What's Causing Your Leg Pain, Burning and Numbness?

Aching calves, burning legs, numbness in the feet — pain and discomfort in the lower extremities is a common complaint that sends many of us to our doctors seeking relief.

But unless the cause is something obvious, like a fall, pinpointing the source may require some medical detective work. Trying to tough it out, though, will not get you any closer to the answers.

“Leg pain that comes on acutely with a bang, is severe and doesn’t resolve within minutes probably needs to be seen right away,” as it could be a sign of a more serious condition, says Dr. Benjamin Wedro, a clinical professor of medicine at the University of Wisconsin and an emergency physician at Gundersen Medical Center in Lacrosse, Wis. “There’s no trophy for suffering.”

Here are some of the potential causes of leg and foot pain:

Blood Vessel Distress

Pain that occurs when walking or exercising may be the result of claudication or decreased blood supply to the legs. This condition is most often a symptom of peripheral arterial disease, or PAD, a narrowing of the arteries that deliver blood to your limbs, typically caused by the buildup of plaque or fatty deposits. Smoking, high cholesterol, high blood pressure and obesity are major risk factors for PAD.

“The leg pain from PAD tends to occur when you’re active,” says John Fesperman, a family nurse practitioner at Duke Primary Care in North Carolina. “When you’re active, muscles need more blood. The lack of adequate blood triggers pain, which is known as intermittent claudication. Once you stop moving, the pain usually disappears.”

Deep vein thrombosis, or DVT, a blood clot in a deep vein that develops after extended periods of inactivity, can also cause major leg pain. Long flights or car rides make it difficult for the leg to return blood back to the heart. If that blood return slows or stops, it can create a clot within the vein. And if part of a clot breaks off and travels to the lungs, it can cause a pulmonary embolism, a serious and potentially fatal blockage of blood flow to the lungs.

DVT usually occurs in only one leg, Wedro says, causing it to swell and turn a bluish hue. “The onset of pain is gradual and tends to occur over a course of hours,” he says.

Peripheral Neuropathy

In some people, leg and foot (and sometimes arm and hand) pain can be the result of neuropathy, a disorder of the peripheral motor, sensory and autonomic nerves that connect the spinal cord to our muscles, skin and internal organs. Neuropathy can cause numbness, tingling and a heavy sensation. “It usually starts in the feet and may cause a burning sensation in the legs,” Fesperman says. In some cases, people may lose their ability to feel sensation in their legs, which can put them at risk for injury and infection.

Neuropathy can be brought on by many factors, including infection, toxins and the effects of alcoholism, but diabetes is the most common cause. According to the Neuropathy Association, approximately 60 to 70 percent of people with diabetes will at some point develop peripheral neuropathy. It can also affect people who have pre-diabetes and may not be experiencing any other diabetic symptoms.

Electrolyte Imbalance

Healthy muscle function depends on nerves being supported by a well-balanced mix of electrolytes — minerals like sodium, potassium, calcium and magnesium that have an electric charge. Electrolytes transmit signals that support nerve, heart and muscle function, and affect the amount of water in your body as well.

But certain medications; dehydration; and conditions like diarrhea and kidney disease can alter your electrolyte balance. When electrolyte levels become too low, it can cause leg pain. For example, when sodium, which attracts water to cells, is depleted, cells straining to compensate for the lack of fluid can bring on painful cramps.

Diuretics prescribed to control blood pressure are the most common culprits, Fesperman says, because they can deplete electrolytes in the blood. “Potassium and calcium mediate muscle contraction,” he says. “An imbalance in either or both can cause muscle cramping.”

By reducing blood flow, dehydration can cause electrolyte imbalance, and cramps, as well. Likewise, if you drink too much water, you can flush out too many electrolytes.

Back Problems

Conditions that affect your back often lead to pain in the legs as well. Spinal stenosis, in which the spinal canal gradually narrows, pressuring the nerves, usually affects people over 50 and can be caused by arthritis, scoliosis or spinal injury. The pressure can impinge on nerve roots as they leave the spinal cord to form the sciatic nerve, the body’s largest. The irritated nerves can cause significant pain.

