Runner massaging pain in leg. Consider PAD treatment.
Heart & Vascular

Legs aching when you exercise? It might be PAD


May 29, 2019

Peripheral artery disease, or PAD, occurs when one or more of the arteries supplying blood to the extremities is compromised. Here’s what to watch for, and when to seek help.

If you have leg pain that comes on with exercise, like walking, running or using a cardio machine, and then goes away with rest, you might be experiencing peripheral artery disease, a narrowing of the arteries that carry blood to your limbs. During exercise, your legs demand an increase in blood supply. If you have PAD, pain can result, but finding treatment isn’t too difficult.

“It’s typically in the backs of the legs,” said Aaron Aday, M.D., a cardiovascular specialist at the Vanderbilt Heart and Vascular Institute. “But it can be in the buttocks, the thighs or the calves,  and the pain can present differently.”

Some people describe it as achy, while others talk of a burning sensation. In most cases, this form of chronic pain crops up during exertion and then dissipates within about five minutes of stopping or resting. The intensity of the discomfort can vary from mild to severe.

“In more severe cases,” Aday said, “the pain can come on with less and less activity or even occur just at rest.”

The reduced blood supply can eventually impact tissue, resulting in ulcers on the feet or lower legs that do not heal.

Those who are at risk for developing PAD include people who have diabetes or hypertension, and those who are older. “Smoking is the number one risk factor for this,” Aday said. “And it’s not just current smokers — people who were heavy smokers in the past are still at higher risk.”

When to go to the doctor and discuss PAD treatment

If you’re experiencing leg pain while exercising, talk to your doctor about PAD treatment. Aday recommends not only bringing up the discomfort but also asking whether it could be an artery problem. “Other things like osteoarthritis, orthopedic injuries or spinal injuries can cause leg pain as well,” he explained. “But we want people to be aware that it’s not always orthopedic, and sometimes the limitation may be due to an arterial issue.”

While milder symptoms don’t necessarily require an emergency visit to your physician, you shouldn’t wait several months to make an appointment. Sudden onset of severe pain in the legs, however, is a reason to reach out right away, Aday said.

A few noninvasive tests will help your physician determine if the blood flow to your legs is normal. “We most commonly just check the blood pressure in both their ankles and their arms and see if there’s a discrepancy that is suggestive of a blockage,” Aday explained. “There are other tests involving ultrasound that can help us get more information.”

Prevention and management of PAD

People who have PAD are at high risk of heart attack, stroke and even death. “The physical activity limitations can be severe,” Aday said. “Over time, people often become less and less active as a result.” This can create a vicious cycle in terms of worsening PAD and creating or exacerbating other health issues. “They may need stents or surgeries in the legs, or they sometimes require an amputation,” Aday added.

Exercise may be one of the easiest PAD treatment procedures patients can undergo. People with PAD greatly benefit from a prescribed formalized exercise program that helps them slowly increase activity over time as their body adapts. “It strengthens the muscles and may help grow new blood vessels that can bypass some of these blockages,” Aday explained.

“However, prevention is the number one key. That’s why we work very hard with individuals who are smoking to try to get them to stop, or with individuals who have diabetes to get them on the right treatment.”

Man and woman playing with dog while on hike.

The Vascular Disease Program at Vanderbilt University Medical Center treats blood vessel conditions anywhere in your body. We bring together a range of cardiovascular specialists — including vascular medicine and surgery experts — so you get the specific care you need. Details: 615-322-2318.

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