Leg Gives Out

Spontaneous Leg Weakness

Get Help With Leg Gives Out

Have you ever been walking and your leg gives out? It can be both surprising and alarming What would cause your leg to give out? Can sciatica cause your leg to give out? How do you treat weak legs? Let’s dig in.

What Would Cause Your Leg to Give Out?

Weakness in the leg can arise from three principal sources: nerve problems, muscle weakness, and SI joint dysfunction. Weakness in the legs may indicate a significant nerve problem. In many cases, it may be the first indication of a nerve problem. There are three common causes of nerve injury: low back disorders, nerve compression as it descends down into the hip, thigh, and shin and medical conditions such as diabetes.

Spinal Causes of Nerve Injury

Spinal tumor with irritation or compression of the spinal nerves.
Lumbar disc protrusion or herniation with compression of the spinal nerve can result in weakness and the feeling that your leg gives out (1).
Slipped disc with compression of the spinal nerve. This is also referred to as spondylolisthesis (2).
Lumbar spinal stenosis with compression of spinal nerves. Stenosis refers to the narrowing of the spinal canal. The cardinal symptoms lumbar spinal stenosis are leg pain and weakness brought on with walking and relieved by sitting or flexing forward at the level of the hip (3).

Other Causes of Nerve Injury

Direct trauma to a nerve or nerves in the lower extremity can cause weakness. Contact sports, martial arts, and motor vehicle accidents can all cause direct nerve trauma.
Diabetes. the elevated blood sugars can damage the small nerve fibers (diabetic neuropathy) which is the most common complication of type 1 and 2 diabetes (4).
The compression of a nerve as it descends down the leg (entrapment neuropathy) can cause weakness. Often times your leg gives out. Common examples include entrapment of the sciatic nerve, common peroneal nerve, and posterior tibial nerve. The latter is commonly called tarsal tunnel syndrome

Muscle Weakness

Muscle weakness can arise from many sources which include fatigue, infections, dehydration, electrolyte disorders, and medications such as statins (5). The spinal nerves transmit the electrical signal from the brain to the muscle. This signal tells the muscle to contract. If the nerve signal to the muscle is compromised the muscle may not respond. If this continues over time, the size of the muscle may decrease. A diminished or weak nerve signal with a smaller muscle oftentimes results in muscle weakness. The first sign may be your leg gives out. It is critical that one understands a larger issue both in the muscle and lumbar spine may be at hand. If left untreated, the low back, muscle, and nerve injuries can progress. At some point, nerves and muscles do not recover.

SI Joint

The sacroiliac joint (SIJ) is where the tailbone (sacrum) connects with the hip (ilium) to form a very important joint. Each of us has two SI joints, one on the right and one on the left which have thick supporting ligaments. The two SI joints connect with a small joint in the front, the pubic symphysis. The two SIJ’s and pubic symphysis form a very important functional unit that transfers the forces between your legs and upper body. If one or both the SI joints have loose or injured ligaments effective transfer of the forces from the leg to the spine and upper body can be compromised and leg weakness may occur (6). The first warning sign may be when your leg gives out.

Can Sciatica Cause Your Leg to Give Out? (Pinched Nerve)

Yes! When your leg gives out this may be the first signal that there is a problem in your low back. The sciatic nerve is the largest nerve in the body and provides critical information to all the muscles in the lower extremities. Sciatica is debilitating lower back, buttock and leg pain that is caused by a herniated disc, protrusion, joint overgrowth, or bone spur that compresses the nerve. Compression of the nerve compromises the nerve signal to the muscle which in turn can result in leg weakness and episodes when your leg gives out.

Bone Spurs

Bone spurs, also known as osteophytes, are bony projections that develop along the edges of bones. They are most commonly found in joints — where bones meet — but can also appear on bones where tendons, ligaments, and muscles attach. Bone spurs are often associated with aging and are a common condition. While they can occur in any bone, they’re most often found in areas such as the spine, shoulders, hands, hips, knees, and feet. Bone spurs form as the result of the body trying to repair itself by building extra bone. This process can be triggered by several factors: Osteoarthritis: The most common…

Bulging Disc In Thoracic Spine

A bulging disc in the thoracic spine is a serious medical condition that occurs when the outer layer of the disc weakens, causing it to bulge outward and put pressure on nerves and the spinal cord. The disc has two components, a soft center and a thick outer layer, and weakening or tears in the outer layer can lead to a bulge. Symptoms include pain, numbness, and weakness in the affected area. The thoracic spine is that portion of the spine that resides below the neck and above the low back. It is commonly referred to as the mid-back. A bulging…

Read More About Bulging Disc In Thoracic Spine

Degenerative Scoliosis

Degenerative Scoliosis, also known as Adult-onset Scoliosis, is a medical condition that involves a side bending in the spine. The bending can be mild, moderate, or severe with side-bending to either the right or the left. The term degenerative means generalized wear and tear and is common as we get older. Degenerative scoliosis is the curvature of the spine that occurs as a result of degeneration of the discs, small joints, and building blocks. The Degenerative Scoliosis curve is often located in the low back and forms a ‘C” shape. There is a convex and a concave side. The convex side is the open side where it curves outward.

