Leg pain when lying down: 15 possible causes (what to do?)

supine psoas stretch

The legs are parts of the body very rich in anatomical elements such as os, muscles, tendons, ligaments, nerves, blood vessels et lymphatic…Each of these elements can be the seat of an affection likely to manifest itself by pain.

Discover in this article the possible causes of leg pain which are particularly evident in lying position, as well as the attitude to have in such a situation!

Lower limb: some notions of anatomy

To better understand the causes of pain at the level of the leg, some basic notions on lower limb anatomy are required!

Man is an animal species biped, that is, we have two lower limbs that allow us to stand, to move around by walking or running.

We can divide each of the two lower limbs into six main regions, from top to bottom :

  1. The gluteal region ou “gluteal”: it extends between the pelvis and the thigh.
  2. The thigh area ou “femoral”: extends between the buttock and the knee region (bony framework represented by the femur).
  3. The knee area: area where the femoral and crural segments articulate (joint between the thigh and the leg).
  4. The leg area ou “crural”: extends from the knee region to the ankle (bony framework represented by the tibia and the fibula or "fibula").
  5. The ankle region ou “talo-crural”: extends between the leg and the foot.
  6. The foot region: most distal part of the lower limb.

Each of these six regions comprises different anatomical elements that allow obtaining a lower limb capable of carrying out its main function, that is to say the locomotion :

  • Bone elements: the bony framework of the lower limb is represented by the femur at the level of the thigh; the patella (also called patella) at the knee; the tibia and fibula (also called fibula) in the leg; the mortise represented by the Bank et the calcaneal bone at the heel; and finally the foot bones (tarsal bones, 5 metatarsals and 15 phalanges).
  • Muscles : their role is to give mobility to the different segments of the lower limb. Mention may be made in particular of the gluteal muscles, quadriceps, rectus femoris, adductors, gastrocnemius (calves), the anterior tibialis…
  • Nerves: their role is to give sensitivity to the lower limb and to activate the different muscles to allow movement. The motor and sensory innervation of the lower limb is provided essentially by the numerous branches of the nerf sciatica, the largest nerve in the human body.
  • Arteries: they bring oxygenated blood to vascularize all the anatomical elements (muscles, bones, skin, etc.). The main artery of the lower limb is the femoral artery which comes from the external iliac artery.
  • Veins: they drain the deoxygenated blood and transport it to the lungs. The main vein of the lower limb is the vein deep femoral which drains into the common femoral vein.
  • Lymphatic vessels: they circulate the lymph at the level of the lower limb to the lymph nodes before pouring everything into the venous system.
  • Skin covering: obviously the lower limb is also covered with a skin which separates it from the external environment.

The lower limb pain are therefore the result damage to one or more of the anatomical elements mentioned above.

Pain in the leg, what causes?

The leg pain, whether or not they are favored by the position elongated, may relate to one or more anatomical structures of the lower limb. They can therefore be:

  • Of bone origin(bone) ;
  • Of muscular origin (muscles and tendons);
  • Of articular origin (cartilage, capsule, ligaments, etc.);
  • Of nervous origin (nerves sciatica, crural, popliteal…);
  • Of vascular origin (arteries and veins);
  • Of lymphatic origin (lymphatic vessels);
  • Of cutaneous origin (skin).

In the next section, we will show you some of the possible causes of leg pain (with examples for each origin):

Bone origin

1. Post-traumatic fracture

Leg pain can be explained by a bone fracture benign that went unnoticed after a kick Or other trauma.

Indeed, after a trauma, we do not always feel the pain directly. These can be delayed, i.e. manifest at a distance from the trauma, usually at night when pressing on the lesion or edema (formed around the fracture) in lying position.

2. Pathological fracture

broken bones without notion of trauma are also possible in a context of bone fragility. They are called "pathological fractures" and they are very frequently encountered in elderly and menopausal women.

This kind of fractures generally go unnoticed, but they can cause pain a cas de pressure on pathological areas, Including lying position.