Sciatica, a painful inflammation of the sciatic nerve, is typically experienced on one side of the body, and can travel from your lower back down your leg to your feet or even toes. Sciatica is difficult to diagnose and sometimes goes away on its own. It can be brought on by spinal stenosis.

“Sciatic and spinal conditions may come on gradually over time but may also have an acute onset,” Wedro says. “Over time, what had been tolerable becomes an acute issue. Sciatic nerve inflammation caused by changes in the back, such as arthritis, muscle spasm or injury, may radiate into the buttocks and down the leg.”

If the leg pain is accompanied by the loss of bladder or bowel control or numbness near the anus or vagina, seek emergency care immediately. You may have cauda equina syndrome, a rare disorder affecting the nerve roots at the lower end of the spine. Without immediate treatment, the spinal cord can shut down and you may develop permanent paralysis.

Arthritis

There are many types of arthritis. Osteoarthritis, the most common form, breaks down the cartilage in your joints, causing a buildup of painful bone spurs, cartilage loss, inflammation or soreness. Rheumatoid arthritis, an autoimmune disease, attacks the lining of the joints, also causing inflammation and pain.

Although arthritis is a joint disease, the pain it causes can be felt in the surrounding leg and foot muscles. “Any joint under stress can cause pain,” Wedro says. “The pain is within the joints. But the muscles around it try to protect it and you can go into spasms and get secondary muscle pain.”

Getting Treatment for Leg Pain

The appropriate treatment for leg pain depends on the underlying cause. Diabetics may need to improve their blood glucose control to prevent diabetic neuropathy, while arthritis sufferers may need medication or surgery.

“All treatments aim for long-term control of symptoms,” Wedro says. “There may not be one cocktail that works for everybody. It all depends on what has caused the leg pain. It will be trial and error for you and your doctor to find the treatment that works.”

The bottom line? Take all leg and foot discomfort seriously. “Pain means part of the body isn’t working right,” Wedro says. “The problem might be a disaster that is life- or limb-threatening, or it may be an inconvenience that might resolve with a little time and care. But if you have pain, see your doctor. Never dismiss it.”

This article originally appeared on nextavenue.com and was written by Winnie Yu.

Top 5 Massages for Cyclists

Spending hours on a bicycle can cause much joy, satisfaction, and a sense of accomplishment. But it can also lead to muscle fatigue, tightness, and even pain. We pulled together a panel of experts to compile a list of the Top 5 Massages for Cyclists and a collection of FAQs to help you find the right massage to treat your cycling symptoms and help you meet your individual riding goals.

1 / Swedish Massage

Arthur Robinson from Kinetic Bodyworks (AR): Swedish Massage is a body work technique used to relax the entire body using long, gliding strokes pushing blood towards the heart.

Anne Marie Di Caro from Athlete’s Care Sports Medicine Clinic (AMD): Swedish Massage uses kneading techniques to increase blood flow and remove lactic acid build up in the tissues and is gentle enough for all levels of cycling ability

2 / Deep Tissue Massage

AR: Deep Tissue Massage is similar to Swedish massage, but the therapist will use slow deliberate strokes with deeper pressure to affect chronic muscle tension.

Jodie Mainwaring from UnravelSF (JM): Deep Tissue Massage is designed to release tension that can be hidden in the deeper layers of your connective tissue and muscles. Deep muscle techniques address adhesions, knots and reduced range of motion that occurs in the body. These techniques release toxins that are trapped in tissues and allows for new blood to flow to overworked, tight tissues and muscles. This type of massage is a great tool to use as a stress reliever and as a key component to a cyclists recovery program.

Does Deep Tissue Massage Hurt?

Drew Freedman at Boston Bodyworker (DF): Many clients base the success of the treatment upon the amount of pain that they feel. If it doesn’t hurt, the therapist wasn’t going ‘deep’ enough. However, we all experience pain in different ways. Depth of pressure does not directly correlate with levels of pain.