Facet Synovial Cyst

A facet cyst, also known as a synovial cyst, is a fluid-filled sac that forms in the facet joint of the spine. The facet joints are small joints located between the vertebrae of the spine that provide stability and enable movement. Facet cysts typically develop due to degeneration and wear and tear of the facet joint, which can cause the joint capsule to stretch and weaken. This weakened capsule can then allow synovial fluid, which normally lubricates and nourishes the joint, to leak out and form a cyst. Facet cysts can cause various symptoms such as back pain, leg pain…

Pinched Nerves in the Back

We talk a lot about leg pain stemming from a pinched or irritated nerve in the lower back. And, indeed, that’s what our physicians are traditionally taught in medical school—a pinched nerve in the lumbar spine typically presents as a symptom in the leg. However, what if you have some butt pain but no pain or other symptoms in the leg? Does this mean it couldn’t be a pinched nerve? Not so fast. Turns out a pinched low back nerve doesn’t always have to be accompanied by leg symptoms. Let’s start by taking a look at how the back is structured.

Read More About Pinched Nerves in the Back

Sciatica

Disc herniation, disc protrusion, overgrowth of the facet joint, and thickening of the ligaments can result in nerve root compression or irritation, causing symptoms of sciatic compression. Some causes of sciatic compression can be interrelated with the following conditions: Degenerative disc disease, Spinal stenosis, damage or injuries to the discs, spondylolisthesis, piriformis syndrome, osteoarthritis. The symptoms of sciatica include pain in the lower back, buttock, and down your leg, numbness and weakness in low back, buttock, leg, and/or feet, pain increase with movement, “Pins and needles” feeling in your legs, toes, or feet., loss of bowel control, and incontinence. Sciatica can be treated…

SI Joint Syndrome

The sacroiliac joints reside between the sacrum (the tailbone segment of the spinal column) and the prominent wing-like iliac bones that form the pelvic girdle. There are two SI joints, one on the left and one on the right (highlighted in red in the image above), and along with the symphysis pubis joint at the front of the structure, they are critical for transferring forces and energy back and forth between the spine and the lower limbs. There are a number of reasons that an SI joint can become painful and inflamed, leading to SI joint syndrome. Trauma, such as a fall injury to the tail bone or a forced injury from a car accident for example, obviously can create problems in the SI joint…

Spinal Stenosis

Spinal stenosis is the narrowing of the central spinal canal and is a cause of significant pain and disability. Common causes of spinal stenosis include disc protrusion, facet overgrowth and ligamentum flavum thickening. Surgery is often chosen when conservative therapies fail despite the lack of convincing evidence that it is a superior treatment option. Are there alternatives to back surgery for spinal stenosis? Yes. Regenexx DDD utilizes precise platelet injections into the facets, muscles, and ligaments to treat the lumbar stenosis, treating all of the components of the issue, which is crucial. Spinal stenosis is often an age-related condition attributed…

Spondylolisthesis

Spondylolisthesis means that one vertebra is slipping forward or backwards on another. This causes the hole where the nerve exits (foramen) to get smaller (also called foraminal stenosis). It also causes more wear and tear on the facet joint which can lead to arthritis or what’s called “facet hypertrophy”. spondylolisthesis recovery The amount of slippage is graded 1-4, with grade 1 meaning that the one vertebra has slipped up to 25% on the other vertebra. Grade 2 means that one bone has slipped from 25-50% with higher grades indicating more slippage. The vast majority of patients are grade 1 to 2.

Thoracic Cyst

Cysts are abnormal, closed sacs that contain fluid, gas or semi-fluid material. They can develop in various parts of the body. They can vary in size from very small to large and can be located within organs, tissues or bones. Cysts can be either benign (non-cancerous) or malignant (cancerous). Most cysts are benign. They occur due to a number of different reasons that include obstruction, infection, chronic inflammation, instability or cellular abnormalities. So, thoracic spine cysts are abnormal, closed sacs that occur in the spine below the neck and above the low back.