The bone tumors localized to the lower limb (primary bone cancer or bone metastases another cancer) can also cause pain. The latter are willing to upsurge nocturne and generally evolve in a context asthenia (intense fatigue) and loss of unexplained weight.

Muscular origin

3. Muscle tension (cramps, contractures)

The cramps are involuntary and temporary muscle tension which can lead to more or less intense pain.

They are common in the lower limb. Most often it is mild idiopathic cramps (punctual muscle cramps without specific cause) or exercise-related muscle cramps.

To prevent recurrent cramps, it is recommended to to drink a lot of water and avoid the excessive caffeine consumption.

In case of repeated cramps, occurring regularlynt, ycomtaken at night, magnesium deficiency may be the cause. A single supplementation in this mineral is enough to get rid of it.

As to contractions, it is tensions involuntary and permanent muscles. They are frequent in the muscles of the of and legs, favored by many factors such as the stress, fatigue, lack of hydration, a bad nutrition, physical overwork (intense training after a long break)…

The painful muscle spasms can also be linked to a fibromyalgia. The latter is a disease with a very rich clinical picture (many symptoms), notably associating a fatigue chronic, a increased sensitivity to pain, poor quality sleep and mood disorders.

4. Traumatic injuries (stretching, tearing)

If you have a lower limb trauma, usually in the context of a sporting accident, a pulled muscle can occur. It is muscle fiber micro tears due to a simple overstretching of a muscle during a sudden movement or other exaggerated movement of the lower limb. The healing is generally obtained in a way spontaneous in a few days to a few weeks, but in the meantime, pain may exist.

If you have a greater trauma, one of the muscles of the lower limb may be the seat of a breakdown (rupture of part of the muscle fibres) or of a tear (rupture of a muscle): painful pathologies that require adequate medical and surgical care and who take more time to heal.

5. Inflammation (tendonitis)

When excessive demand is placed on a tendon (physical overwork, repetitive movements…), it can ignite or be the seat of degeneration. We will then talk about "tendonitis" (health professionals prefer to use the term “tendinopathy”).

The tendinitis of the lower limbs (such as the gluteus medius tendonitis, proximal hamstring tendinitis, quadriceps tendinitis, etc.) can cause sometimes intense pain.

Articular origin

6. Sprain

A sprain is a ligament injury occurring most often after jerk responsible for a overstretching of a ligament.

The level of inferior member, sprains generally concern the ankle. They are then manifested by pain, swelling (edema) and increased local heat.

The knee ligament can also be the seat of sprains, but clearly very rare.

Whether ankle or knee, sprains of the lower limb can cause pain when lying down. These are usually due to pressure on the edema et stretching the injured ligament when moving during sleep.

7. Osteoarthritis

osteoarthritis is a age-related chronic disease characterized by a joint cartilage degeneration. It mainly results in joint pain, muscle stiffness and functional loss more or less marked.

Le knee and hip are frequent locations of osteoarthritis, called respectively "gonarthrosis" and "coxarthrosis".

The pain related to osteoarthritis of the lower limb can manifest as pain when lying down in some people (nocturnal recrudescence pain).

However, as a general rule, the osteoarthritis pain are from type mechanical. That is to say, they are favored by the effort, for example walking and standing.

8. Arthritis

arthritis is a term used to refer to many joint pathologies characterized by the presence of a inflammation one or more structures forming the joints (infectious arthritis, immunological arthritis, juvenile arthritis, etc.).

The hip, knee, ankle and joints of the foot can be the seat of a arthritis the main manifestations of which are pain, swelling and increased local heat (local inflammatory signs).

The arthritis pain affecting one of the joints of the lower limb Peuvent être favored by lying down, because it is inflammatory type pain.

As a reminder, the inflammatory type pain worsen with inactivity et diminish with physical activity (quite the opposite of mechanical type pain).

nervous origin

9. Sciatica neuralgia

Le sciatic nerve is the nerve responsible for the sensory and motor innervation of the whole inferior member. It originates at the level of Lumbar spine thanks to the meeting of several nerve roots from the spinal cord.

