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Q. Why is pain going from my butt to my lower leg?

A. You probably feel worse when sitting and better when walking. And you might feel numbness in your buttock and lower leg. These symptoms suggest a herniated disc in your lower back. That means a little piece of disc is protruding outside the spinal column and is pressing on a nerve draped over it. When you sit, the nerve tightens around the piece of disc – picture tightening a guitar string — and pain intensifies. 

Start by seeing your primary care doctor. The standard first treatment is oral anti-inflammatories, physical therapy, and activity modification that includes sitting less.

If you don’t feel better, I advise imaging, such as an MRI, to confirm the diagnosis. Further treatment may include an injection of cortisone to relieve pain. This buys your body time as the spinal column reabsorbs the protruding disc material and the nerve is released. Occasionally, surgery is needed to remove the disc fragment. Once the problem resolves, reduce the risk of recurrence by keeping your weight down, doing trunk-strengthening exercise, and avoiding heavy lifting.

Q. Why do I feel pain in my leg when walking that goes away when I sit down?

A. A common cause is spinal stenosis, the narrowing of the open spaces within the spine. As we age and arthritis builds up around the spinal canal, disc material often bulges out, thus narrowing the space for nerves running down the spinal column. That puts pressure on nerves going to the legs. When you stand and walk, the area for nerves narrows, causing pain; when you sit, it widens and pain often disappears.

Start with a physical exam with your primary care physician. That will determine if it’s a nerve problem, as I describe above, or a blood flow issue (described in answer #3). Your doctor will likely check your legs’ strength and sensation to confirm there’s no nerve damage. If the cause is spinal stenosis, you may undergo imaging to confirm the diagnosis, and you’ll be advised to start physical therapy. PT exercises will help you strengthen your core and legs, and temporarily widen the channel to provide relief. This isn’t a permanent fix and spinal stenosis tends to progress as we age resulting in the need for surgery to fix the problem.

Q. What should I do about pain down both legs that gets better when I bend over or sit?

A. You may feel pain in only one leg. Often the cause is hardening and narrowing of blood vessels to the legs, which reduces blood flow. The problem is typically a build-up of sclerotic plaque in the vessels, similar to what can happen in vessels supplying the heart. Because your legs lack enough blood, you feel pain while walking. When you stop walking, the pain goes away.

Start with a physical exam with your doctor. If it’s a blood flow issue, you’ll be referred to a vascular surgeon. The remedy can be medication or activity modification; or possibly a stent or surgery to restore adequate blood flow.

Learn More About Dr. Peris
Co-Director, Spine Surgery
Orthopedic and Spine Institute
Northern Westchester Hospital

Northern Westchester Hospital is a proud member of Northwell Health.

Read Past Topics from Dr. Peris: 
Scoliosis and Lateral Spine Fusion
Cervical Spine Disc Replacement 
Cervical Stenosis 
Preventing Chronic Back Pain – Starting Today 
Q&A Topic: Is Your SI Joint Causing Your Back Pain?

Marshal D. Peris, MD, FAAOS


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