays and an MRI.

“Using those three parts is how we try to figure out whether this a relatively benign thing, or if it’s more serious and whether we need to intervene quicker,” Dr. Steuer explains.

Under what circumstances might there need to be quicker intervention? Well, consider some patients who have some neurologic problems, like weakness and numbness, in their legs. If we’re monitoring them carefully over several weeks, and the weakness and numbness is improving, that’s a good sign that we can potentially hold off on surgical intervention.

TAKEAWAY: Leg pain should not be ignored, especially if it’s accompanied by weakness, numbness or tingling. But neither does it mean the patient is in immediate danger of permanent damage. The best course of action is to consult with a spine specialist to diagnose the problem and come up with a treatment plan. “Just because you have weakness and numbness doesn’t mean you’re going to have surgery,” says Dr. Steuer.

Leg Pain vs. Back Pain: The Bottom Line

Neither back pain nor leg pain automatically points to a need for surgery — but patients also need to be cautious about making assumptions when they are experiencing either or both types of pain. The best and most accurate indicator is a diagnosis from a spine specialist based on patient history, a physical exam and thorough imaging.

Why Polaris Spine & Neurosurgery Center?

Our team of spine doctors and specialists take a holistic approach to treating leg and back pain in patients — one that involves physical therapy, exercise, chiropractic care, and, in some cases, epidural or steroid injections. We recommend surgery only when it is absolutely necessary, and those recommendations are based on a thorough analysis of the patient’s unique medical history, physical exams, and radiological studies.

If you’re suffering from leg or back pain, we can help. Call Polaris Spine and Neurosurgery Center at 404-256-2633 for an evaluation.