When thinking of low back pain (LBP), one may visualize a person half-bent over with their hand on their back. Many of us have experienced low back pain during our lifetime. We can usually relate to a personal experience and recall the limitations during our last LBP episode. However, when the symptoms associated with LBP are different, it can be both confusing and worrisome. Symptoms can include tingling or shooting pain down one leg. Let’s look at the anatomy of the low back to better understand where these symptoms originate.
Vertebral Body & Pedicles
In the front of the spine, there are big vertebral bodies and shock-absorbing disks that support about 80% of our weight. At the back of each vertebra, you’ll find the spinous and transverse processes. They connect the muscles and ligaments in the back to the spine. Between the vertebral body, these processes are the tiny boney pieces or the pedicles. The length of the pedicle partially determines the size of the holes where the nerves exit the spine.
When the pedicles are short (commonly a genetic cause), the exiting nerves can compress due to the narrowed opening. This is foraminal spinal stenosis. This compression usually occurs later in life when osteoarthritis and/or degenerative disk disease further crowds these “foramen” where the nerves exit the spine. Similarly, short pedicles can narrow the “central canal.” This is where the spinal cord travels up and down the spine from the brain.
Later in life, the combined effects of the narrow canal plus disk bulging, osteoarthritic spurs, and/or thickening or calcification of ligaments can add up to “central spinal stenosis.” Spinal stenosis symptoms include difficulty walking due to a gradual increase in tingling, heavy, crampy, achy, and/or sore feelings in one or both legs. The tingling in the legs in association with spinal stenosis is “neurogenic claudication.” It is different from “vascular claudication”, which feels similar but occurs by a lack of blood flow to the leg(s) as opposed to nerve flow.
Tingling Leg
At a younger age, tingling in the legs can occur from either a bulging disk, lumbar disk herniation, or referred pain from a joint – usually a facet or sacroiliac joint. The main difference in symptoms between nerve vs. joint leg tingling symptoms is that nerve pinching from a deranged disk is located in a specific area in the leg such as the inside or outside of the foot. In other words, the tingling can be traced fairly specifically in the leg. Tingling from a joint is often described as a deep, “inside the leg,” generalized achy-tingling that can affect the whole leg and/or foot or it may stop at the knee, but it’s more difficult to describe by the patient as it’s less geographic or specific in its location.
Chiropractic management of all these conditions offers a non-invasive, effective form of non-surgical, non-drug care. LBP guidelines recommend chiropractic care as an option when treating these conditions.