The key to a successful Deep Tissue massage is finding a therapist that understands the concept of “matching tissue tension” and knowing how to respond to a muscle when it reacts to an external stimulus. If done properly, a true Deep Tissue massage should “hurt so good,” and for the most part be a pleasant experience.

 

 3 / Sports Massage

JM: Using Deep Tissue techniques, Sports Massage is used to target a certain area of the body and to focus on their specific problem such as mobility issues, chronic pain, or injury. Sports Massage is great for any serious cyclist looking to prevent injuries from intense training routine and competitions.

AR: Sports Massage helps keep the body at optimal function, focusing on the overused and stressed parts of the body. This type of bodywork targets the muscles and joints commonly emphasized during repetitive actions, like pedaling a bike.

Candace Combs from In-Symmetry (CC): Sports massage is the best for cyclists. We provide a hot rock sports massage which means hot stones are incorporated into the massage to allow the therapist to go deeper into the muscle. It is very important for the Iliotibial Bands (IT Bands) to be released on a cyclist during a Sports Massage.

4 / Trigger Point Therapy

AR: Trigger Point Therapy is a bodywork technique that involves applying pressure to the muscles in order to relieve pain and dysfunction in other parts of the body. Many times deep tissue massage and trigger point therapy are performed together.

AMD: “Trigger points” are best described as an area of hypersensitivity in a muscle that gives a referral of pain. The area is treated with deep compression until the referral pattern lessens or dissipates completely. This is a more painful type of treatment, but all levels can be accompanied by pain if an issue is present.

5 / Myofascial Release

JM: The fascia is a web of connective tissue that provides support and structure for your body. Myofascial work addresses both the connective tissues and muscles to enhance ease of movement, relieve pain, improve strength, and increase flexibility. This technique, combined with Deep Tissue Massage, releases adhesions and tension and promotes faster recovery for cyclists.

AMD: Myofascial Release Massage releases the fascia using specific techniques similar to kneading. Because less lotion is used, it can sometimes be more painful. This technique is commonly used on the Iliotibial Bands (IT Bands), quads, hamstrings, and lower back in cyclist, as these are the muscles that tend to be tight from riding.

FAQs for Cycling Massages

What massage is best for me?

DF: The answer I give is always the same: “It depends.” Massage has been around for thousands of years, and only in the last 100 or so have people started to classify massage into technique categories. In order to achieve the desired response to a massage, your therapist must be paying close attention to how you are responding to their touch.

Are different massages recommended for different levels of cyclist?

AR: At Kinetic Bodyworks, we take into consideration that your body is unique, and each of your visits may present different issues requiring a combination of massage techniques. It really depends on what issues the athlete comes in with. A recreational cyclist may need something relaxing (Swedish Massage), where a pro cyclist may want something specific to target problem areas (Sports Massage, Deep Tissue, Myofascial Release or Connective Tissue Release).

JM: Each cyclist has different goals. Experienced cyclists/athletes can include soft tissue massage work in their workout programs to reduce the risk of having overworked, fatigued muscles that leave them vulnerable to injury. Or, if you are looking to enhance your level of performance and get better and faster, then focusing on techniques to improve your level of fitness is key to achieving the next level and goals on your list.

Is there just one type of massage that will work for me?

DF: Buzz words like “Sports Massage,” “Trigger Point,” and “Myofascial Massage” come into play when clients are uncertain about the type of massage they need but know they don’t want a basic relaxation or ‘Swedish’ massage. A good therapist is well-versed in multiple approaches of massage therapy. Throughout the course of a clinical massage, your therapist will implement many different ‘techniques’ in order to achieve the outcome that elicits the proper responses from the connective tissues.

How Often Should I Seek Massage Therapy?

Our experts recommend a range of frequencies for different levels of cyclists, but generally, once or twice per month is recommended for beginners or occasional cyclists, while the experts recommend a massage once per week or every other week for advanced or active cyclists.

