leg pain lying night

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

An assortment of conditions cause leg pain at night.

Claudication typically occurs during physical activity such as walking and is promptly relieved by a brief resting period (2-5 minutes). Normally, blood flow can increase up to ten-fold to meet the increased need for additional oxygen in exercising muscles. However, when the leg arteries are blocked, blood flow cannot increase in response to exercise and pain develops. Claudication pain always involves the same muscle groups, usually the calves, and does not change from day to day. The vascular surgeon relates the onset of claudication pain to a particular walking distance in terms of street blocks (e.g. “2-block claudication”) or distance traveled before the symptom occurs. This helps to provide a standard of measuring if there has been any change before and after therapy has been initiated.

As atherosclerosis progresses and blockage becomes more severe, a burning/aching pain in the feet and toes will occur particularly at night time while lying flat. This pain, known as rest pain, occurs because the arteries of the leg can no longer deliver adequate blood flow to the feet, even at rest. Rest pain generally worsens when the legs are elevated, such as when lying in bed at night. Relief from this pain may occur only when the feet are dangled.

Gangrene or “death of tissue” may occur when nutrition needed for normal growth and repair can no longer be provided because of extensive arterial narrowing (stenosis) or complete blockage (occlusion) of lower extremity arteries.

When claudication is used as an indicator of lower extremity arterial disease, estimates are that 2% of the population aged 40 to 60 years and 6% older than 70 years of age are affected. With the elderly population expected to increase to 22% by the year 2040, lower extremity arterial disease will be even more common.

70% of older adults experience benign nocturnal leg cramps. Leg cramps occur when an involuntary contraction of the calf muscle causes an uncontrollable spasm. Pain can be mild to severe. Some people have frequent episodes while others have occasional ones. The cause of benign leg cramps is unknown. However dehydration may play a role and leg cramps can be a side effect of many medications. Underlying medical problems, such as thyroid disease, may also contribute to the problem.

These usually awaken the sufferer with a spasm-like pain in the calf like a charley horse. The incident lasts a few seconds or minutes and may be repeated throughout the night. Some bouts of leg cramps occur frequently over weeks and months, while other people have isolated occurrences and still others may regularly have leg cramps. They commonly occur with strenuous exercise, when using a group of muscles repeatedly, or when circulation is cut off from sitting awkwardly. Most cramps last only a few seconds, and at most a few minutes. Leg cramps are particularly common in pregnant women and the elderly.

- While lying in bed, gently pull toes toward knees. Do not let feet point down.

To relieve a cramp, extend the leg straight and flex foot toward the knees, or grab toes and pull them upward. Also, gently stretch the calf by standing up, bending the affected leg at the knee and putting weight on the leg for several minutes. Massage the muscles that are in spasm or apply heat or cold to ease pain and promote muscle relaxation.

Low back pain and leg pain at night that is not relieved by lying down may be caused by a tumor in the cauda equina (the roots of the spinal nerves controlling sensation in and movement of the legs), or a cancer that has spread to the spine from the prostate, breasts, or lungs. The risk factors for the spread of cancer to the lower back include a history of smoking, sudden weight loss, and age over 50.

Ankylosing spondylitis is a form of arthritis that causes chronic pain in the lower back. The pain is made worse by sitting or lying down and improves when the patient gets up. It is most commonly seen in males between 16 and 35. Ankylosing spondylitis is often confused with mechanical back pain in its early stages.

Disk herniation is a disorder in which a spinal disk begins to bulge outward between the vertebrae. Herniated or ruptured disks are a common cause of chronic low back pain in adults. The pain from herniated disc is referred to as sciatica. Sciatica rarely causes leg pain at night... but it may.

Back and leg pain that is out of proportion to a minor injury, or that is unusually prolonged, may be associated with a somatoform disorder or other psychiatric disturbance.

Low back pain with leg involvement

As noted earlier, low back pain that radiates down the leg usually indicates involvement of the sciatic nerve. The nerve can be pinched or irritated by herniated disks, tumors of the cauda equina, abscesses in the space between the spinal cord and its covering, spinal stenosis, and compression fractures. Some patients experience numbness or weakness of the legs as well as pain.

Fibromyalgia is another cause of leg pain at night. Generally, though, there is pain involving other areas in addition to the leg.

Leg pain lying night