Leg muscle pain is common. Sometimes there is an obvious reason like injury or physical activity. But sometimes the reason is harder to find. Knowing the cause is important because treatment depends on the cause.
Is this Really Muscle Pain?
The words that most people use to describe muscle pain are “cramping”, “tight”, “aching” and “deep”. These may sound unique, but sometimes leg muscle pain is hard to tell from other causes.
Of course, there are times when it is obvious that the cause of pain is from the bones, joints or skin. Also, sometimes it is clear that the pain is a result of peripheral neuropathy. The pain in these conditions is different than muscle pain and there are often other signs that give away the cause. Having said that, some types of pain are hard to localize. For instance, spinal stenosis can cause leg pain when walking that is hard to distinguish from muscle pain from artery blockages.
For this reason, I would never assume that pain is from the muscles, unless it is very obvious. Sometimes, objective testing will not be a mistake to help pinpoint the cause.
Causes of Leg Muscle Pain
There are many potential reasons for muscular pain. Some are obvious, like injury or physical activity. But others are less obvious. Here are a few of the less obvious causes.
1. Leg Muscle Pain with Walking
Calf pain when walking is very different than calf pain at night in bed. In other words, leg pain at night has a very different list of causes than leg pain when walking. For instance, most artery blockages will not result in leg pain at night unless the blockages are very advanced and severe. But even relatively mild artery blockages can cause leg pain when walking.
Calf Pain with Walking
2. Pain that Happens at Night
The timing of the pain is important. As I wrote, leg pain at night has a set of causes that is not identical to pain that happens also at other times. The three main causes to think about are:
- Lack of blood flow to the muscles. This is probably the most severe option. For artery blockages to cause leg pain at night, they have to be very severe.
- Calf cramps at night. Muscle cramps are very common. They can be very painful.
- Neuropathy. Nerve pain is also very common and people tend to feel it mostly during the night.
Simple stretching exercises can prevent night-time cramping.
3. Leg Muscle Pain from Medications
Many medications can cause muscle cramps. Statins and leg pain are a well known combination. But if the pain started after changing a medication or a dose, it is worthwhile looking into.
4. Masses and Tumors
Some masses and tumors favor the muscles. Sarcoma, of course, are the most well known. It is important not to neglect pain that is unusual or longstanding. If there is a palpable mass that is even more important to investigate quickly.
5. Muscle Inflammation
A rare group of conditions are called myositis. Myositis means inflammation of the muscles. These conditions can be hard to diagnose. But it is important to make the diagnosis because they can be progressive. Some are associated with cancer.
6. Primary Nervous System Disorders
Some primary nervous system disorders can cause muscle symptoms. Symptoms can include weakness and pain.
7. Muscle Tightness
As “unmedical” as it sounds, leg pain from tight muscles is very common. It can be harder than you’d think to tell it apart from vascular leg pain or from other causes of muscular leg pain.
When Should You be Concerned about Leg Muscle Pain?
I’ll start by saying that this is honestly a hard question to answer. There is never “never” in medicine. Practically, this really does mean that if you are worried, you should talk to your doctor, even if you cannot find your problem in the list here. But still, some symptoms raise concern more than others. Here are a few considerations:
How Old is the Patient?
You can imagine that the same symptoms in a young or old person can have very different meaning. Muscle pain, especially if chronic, should never be present in a young person. On the other hand, older people who have new onset pain without a specific cause should see a medical specialist as well.
How Long have You had Pain for?
New onset pain is very different than longstanding pain. Obviously, new pain can mean something wrong is happening. But pain that does not resolve surely means there is a problem that is present.
How Severe is the Pain?
Very severe pain is always worrisome. But less severe pain can also mean there is a problem, especially if it does not resolve.
Did You Start a New Medication?
As I wrote, many medicines can cause leg muscle pain. Steroids can cause muscle weakness. The typical complaint is that it is hard to get up from a chair or to climb up stairs. Statins are probably the most famous example.
Are there Other Signs or Symptoms?
I left a very important point for last. Many medical conditions that are important to diagnose present with muscle pain and other symptoms. Sometimes the symptoms can be subtle. Also, it will not always be immediately apparent that they are related to the leg muscle pain. Examples of such symptoms include rash, fever, weight loss, nigh sweats, and neurological symptoms.