When the sciatic nerve ou one of its nerve roots is compressed or irritated, there are lower limb pain which follow the course of this nerve. This is called a "sciatica neuralgia", better known as "sciatica" short!

Sciatica is most often caused by a herniated disc, a protrusion of part of a intervertebral disc (its pulpy or gelatinous nucleus) out of its usual position thus compressing the sciatic nerve or one of its branches.

Therefore, any positions that aggravate this compression can trigger or increase sciatic pain, including the lying position (but in general, it is the standing and sitting positions maintained for a long time that favor the pain of sciatica by herniated disc).

For more details on the sciatica, see the following article.

10. Piriformis Syndrome

Among the many muscles of the lower limb, the piriformis muscle. This is a muscle in the gluteal region that extends from the sacrum to the femur (greater trochanter).

It should be known that the sciatic nerve passes just below piriformis muscle. In some cases, it may even pass through this last !

Thus, when this muscle is the seat of a inflammation or an contraction, it causes a irritation or an compressing the sciatic nerve (which crosses it). Of the pain then appear along this nerve.

In case of sciatica caused by a piriformis syndrome, pain can be favored by lying down. It is then recommended to sleep on your stomach with open thigh (like a frog) in order to relieve them by reducing pressure on the sciatic nerve.

For more details on the piriformis syndrome, see the following article.

11. Cauda equina syndrome

From the second vertebrate lumbar (L2), our spinal cord (part of the central nervous system through which the brain communicates with the rest of the body) ends giving multiple nerve cords which give it the appearance of a " ponytail ".

This ponytail is, among other things, responsible for sensory and motor innervation for the genitourinary region (via in particular the pudendal nerve) And some legs (via the sciatic nerve).

In certain situations, this terminal part of the spinal cord may be compressed by a pathological process such as herniated disc lumbar, narrow lumbar canal (lumbar spinal stenosis), a spinal slip (spondylolisthesis ou retrolisthesis), a tumor vertebral, a bone infection...

This compression then results in a set of symptoms at the level of the inferior member and perineal region which we have grouped under the "cauda equina syndrome" :

  • Pains of varying intensity;
  • Tingling, numbness, tingling;
  • Changes in sensitivity (decrease, loss or increase);
  • Muscular weakness ;
  • Urinary and/or fecal incontinence;
  • Erectile dysfunction…

Le cauda equina syndrome is a urgesmedical nce (implementation of the functional prognosis, but no vital risk in general). It must be taken care of as soon as possible to avoid complications neurological irreversible.

For more details on the cauda equina syndrome, see the following article.

vascular origin

12. Venous insufficiency

Venous insufficiency of the lower limbs is a common situation in which the blood circulating in the veins of the legs has hard to get up to win back the heart.

It translates clinically into a feeling of heavy legs, swelling (particularly in the ankles and calves), pain, cramps, itching and venous dilations that we call "varicose veins".

The pain related to venous insufficiency can occur both while standing than elongated.

13. Arteriopathy obliterans (PAD)

Obliterating arteriopathy of the lower limbs (PAD), also called “arteritis of the lower limbs”, is a frequent pathology characterized by the development of plates atheroma (deposits of cholesterol and other fats) in the inner walls of the arteries of the legs.

This disease of the arteries is usually manifested by muscle pain (type of cramps) when walking, then causing a lameness or requiring the person to stop regularly to relieve pain. This is called the «intermittent claudication ».

In case advanced AOMI, the pain may even appear resting, sitting or lying down.

Please note that in the absence of adequate treatment, PAD can lead to lower limb ischemia can result in a amputation !

14. Deep vein thrombosis (DVT)

A deep vein thrombosis (DVT) of the lower limb is a condition in which a blood clot forms in one of deep leg veins.

La TVP clinically translates into calf pain. In advanced cases, the leg increases in volumebecomes very painful and take a blue coloring (doctors speak among themselves of a picture of a “big painful leg”).

