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Apr 01 , 2019
The key to finding comfort when your symptoms radiate down your arm / leg

Neck and Back pain isn’t the big problem

Have you ever woken up the day after a tough workout and noticed a low-grade ache in what felt like your whole spine? Or how about at the end of a long day where you spent most of it sitting or standing? Yeah me too…just thinking about those days make my back ache.

That’s because aches and pains in the spine are natural occurrences in the body and most of the time, back pain doesn’t directly relate to any one specific issue or problem. It can just come on at no particular time of day or body position, stay as long as it pleases, and just as quickly disappear without you even realizing it.

It’s so natural, the likelihood of sustaining an episode of low back pain in your lifetime has been projected to be roughly 60-70% with the highest incidences in individuals aged 35-55 (1,2); Plus that number is likely conservative as it only takes into consideration documented visits to a healthcare professional.

Then what is the problem?

While having sporadic back pain that lasts for 1-2 days at a time shouldn’t be a cause for major concern there are times when back pain can become a little more serious. This is when you begin to notice an increase in pain/tingling/numbness [commonly referred to as “radicular” or “referred” symptoms] into the buttock, down the front or back of your leg/arm, or into your ankle/hand. This is usually a sign of nerve or vascular compromise and should be addressed promptly.

Our Spine is a very complex part of our body. Between our skull and our tailbone (sacrum) stands 24 individual vertebral bones connected on top of one another and separated by collagen-filled fibrous discs. Posteriorly, two facet joints help facilitate spinal motion but also provide security for the nerve to branch off from the spinal cord and begin its journey down the extremity.

*Immediate/Sudden occurrence of numbness or tingling down both legs simultaneously or in the groin / saddle-region should be a cause for concern and should seek medical attention immediately.

The key to finding comfort

If you’ve ever had these symptoms before, you’ll know that it’s a difficult time. Depending on the severity of the pathology, moving the body in different directions while performing daily life activities may cause a fluctuation of symptoms. For instance you might find that sitting down always relieves your pain but standing brings them on. Or maybe jogging causes peripheralization but cycling/bike-riding tends to be pain-free.

Centralization vs Peripheralization:

Spinal nerve symptoms that present away from the spine itself (such as the buttock, shoulder blade, or into the extremity) is commonly described as peripheralization, or when symptoms travel into the periphery. When peripheral symptoms begin to travel from their most distal area of presentation back towards the central spine, this is known as centralization.

Leg symptoms are frustrating, uncomfortable, and often worrisome. So if you want to stay symptom free, maximize your recovery, and improve your overall well-being, follow one simple rule:

Avoid activities or movements that peripheralize symptoms and concentrate only on activities that centralize your symptoms.

The goal is to limit the amount of peripheral symptoms throughout your daily life to prevent longer duration compromise.

 

Let’s break this rule down a little more:

In order to identify which activities or movements result in peripheral symptoms, centralizing symptoms, or remaining asymptomatic:

-Try bending to touch your toes a few times then put your hands on your hips and bend backward a few more times. Any changes?
-Now try bending down your side bringing your arm straight as far down your leg as possible. Then switch sides.
-Consider holding each of these postures at its end-range for about 15-30 seconds?
-If you are standing, try this laying down in bed…Or vice versa (see picture below).

 

As you are observing which positions cause distal symptoms and the most discomfort also keep a tab on which positions ‘feel good’ and re-test them when you are having symptoms into the extremity to determine if they can help with centralization.

It’s critical to find out which activities peripheralize your symptoms but it’s equally important to know what can help you get over the hump. Discovering early on how to identify and modify simple tasks such as getting out of bed, standing up from a chair, squatting down, or reaching in the air can save you from a whole bunch of problems.

The Goal

Ideally these referred symptoms will soon become less common and few and far between. Eventually, when any symptoms do occur you can use this as your body’s warning light, similar to that on the dashboard in your car. Similar to a diagnostic test at your mechanic, this “warning sign” is a reminder telling you to go through your routine (picture above) of spinal motions to know which to avoid or perform.

As you become more comfortable using this quick-screen, it should be noted that these directional preferences can often change and it is important to monitor your symptoms from day-to-day to assess for any differences from the day before. It wouldn’t be uncommon for identifying sitting as an activity that centralizes symptoms on one day to find that it may peripheralize symptoms another. When this occurs, just remember our simple rule:

Avoid activities or movements that peripheralize and use activities that centralize symptoms to your advantage.

Disclaimer
*This discussion is specific to symptoms in the extremity that originate from the spine. While disc-herniations and facet joint irritations have been reported as a common cause for radicular symptoms, there are several other common compression sites the vascular/nerve must pass through in order for it to fully serve the various muscles, joints, and skin regions of the arm or leg. A comprehensive evaluation from a physical therapist or MD should be completed to accurately determine the site of any neurovascular compromise. If your back pain and/or leg symptoms continues to persists or worsens for several days and you are unsure how to manage this, see your local physical therapist to get you back on the right track.

References:
1. Taimela S, Kujala UM, Salminen JJ & Viljanen T. The prevalence of low back pain among children and adolescents: a nationwide, cohort- based questionnaire survey in Finland. Spine, 1997, 22: 1132–1136.
2. Balague F, Troussier B & Salminen JJ. Non-specific low back pain in children and adolescents: risk factors. Eur Spine J,1999, 8: 429–438.