Thoracic Spondylosis

The thoracic spine, also known as the mid back, is that portion of the spine that is below the cervical spine (neck) and above the lumbar spine (low back). Thoracic spondylosis is a degenerative condition of the thoracic spine. The thoracic spine, also known as the mid back, is composed of many important different structures that work together to provide stability and movement. Thoracic spondylosis is a degenerative condition affecting the middle region of the spine, known as the thoracic spine. The major causes include: aging, genetics, poor posture, repetitive strain, and more. Symptoms can be mild, moderate, or severe…

Torn Discs

The spinal discs are shock absorbers that live at each level between the vertebral bones (1). They have a tough outer annulus part and a soft inner gel part (nucleus pulposis). The outer covering can get damaged which can sometimes be seen on MRI and other times requires additional testing to identify. These tears are called: a torn disc, a disc tear, an annular tear, and when seen on MRI a “High-Intensity Zone” or HIZ. They can cause pain, mostly through ingrown nerves. There are torn disc findings that can be seen on MRI (HIZ) and these can be either asymptomatic (i.e. not painful) or…

How Do You Treat Leg Weakness?

For the best clinical outcome, it is best to address the underlying cause of leg weakness. Activity modification, rest and PT are first-line treatment options for mild direct trauma and nerve entrapment. Optimizing the glucose, and increasing activity may benefit patients with diabetes-related muscle weakness. SI joint-related leg weakness is frequently missed as it is not well understood or appreciated by doctors. Steroids are frequently injected into the SI joint and should be avoided as steroids are toxic to the cartilage (7). In addition, steroids can loosen the injured SI joint ligaments.

At the Centeno-Schultz Clinic, we have extensive experience in the treatment of SI joint pain, instability, and related leg weakness. PRP and bone marrow-derived stem cells are precisely injected into injured areas utilizing x-ray and ultrasound. Lumbar disc protrusions, herniations, spinal stenosis, and slippage should not be treated with steroids given their toxicity to orthopedic tissue. The Centeno-Schultz Clinic demonstrated that PRP is a safer, more effective, and longer-lasting option than steroids in the treatment of lumbar disc and leg pain (8). To better understand current treatment options for low back and leg pain due to disc injuries please click on the video below.

In Conclusion: Legs Giving Out is A Warning Sign

When your leg gives out it may a signal that you have problems brewing. Weakness in the leg can arise from three principal causes: nerve problems, muscle weakness, and SI joint dysfunction. Treatment is best directed at the underlying problem. Lumbar disc disorders such as protrusion and herniations can compress the spinal nerve thereby compromising the nerve signal to the muscle. Loose SI joint ligaments can also result in your leg giving out. Steroids are toxic and should be avoided. PRP, and stem cells when needed, are effective treatment options for both SIJ and lumbar disc injuries. If left untreated the underlying problem can progress, and new injuries may occur as the result of falls when your leg goes out.

Heed the warning signal! If your leg gives out, get an evaluation that includes muscle strength, low back, and sacroiliac joint integrity.

Resources

1.Choi HS, Kwak KW, Kim SW, Ahn SH. Surgical versus Conservative Treatment for Lumbar Disc Herniation with Motor Weakness. J Korean Neurosurg Soc. 2013;54(3):183-8.doi: 10.3340/jkns.2013.54.3.183.

2.Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-35.doi: 10.1007/s00586-007-0543-3.

3.Egli D, Hausmann O, Schmid M, Boos N, Dietz V, Curt A. Lumbar spinal stenosis: assessment of cauda equina involvement by electrophysiological recordings. J Neurol. 2007;254(6):741-50. DOI: 10.1007/s00415-006-0427-1.

Schreiber AK, Nones CF, Reis RC, Chichorro JG, Cunha JM. Diabetic neuropathic pain: Physiopathology and treatment. World J Diabetes. 2015;6(3):432-44. doi: 10.4239/wjd.v6.i3.432.
Saguil A. Evaluation of the Patient with Muscle Weakness. Am Fam Physician. 2005 Apr 1;71(7):1327-1336.
Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther. 2008;16(3):142-52. doi: 10.1179/jmt.2008.16.3.142.

7.McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967-75. doi: 10.1001/jama.2017.5283.

Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injection of platelet lysate for treatment of radicular pain. J Exp Orthop. 2017;4(1):38. Published 2017 Nov 25. doi:10.1186/s40634-017-0113-5