The Therapy
Depending on the cause of the pulling in the leg, various conventional and surgical therapy concepts can be considered for treatment. In most cases, an attempt is first made to treat the cause of the pulling in the leg with conservative measures, such as the administration of painkilling medication and regular physiotherapy. If the patient does not respond to conventional therapy, surgical intervention may become necessary.
Prognosis and prophylaxis
The prognosis of the symptom pulling in the leg is very variable and depends on the underlying disease. If aching muscles, pulled muscles, torn muscle fibres or hardened muscles are the reason for a pulling sensation in the leg, the prognosis is very good.If the pulling in the leg is based on blood vessel diseases, for example deep vein thrombosis, inadequate therapy can lead to complications such as pulmonary embolism and worsen the prognosis significantly. Depending on the cause of the pulling in the leg, various preventive measures can be taken to avoid a recurrence.
When does pulling pain occur?
The nocturnal occurrence of pulling pain in the legs may indicate the presence of peripheral arterial occlusive disease (PAD). PAD is a circulatory disorder of the legs, or more rarely of the arms, which is usually caused by severe calcification of the arteries. Typically, the circulatory disorder results in a lack of oxygen in the muscles, which is particularly noticeable under stress.
This results in load-dependent pulling pain in the affected leg, and the affected leg can also be pale and cool. In advanced stages of the disease, the pain and pulling in the leg occurs at rest, especially at night when the legs are elevated. The diagnosis of PAD is made on the basis of the typical symptoms, a physical examination, Doppler sonography and possibly other imaging techniques such as MRI angiography.
Pulling in the leg also occurs in restless legs syndrome (RLS), especially at night. In RLS, there is a lot of pulling, tingling and sensation in the legs, especially in the evening and at night, as well as restlessness and the urge to move. As the disease can lead to sleep disorders and a severe impairment of quality of life if it persists, RLS should be treated.
For therapy, medications such as L-dopa or dopamine agonists can be considered. In principle, pulling in the leg during pregnancy can be based on all the causes mentioned, such as sore muscles, pulled muscles, torn muscle fibers, deep vein thrombosis, PAD, herniated discs, polyneuropathy, RLS, or hip joint arthrosis. During pregnancy, however, there is a significantly increased risk, especially for deep vein thrombosis (DVT), which is why thrombosis should always be considered if a pulling in the leg occurs during pregnancy.
DVT is a blood clot in a deep vein of the leg, which clogs the affected blood vessel and impedes blood flow. The reason why deep vein thrombosis is about six times more common during pregnancy than in non-pregnant women is due to a change in the composition of the blood caused by pregnancy hormones, a dilatation of the venous blood vessels and thus a slowing of the blood flow. The risk of thrombosis during pregnancy can be further increased by numerous other factors, such as previous thrombosis or the presence of a coagulation disorder.
DVT is characterized by swelling, a blue coloration and pulling or sore muscles in the affected leg. In addition, the affected leg may be overheated and feel tense. The diagnosis of DVT in pregnancy is made on the basis of the typical symptoms, blood tests and a special ultrasound examination of the leg veins.
DVT in pregnancy must be treated in any case, as the thrombus in the leg can become loose and be washed into the lungs. This is known as pulmonary embolism, a life-threatening complication of DVT. For the treatment of leg vein thrombosis during pregnancy, heparin, a blood-thinning medication, and compression treatment of the leg with stockings are used.
Pulling the legs while sitting can also indicate the presence of deep vein thrombosis. If the patient sits for a long time, for example during a long-distance trip, the blood flow in the legs is slowed down, which significantly increases the risk of DVT. If leg vein thrombosis occurs as a result of prolonged sitting, this can manifest itself as a violent pulling, swelling and blue discoloration of the affected leg.
Blood-thinning medications such as heparin or rivaroxaban and compression treatment with stockings are used to treat DVT. Furthermore, the affected leg should be moved, bed rest and protection of the affected leg are only recommended in the case of severe pain. Depending on the risk, these measures are also used to prevent a new thrombosis in the leg.
If the leg is pulled while lying down, muscular tension may be the cause.A cramp can also cause painful pulling in the leg, for example, when there is a lack of magnesium or after intense physical exertion. Furthermore, it can be the so-called restless legs syndrome (syndrome of restless legs). Restless Legs Syndrome is one of the most common neurological diseases and is characterized by a sensation in the legs at rest (usually at night when lying down), which leads to an urge to move.
