If you break a leg or sprain an ankle during a basketball game, health care providers have a good idea what happened and how to treat it.

But if you have daily aches, pains and swelling in your legs, it will require some investigation.

Causes

Aman Khurana, MD, a vascular medicine physician who sees patients at OSF HealthCare, outlines common causes of leg pain. 

• Arterial disease
  
  “The arterial cause of leg pain is when people walk, and they get leg, calf, hip or thigh pain. That can be from less arterial flow down in the legs,” Dr. Khurana says. “When we walk, the muscles are demanding more blood. But because of blockages, blood doesn’t come.” 
   
• Venous disease
  
  “Venous pain brings heaviness, tiredness and fatigue. Varicose veins and leg discoloration are signs of venous disease,” Dr. Khurana explains. “That pain seems to get better when you lay flat or with your legs up.” 
   
• Arthritis, or inflammation of a joint
   
• Nerve issues
  
  “We have large nerves that go down from the back,” Dr. Khurana explains. When those nerves are irritated, it can cause a condition called sciatica. “Then there’s small vessel nerve pain that causes tingling and numbness in the feet.”

Wounds, such as those associated with diabetes, and lymphedema, a condition where fluid builds up causing swelling, can also contribute to these problems.

Diagnosis and treatment

Dr. Khurana recommends seeing a provider at the first sign of leg pain. He says it’s hard for people to pinpoint the problem, and waiting can make it worse.

A provider, he says, could check the blood pressure in your arms and legs to gauge blood flow and run a test to check for vein leakage.

“Veins have valves. When blood goes up, the valve should close. Some valves don’t close right. Blood goes up, and it keeps coming down. That’s how you have the heaviness, tiredness and swelling in the legs,” associated with venous disease, Dr. Khurana says. You could be given compression stockings for this problem.

Other treatments include medication, a device (such as a lymphedema pump that massages the legs and aids blood flow to the heart) or an ablation procedure to stop the blood flow in the problematic vein.

Prevention

How do I keep my legs moving? Dr. Khurana repeats advice many doctors have given. Daily healthy habits that prevent cardiovascular disease will help prevent leg issues.

• Keep your blood pressure, cholesterol and chronic conditions like diabetes in check.
   
• Don’t smoke. 
   
• Exercise and eat a healthy diet to avoid obesity. When your weight impacts your ability to get around, Dr. Khurana says, it’s definitely time to see a provider.
   
• Know your family history of health issues, and bring these up to your provider at your regular checkups.

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A pinched nerve can also be a culprit.

“The most common cause [of a pinched nerve] is arthritis. Over time, a disc [in your spine] dries out and starts to bulge. Arthritis builds up in the joints of the neck. That can start squeezing on the nerve,” Dr. Syed explains.

“Certain activities can increase the risk for all that,” he adds. “You do something that requires moving your neck a lot. You do a lot of strenuous work. That can cause things to happen a little bit faster. It can also happen if you’re sitting at a desk at an uncomfortable angle for prolonged periods.”

Pain from a pinched nerve can travel down your body and into your hand, for example.

Treatment

Regardless of the cause of your neck pain, Dr. Syed says a good physical therapy program – both in the doctor’s office and continued at home – can take care of many cases before surgery is discussed. He estimates only around 10% of his patients need surgery.

If it does get to surgery: “A lot depends on which nerves are pinched and where,” Dr. Syed says. “For some people, we go in from the back of the neck to free up the nerve. For some, we go in through the front of the neck. Some surgeries are fusion surgeries. Some are what we call motion sparing. Rather than taking the individual bones of the neck and turning them into one bone, we’re able to keep them free. That preserves [the person’s] motion.”

Prevention

Here's an alert to put in your phone for morning, midday and evening: stretch. Stretching often can keep your neck limber. Five to 10 repetitions of up/down and side to side motions can go a long way, Dr. Syed says.

Practicing good posture goes hand-in-hand with stretching. Sit up straight at your work desk, and take breaks to walk around. Dr. Syed says research is still in progress on how much a standing desk or sitting on a big bouncy ball helps. But he says if those decrease your pain, go for it.

“If you work at a very physically involved job, make sure you have good ergonomics [good workplace behaviors]. If something is a two-person lift, grab someone. Don’t try to lift heavy things by yourself,” Dr. Syed implores.

A diet high in protein, vitamins and calcium is another must-do. Calcium helps prevent osteoporosis, a condition that weakens bones and makes them more prone to breaking.