This pathology is diagnostic and therapeutic urgency. At the first signs, a Doppler ultrasound of the lower limbs must be carried out as soon as possible to highlight thrombosis and go to medical treatment (which relies on the intravenous administration of anticoagulants, usually low molecular weight heparin or "LMWH").

Lymphatic origin

15. Lymphedema

Le lower limb lymphedema is a condition characterized by slowing or blockage of lymphatic circulation (vessels similar to veins/arteries in which the lymph circulates).

This “lymph stasis” is clinically manifested by increase diffuse or localized volume of the lower limbs, An feeling of heavy legs, An modification of the skin texture, An decreased joint mobility (due to swelling) and, sometimes, pain.

What to do ?

If you have a leg pain, whether they occur in lying position or not, it is important to see a doctor in order to determine the causes.

This last will question you at length about your personal and family background, lifestyle and profession before examining you from head to toe in order to gather a maximum of clinical elements et guide your diagnosis.

For him, the priority will always be to eliminate a possible emergency such as deep vein thrombosis, cauda equina syndrome ou lower limb ischemia (complication of obliterating arteriopathy of the lower limbs).

Thus, he will look for worrying symptoms like (which should encourage you to consult as soon as possible):

  • THEincontinence urinary ou fecal ;
  • Un erectile disorder ;
  • The notion of severe intermittent claudication ;
  • A unexplained weight loss (possible cancerous pathology);
  • Personalized persistent pain ou steadily worsening ;
  • A saddle anesthesia (loss of feeling in the area of ​​the genitals).

His clinical examination will also be oriented in priority on the research and elimination of serious pathologies. For example, if he suspects a deep vein thrombosis (DVT), he will carry out the Homans maneuver which consists in stretch the calf (while keeping the leg straight). The onset of pain behind the calf indicates the presence of a DVT!

After having eliminated the urgent pathologies during the interrogation and the clinical examination, he will endeavor to look for other causes such as neuralgia sciatica (particularly thanks to the Lasègue maneuver), The tendonitis gluteus medius, a muscle strain/tear, a Osteoarthritis, a arthritis, a venous insufficiency… In short, one of the pathologies mentioned above in the article (or others)!

Sometimes, if the results of the clinical examination require it or if the doctor deems it necessary, a complementary exam (usually a medical imaging) can be achieved. For instance :

  • A Doppler ultrasound lower limbs to look for deep vein thrombosis (DVT) or obliterating arteriopathy of the lower limbs (PAD).
  • A plain x-ray to detect a possible bone fracture.
  • Un scan or MRI: lumbar to detect a herniated disc or a narrow lumbar canal, of the thigh to detect a tear…

Once the cause has been determined, a adequate therapeutic protocol will be put in place and things will be back to normal! So don't hesitate to consult your doctor in case of pain in the leg that occurs when lying down or other position !

References

https://www.lombafit.com/douleur-derriere-la-cuisse/

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[2] “Leg pain: differential diagnosis and treatment”, Swiss Medical Review. https://www.revmed.ch/revue-medicale-suisse/2019/revue-medicale-suisse-635/douleurs-de-la-jambe-diagnostic-differentiel-et-traitement (accessed November 15, 2022).

[3] E. Hachulla, "Pain in the lower limbs and extremities", EMC – Cardiology-Angeiology, flight. 1, no 4, p. 382-392, Nov. 2004, doi: 10.1016/j.emcaa.2004.08.003.

[4] E. Masson, “Lower limb pain”, EM-Consult. https://www.em-consulte.com/article/3041/douleurs-du-membre-inferieur (accessed November 16, 2022).

[5] “Lumbago: understanding pain in the lower limbs”, Low back pain. https://www.lombalgie.fr/comprendre/douleurs-des-membres-inferieurs/ (accessed November 14, 2022).

[6] “Lower Limb – Anatomy, Pathologies, Treatments”, https://www.passeportsante.net/, July 28, 2016. https://www.passeportsante.net/fr/parties-corps/Fiche.aspx?doc=membre-inferieur (accessed November 12, 2022).

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