This can cause sensations such as painful pulling or tingling in the legs. A pulling in the leg, which radiates from the back, can indicate the presence of a herniated disc in the area of the lumbar spine (lumbar spine). A herniated disc in the lumbar spine causes tissue of the gelatinous core of a disc to leak into the spinal canal, exerting pressure on a nerve root.
A herniated disc in the lumbar spine can typically cause sudden onset of back pain and, due to compression of the nerve root, further complaints such as radiation of the pain into the legs, paralysis or loss of strength in the legs and feet and sensory disturbances (formication, tingling or numbness). In most cases a herniated disc of the lumbar spine can be treated conservatively, since the leaked tissue of the disc usually resorbs itself after some time. The goal of conservative therapy of a herniated disc of the lumbar spine is to reduce pain and strengthen the back muscles.
The conservative therapy of a herniated disc of the cervical spine therefore mainly includes the administration of various painkilling drugs (ASS, Ibuprofen, Diclofenac) and regular physiotherapy. If the symptoms increase or if new neurological complaints occur (for example bladder and rectum disorders), surgery should be performed on the herniated disc. A pulling in the leg and buttocks can indicate the presence of sciatica, an irritation of the sciatic nerve (nervus ischiadicus).
Sciatica is usually caused by a herniated disc in the lumbar spine, but can also be caused by piriformis syndrome, spondylolisthesis, infection with borrellia or herpes zoster, and very rarely by space-occupying tumors in the spinal canal. In ischialgia, there may be pulling pain radiating from the buttocks into the legs, paralysis or loss of strength in the legs and feet, and sensory disturbances (formication, tingling or numbness). Depending on the cause of the pulling pain in the leg and buttocks, conservative therapy, the administration of various painkilling drugs (ASA, ibuprofen, diclofenac) and regular physiotherapy or surgery may be considered.
A pulling in the leg and hip can indicate the presence of a hip joint disease, for example arthrosis of the hip joint (coxarthrosis). In the case of coxarthrosis, wear and tear of the joint cartilage occurs, resulting in pulling pain in the hip, which can radiate into the leg, especially into the knee. Typically, the pulling in the hip and leg occurs in the morning or after a heavy load.
The development of coxarthrosis is favored by advanced age, family history of stress, obesity and joint malpositions. The diagnosis of coxarthrosis is made on the basis of a detailed questioning of the affected person about current complaints and underlying diseases (anamnesis), a physical examination and with the help of imaging procedures, especially an X-ray examination. The therapy of coxarthrosis is initially carried out conventionally with painkilling medication (ASA, ibuprofen, diclofenac) and regular physiotherapy.
In some cases, the surgical insertion of a hip joint prosthesis is necessary. A pulling of the hip, which radiates into legs, can also indicate the presence of a herniated disc of the lumbar spine. A pulling in the leg and arm can have numerous causes.
Frequently, pulling pain in the leg and arm occurs as limb pain in the context of a flu-like infection. If pulling pains in the leg and arm are caused by a flu-like infection, further symptoms such as a cold, sore throat, headache and fever can occur and the symptoms usually disappear completely after one to two weeks. In order to accelerate the course of the disease, the affected person should take it easy on his or her body and, depending on the symptoms, use nasal spray, lozenges or pain-relieving medication such as ASA, ibuprofen or paracetamol.A pulling in the arm and leg, which persists over a longer period of time, indicates a chronic disease, for example a polyneuropathy.
Polyneuropathy describes damage to various peripheral nerves, usually caused by diabetes mellitus (increased blood sugar) or heavy alcohol consumption. Damage to the nerves in the legs and arms can lead to sensory disturbances (formication, tingling or numbness), paresthesia and pulling burning pain in the legs and arms. Frequently, the complaints occur in the form of gloves or stockings on the extremities.
The diagnosis of polyneuropathy is usually made by a neurologist with the help of special examinations such as electroneurography, in which the conduction velocity of various nerves is measured. The symptoms of polyneuropathy can be alleviated by treating the underlying disease (e.g. optimal blood sugar levels). In addition, pain-relieving drugs from the group of anticonvulsants and antidepressants can be tried, since conventional painkillers such as ASA, ibuprofen or paracetamol are not effective for nerve pain.
