QUESTION

When I wake up in the middle of the night, the tops of my legs feel so heavy—just like dead weight. What’s going on?

ANSWER

There are a number of possibilities. Fortunately, all of them are treatable. Based on your description, your symptoms could be due to lumbar spinal stenosis (a narrowing of the lower spinal canal) or degenerative spine disease (changes to the spinal discs that are often related to aging). With both of these conditions, people typically experience low-back pain with tingling or shooting pain down one or both legs…and sometimes heaviness and aching in the legs. With spinal stenosis, bony overgrowth slowly surrounds and compresses the nerves as they leave the spinal cord and run into the legs. I prefer physical therapy to treat this condition, while some doctors prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve), or the nerve pain medication gabapentin (Neurontin). If these approaches don’t bring relief, minimally invasive surgery to open up the bony holes (called foramina) through which the nerve roots exit the spinal cord may be recommended. With degenerative spine disease, a protruded or herniated disc or spinal arthritis compresses one or a few nerves as they exit the spinal cord. Surgery is usually not required. Exercise to increase strength and flexibility and pain medication are often sufficient. A muscle condition called inflammatory myopathy also could lead to the symptoms you describe. People with this condition may have aching in the thighs and weakness when doing everyday tasks, such as getting up from a low chair or lifting the arms over the head, as well as trouble swallowing. Some patients may also have a rash on their face or other areas of the body. The cause of this condition is not known, but it is considered an autoimmune disorder, in which the body’s immune system attacks normal tissue, including muscle fibers. Inflammatory myopathy is usually treated with physical therapy, medication (sometimes including steroids to curb inflammation) and rest. A topical cream can be used to treat a rash or other skin problems. Peripheral artery disease (PAD), a fairly common disorder in people over age 50, can cause a feeling of heaviness or aching in the thighs. With this condition, a buildup of fatty deposits in the arteries slows blood flow in the legs. Even though walking often triggers the pain associated with PAD, this form of exercise is usually the best possible treatment because, when done consistently, it brings more oxygen to the muscles, which improves circulation and helps curb the pain. Aspirin, blood-thinning medication and cholesterol-lowering drugs also may be recommended. If these therapies do not control the condition, the next step to consider is a minimally invasive procedure that involves placing a stent in the blocked artery. To get to the bottom of your symptoms, you should visit your primary care physician, who can perform a thorough vascular and neurological examination. Your doctor can determine what tests you may need by checking the temperature of your feet…the pulses in your feet and legs…and your reflexes. Blood tests also may be included to look for enzymes that damaged muscle cells release into the blood, as well as an ultrasound examination of the blood vessels in the legs to check for PAD…or an MRI of the lower back to determine whether you have arthritis in the spine. If any of these tests are abnormal, your doctor may want you to have a test known as an electromyography, in which small needles are inserted into the muscle to check the condition of your muscles and the nerve cells that control the muscles, and a nerve conduction study to check the functioning of your nerves.