Lax lower extremity pain syndrome

Lax Lower Extremity Pain Syndrome (LLEPS) describes a constellation of active pain generators affecting the back and lower extremity united by a common pathophysiologic process. The pain generators have been well-described as individual entities occurring in isolation, but a single unifying process has yet to be described. In LLEPS, laxity and weakness in the lower extremity lead to postural changes which alter the kinetic chain and increase biomechanical stress on certain structures (i.e. joints, ligaments). Painful conditions attributable to LLEPS may include lumbar facet arthropathy, sacroiliitis, trochanteric bursitis, piriformis strain, iliotibial band syndrome, patellofemoral syndrome, ankle degeneration, plantar fasciitis and metatarsalgia. Treatment should include physical therapy to address postural changes due to weakness and laxity, with the goal of optimizing biomechanical forces along the kinetic chain. Medical or interventional management of pain is also essential for effective participation in physical therapy. Orthoses may be beneficial for laxity which does not improve with strengthening. Recognition of LLEPS as a clinical syndrome provides a framework for understanding the pathophysiologic process underlying many common pain complaints. Identification of these clinical features may improve diagnostic precision, allow for more a comprehensive treatment plan and possibly prevent future pain in other related structures.