JM: If you are a beginner, working with a highly trained expert massage therapist will help set you on a routine that will support your needs specifically. This may require more sessions, at the beginning to get your body on track and then reducing to a maintenance program once your body has adapted and is working efficiently.

When Should I Seek Massage Therapy?

DF: Many of our riders come in frequently in the months leading up to a big ride for ‘tune-ups.’ Just like they take care of their bikes, they do so with their bodies BEFORE they break down. A typical tune-up will consist of work on the legs and hips in conjunction with some range of motion work to open up those shortened hip flexors. We also work on the upper body to provide relief to riders who complain of tightness and pain in their mid-back due to their forward lean on the bike. Working with our riders both before and after these rides helps them to better understand their bodies and allows them to acclimate accordingly during the long rides so that they may continue without injury.

Leave it to the Experts

DF: No one goes to their cardiologist and asks for an angioplasty or a cardiomyoplasty. There is more than one way to treat a muscle, and there are qualified experts who can determine this. It should never be up to the client to determine what the best ‘technique’ should be. Find a massage clinic and spend some time with your therapist telling them about your pain, and they can recommend the right treatment for you. Speak with your therapist about your individual goals, and don’t ever hesitate to ask questions during a treatment. It is the objective of the therapist to help you achieve everything you are seeking from a great massage.

This article originally appeared on duvine.com

Acupuncture and Migraine Management

How acupuncture can help

There have now been many controlled trials of acupuncture for migraine, with some large, high-quality ones in recent years. The results of the latest reviews are quite consistent: acupuncture is significantly better than no treatment/basic care for managingmigraine, and appears to be at least as effective as prophylactic drug therapy, with few contraindications or unpleasant side effects (Linde 2009, Wang 2008, Sun 2008, Scott 2008).  Acupuncture has a similar or slightly better effect than sham procedures, which themselves can perform as well as conventional drugs, indicating that sham acupuncture is not an inactive placebo but a contentious alternative intervention. Acupuncture has been found to be cost-effective (Witt 2008; Wonderling 2004). As well as prevention it may also be used to alleviate symptoms in acute attacks (Li 2009). There is preliminary qualitative evidence from patients that acupuncture can increase coping mechanisms as well as relieve migraine symptoms (Rutberg 2009).

Migraine is thought to begin as an electrical phenomenon in the cerebrum that then affects blood vessels, biochemistry, and causes neurogenic inflammation.

Acupuncture can help in the treatment of migraine by:

• Providing pain relief - by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurochumoral factors and changes the processing of pain in the brain and spinal cord (Zhao 2008, Zijlstra 2003, Pomeranz, 1987)
• Reducing inflammation - by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007, Zijlstra 2003).
• Reducing the degree of cortical spreading depression (an electrical wave in the brain associated with migraine) and plasmalevels of calcitonin gene-related peptide and substance P (both implicated in the pathophysiology of migraine) (Shi 2010).
• Modulating extracranial and intracranial blood flow (Park 2009).
• Affecting serotonin (5-hydroxytriptamine) levels in the brain (Zhong 2007). (Serotonin may be linked to the initiation of migraines; 5-HT agonists (triptans) are used against acute attacks.)
  
  This article originally appeared on acupuncture.org.uk

Massage for Runners: The What, When & How

Runners love getting massages. Not only does it feel great, but it can also speed recovery, reduce muscles soreness, and facilitate injury healing. However, there is a lot of confusion when it comes to massage. When is the best time to get one? What type is best for runners? What common mistakes should I be wary of?

Having been a massage therapist for 4 years, I had the opportunity to work with a lot of runners. Not only did this experience help me identify a lot of the common questions and misconceptions about massage, but it also allowed me to test a variety of theories when it comes to the optimal timing, pressure, and massage modality.

In this article, I am going to share with you some of the different types of massage and when each can be most effectively utilized. I’m also going to outline when, and how often, you should schedule a massage to make sure you get maximum benefit without impacting your workouts or races.