And lastly, manage chronic illnesses, and drop the cigarettes.

“We know from a lot of studies that smoking damages bone metabolism. It accelerates arthritis. It’s bad for blood supply and nerves,” Dr. Syed warns.

Learn more

Read more about how to keep your body in top shape on the OSF HealthCare website.

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The harsh reality of a typical Midwestern winter is upon us. While mounds of snow and brutal temperatures sit outside our door, that’s no excuse to not take care of physical ailments that can benefit from aquatic physical therapy.

Working with an experienced therapist in a pool, patients who require aquatic therapy may experience ease of movement without pain, relaxing muscles, increased strength and better endurance – all of which can help the spine and joints and improve lung performance.

Nicole Bartoszek is a physical therapist assistant with OSF HealthCare. She says therapy in a pool offers more buoyancy, which means less pressure on the joints. And warm water can help when it comes to relaxation and decreasing blood pressure.

“The biggest benefit of water exercise is there's hydrostatic pressure when you're submerged into the water," says Bartoszek. "So, what that does is increase blood flow to the muscles and increases blood flow to the joints which also helps with ease of exercise.”

There are many people who benefit from water therapy including stroke patients, people with balance or gait issues and children experiencing sensory processing disorders.  

Bartoszek sees many people who are dealing with mobility, pain, weakness and cardiovascular function issues. Another benefit to aquatic therapy is patients do not have to worry about getting injured while falling, which can be an issue during land therapy for those with balance issues.

“The people who benefit the most from aquatic therapy have bad arthritis and have a hard time with weight bearing issues on land. In the pool they’re more buoyant and that can take more pressure off their joints,” she says. "Some people with mild COPD or blood pressure, hypertension issues can benefit from increased cardiac output from the hydrostatic pressure on the body. It also can help with swelling and edema. We also work with people who are trying to return to sports using plyometric exercises, which are easier on the joints in the water.”

Among the most common exercises offered in aquatic therapy are gentle stretching and floating exercises, strengthening work, balance training and cardiovascular conditioning.

And people are seeing good results. One study published in JAMA Network Open found patients with low back pain reported better outcomes with aquatic therapy than other modalities when it came to pain relief, better sleep and improved quality of life.

Bartoszek adds that aquatic therapy is a great start for people who want to continue water exercise. Check your local resources for group aquatic classes that are available in your community.

“It's important to do group therapy to have that support system," she says. "People like to communicate and visit and socialize while they're in the pool and have that camaraderie when they're exercising in a relaxing environment.”

The water temperature is also important. To be classified as a licensed therapy pool, the temperature should be at least 90 degrees.

And you don’t have to be a world-class swimmer to take part in aquatic therapy. Licensed therapy programs have CPR trained therapists on hand who are in the pool with patients. 

“It's a good medium to work in and especially with people who are high risk for falls and balance because you have the buoyancy of the water to help with that," says Bartoszek. "And if there's someone who has a really hard time or is in pain, and has a hard time exercising on land, a pool is a good alternative because it's so much easier on the joints and the warm water helps with relaxation and pain.” 

For more information about how aquatic therapy can benefit you, visit OSF HealthCare.

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There’s good news for both “weekend warriors” and “marathon maniacs” who prioritize running.

Researchers from Northwestern University surveyed more than 3,800 Chicago Marathon runners about how many years they’d been running, their pace, and if they had any family history of arthritis. The results, which were presented at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting, showed no connection between their running habits and an increased risk of knee or hip arthritis.

Karan Rai, MD, an OSF HealthCare physician who specializes in sports medicine, says the benefits of running far outweigh the risks.

“The common myth or misnomer out there is that running can cause arthritis or that it’s a big risk factor for arthritis,” says Dr. Rai. “What we’ve found over time is that it helps the joints. There’s a little bit of that ‘use it or lost it’ where the little bit of stress that running can do, when performed safely, can actually help the joint health.”

Dr. Rai works on running plans with patients who have arthritis. He says if you love running, you can still personalize your plan to make it work for you.

“For people who already have arthritis, you may want to modify how you run. Choose surfaces that are more even, maybe go for shorter periods of time,” Dr. Rai says. “Usually, when I’m having that discussion with my patients regarding running and arthritis, I first get a basic understanding of what their physical activity level is before suggesting how to introduce running into their exercise regimens.”

