When considering low back pain (LBP), you may imagine someone bent over rubbing the sore point on their back. Many of us have experienced low back pain at some stage in our life, so we can relate to an episode and recall how restricted we were during the acute stage of our last LBP occurrence. However, when the symptoms connected to LBP are contrasting, such as tingling or a sharp pain down one leg, it can be confusing and concerning. To best understand where these symptoms derive from, we need to look at the anatomy of the low back.
In the front of the spine, the part mainly on the inside of our body, we have the large vertebral bodies and shock absorbing discs that support about 80% of our bodyweight. At the opposing side of each vertebrae you’ll find the spinous and transverse processes that are connected to the muscles and ligaments in the back, to the spine. Between the vertebral body and these processes are the tiny bone parts called the pedicles. Where the nerves exit the spine, the length of the pedicle partially controls the size of the holes.
When the pedicles are short, the exiting nerves can be compressed due to the narrowed opening; this is known as foraminal spinal stenosis. This compression generally happens as we age, when osteoarthritis and/or degenerative disc disease progressively crowds these “foramen” where the nerves exit the spine.
Likewise, short pedicles can narrow the “central canal” where the spinal cord travels up and down the spine from the brain. As we get older, the effects of the narrow canal plus disc bulging, osteoarthritic spurs, and/or thickening or calcification of ligaments can result in “central spinal stenosis.” The indicators linked with spinal stenosis include difficulty walking due to a gradual increase in tingling, heavy, crampy, achy and/or sore feeling in one or both legs. The tingling in the legs associated with spinal stenosis is called “neurogenic claudication” and must be segmented from “vascular claudication”, which feels similar but is caused from lack of blood flow to the leg(s) instead of to the nerve.
When we are younger, tingling in the legs can be caused by either a bulging or herniated lumbar disc or it can be referred pain from a joint – usually a facet or sacroiliac joint. The main difference in issues between nerve vs. joint leg tingling sensation is that nerve pinching from a deranged disc is found in a specific area in the leg, such as the inside or outside of the foot. So, the tingling can be identified pretty much exactly in the leg. Tingling from a joint is often named as a deep, “inside the leg,” generalised aching and tingling that can affect the whole leg and/or foot, however it’s harder to describe by the patient as it’s less specific in its whereabouts.
Osteopathic management of all these conditions offers a non-invasive, sufficient form of non-drug, non-surgical care and is the recommended in LBP guidelines as an option when treating these issues.