What type of massage is best for runners

It’s not surprising that runners get a little confused about what type of massage would benefit them most. Wikipedia lists 31 different types of massage. Of course, some of these are obviously not specifically beneficial to athletes, but runners can go beyond the typical “sports massage” to get results. The following are the five most beneficial types of massages for runners:

Active release

Active release technique, also known as A.R.T. is massage technique that combines movement with specific, deep pressure to help relieve muscle adhesions and reduce scar tissue build-up.

During an A.R.T session, the therapist uses his or her hands to evaluate the texture, tightness and mobility of the soft tissue and then works to break up these adhesions with their hands, as well as movement of the muscle.

Active release is best used when treating a specific injury, especially one where the formation of scar tissue impacts the ability for the body to heal itself. Most notably, A.R.T. is an effective treatment method for hamstring injuries, plantar fasciitis, and shin splints.

Swedish Massage or Effleurage

Swedish massage is the most well-known of the massage modalities and is often associated with relaxation and pampering. However, Swedish massage can also benefit runners, especially before big competitions.

Swedish massage utilizes long, flowing strokes of various pressure, although usually light, to release muscle tension and increase blood flow.

Swedish massage is best used in the days before big competitions or as a recovery tool after hard workouts. The lighter, relaxing strokes help relieve stress and muscle tension without damaging the muscles, which is important if you have a big race approaching. A Swedish massage before a race, especially if you’re coming off a hard week of training, can help you reenergize, relax, and build your confidence in your ability to run fast.

Trigger point

Trigger point therapy is massage modality that targets muscle knots and areas of referred pain in the muscle tissue. Therapists target and find knots in the muscles or areas of referred pain and use deep pressure to help loosen the adhesions.

Like A.R.T., trigger point therapy is best used to treat injuries. Specifically, trigger point therapy is effective in the treatment of IT band tightness, calf strains (did you read our post looking at the association between age and calf injuries), and hamstring injuries.

Deep tissue massage

Most runners are familiar with deep tissue massage, which is often confused with deep pressure (like when you say “go harder”). Deep tissue massage targets both the superficial and deep layers of muscles and fascia and are often quite intense due to the deliberate, focused work.

Deep tissue massages typically focus in on a few specific problem areas and, unlike trigger point therapy, work the entire muscle. Because runners often have quite a few tight spots and interconnected issues, deep tissue massage is often the modality of choice during hard training segments.

When should you get a massage and how often

The frequency at which you get a massage is completely up to you, and depends on how much you like massage, how hard you’re training, and your budget.

If you’re able to afford it, getting a monthly or weekly massage can help prevent injuries by catching tight areas before they become problematic. If it is not possible to fit a recurring massage in your budget, consider one or two per training segment during your hardest training block or when you’re performing more intense speed work, which tends to elicit injuries that can be treated by massage, like tight hamstrings or hips.

I always recommend that runners get a massage either the evening after a hard workout, or the next morning. If the therapist is going deep or using methods like A.R.T., the muscles can often be sore or lethargic for a few days after a massage. Timing the massage as close to your last hard workout gives your body the most amount of time to recover and feel back to normal.

If you plan on getting a massage before your next big race, schedule it at least 3-5 days from the race. If it’s been a while since your last massage, stick to further out. Also note that the deeper the massage, the longer it takes for the body to recover and respond – just like running workouts.

Misconceptions and things to watch out for with massage

With those guidelines in mind, here are a few common mistakes runners make with massage:

Drink water lots of water after the session to help flush out some of the toxins and waste products that were flushed from the muscles. Some people report feeling sick after hard massage sessions. Generally, this means the muscles released a lot of toxins and drinking extra water will clear them out.

Massage does not have to hurt to be effective. While working on a tight, troubled area will certainly cause some discomfort, it shouldn’t leave bruising or cause you to jump off the table. If you do find yourself consistently bruised after massage sessions, your therapist may be going too hard.

It takes time to recover and not feel lethargic after a hard massage. If your legs feel a little dead the next day, that’s ok. This is why it’s important to schedule at least one easy day between a hard massage and a hard workout.

This article originally appeared on competitor.com