If you’re looking to get into running, Dr. Rai says running on an indoor surface is a good place to start.

“Outdoor running can be a little more problematic for people with arthritis. Another thing I discuss with my patients is your mileage. Studies have shown as we get up to more than 15-20 miles a week, your risk for injury rises significantly,” explains Dr. Rai. “Impact matters. Footwear helps cushion that impact. If you’re a regular runner I strongly recommend switching your shoes out every six months or so. Or every 300-500 miles.”

But if arthritis becomes more severe, Dr. Rai says running won’t be recommended.

“If someone is exhibiting signs of moderate to severe arthritis, it can hasten the progression of arthritis,” Dr. Rai says. “But that needs to be individualized. Because I always prioritize, from the medical side, a person’s goals and desires when it comes to activities and hobbies like running. Because there is a great mental health benefit to that, too.”

Dr. Rai recommends new runners start slow, listen to your body and focus on how you feel while you run. He adds that some muscle soreness is normal, but if you have persistent pain multiple days after running, you may be running in a way that is detrimental to yourself.

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Mick Mars has spent more than 40 years as lead guitarist for the legendary rock band Mötley Crüe. During that time, Mars has suffered from a disease called ankylosing spondylitis (AS) – a form of arthritis of the spine that causes inflammation between the vertebrae and in the joints between the spine and pelvis.

Mars has announced that due to his condition, he is retiring from touring with the band. Mars was a teenager when he first experienced the onslaught of AS; he addressed his condition in the band’s biography in 2001.

“My hips started hurting so bad every time I turned my body that it felt like someone was igniting fireworks in my bones,” he said. “I didn’t have enough money to see a doctor, so I just kept hoping that I could do what I usually do: will it away, thought the power of my mind. But it kept getting worse.”

The 71-year-old rocker is not alone in this fight, but is in rare air when it comes to AS: about 300,000 people (less than 1% of the adult population) have this disease. While there is no known cause of AS, there may be a genetic link, according to medical experts. And while anyone can get AS, it tends to affect men more than women. Symptoms generally appear between the ages of 17 and 45. Some people have consistent pain, while others experience milder symptoms.

“The most common symptoms are low back pain or posterior pelvic pain," says Rebekah Lesko, a physical therapist for OSF HealthCare. "It’s a general low back pain or ache. Some people have trouble breathing because as the inflammation progresses it can cause fusion; it can affect the expansion of the rib cage as well. Another common side effect is inflammation or blurriness of vision because it can cause inflammation of the eye.”

AS is a lifelong condition with no cure. While AS affects mostly the spine, it can also inflame joints in the pelvis, shoulders, hips and knees. People with AS are more likely to experience spinal fractures as well as osteoporosis and fused vertebrae.

“The best treatment for ankylosing spondylitis is maintaining a regular exercise regimen to keep the joints from fusing and keeping good posture," says Lesko. "There’s also medical management through non-steroidal anti-inflammatory, anti-rheumatic drugs and in cases of severe inflammation, using steroids to decrease that inflammation as well.”

Lesko knows all about AS, both professionally and personally. At 17, Lesko began developing serious back pain while helping her father bale hale on the family farm. The pain didn’t go away so Lesko consulted with doctors and underwent a battery of tests before she was diagnosed with AS. As a three-sport athlete, Lesko struggled during her senior year of high school as she had to give up all activities, begin a regimen of medications and learn how to manage her symptoms. 

“In my mid 20s I went off my medication and I was really well managed with physical activity," says Lesko. "I’ve had on a few occasions uveitis, which is the inflammation of the eye, where I have to use steroid drops, and steroid dose packs for flares of the back pain on occasion but at this point things are pretty well managed. I know the things to do to get the pain under control, which is usually gentle physical activity and staying in a regular regimen of exercise.”

Lesko says the treatment of AS has drastically changed over time. Years ago, patients were not encouraged to move or take part in physical activity due to their condition. Now, physical therapists teach patients the importance of good posture and ergonomics to avoid prolonged positioning, along with breathing exercises and gentle stretches for the spine.

“The biggest thing is make sure you maintain your posture, stay active, don’t give up on yourself, keep trying different things to manage the pain, get a good rheumatologist who can help you with that and find a physical therapist who can help support you in that because you don’t have to live in daily pain," says Lesko. "It can really be managed.”

For more information about AS, visit OSF HealthCare.

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