Commonly known as a pinched nerve or sciatica, lumbar radiculopathy is a condition in which a nerve root is irritated in the low back causing pain, weakness, and/or numbness/tingling in the low back, groin, buttock, leg or foot.
Lumbar Radiculopathy is typically caused when the space (foramen) where the nerve exits the spinal column narrows and may be a result of bone spurs, stenosis, muscle spasm, or disc herniation around the foramen. Other less common causes include spinal infection or noncancerous/cancerous growth in the spine pressing on the nerve root. Lumbar radiculopathy usually arises when a herniated or bulging disc becomes more severe and places greater pressure on the nerve root. (see Discogenic or Herniated Discs)
Risk factors include smoking, obesity, sedentary lifestyle, poor ergonomics or postures with sitting, stooping and lifting.
You may experience pain, weakness/atrophy, and/or numbness/tingling in back, buttock, groin or leg that may travel to the foot. Pain is often sharp and numbness and tingling may present as burning, pins and needles, a deep ache down the leg or altered sensation to touch of the skin in this area. You may notice pain in back or leg with reaching or leaning forward or backward or toward side of pain. Severe low back pain radiating into the leg may occur when the sciatic leg nerve becomes compressed and irritated. Symptoms of lumbar radiculopathy may feel like burning, searing, shooting and cramping.
Physical examination and movement testing are performed to assess strength, reflexes, and reproduction of symptoms with movement. The result of this testing can help identify the affected nerve root. This testing can be performed by a Results Physiotherapist.
If this testing is unlcear or does not present with expected outcomes with initial treatment by your physiotherapist (PT), further testing may be required. This can include X-ray, CT scan or MRI, or nerve conduction studies and may include referral to Spinal Orthopedist or Nuerosurgeon.
Depending on severity of condition and/or lack of response to conservative treatment (i.e. Physical Therapy) epidural steroid injection may be suggested. In some cases, surgical intervention is required when conservative intervention is not enough to reduce compression of the nerve root or symptoms are progressively worsening. This may involve removing part or all of the disc or vertebra to give more room for the nerve to exit the spinal column.
After diagnosis by your PT or other health care provider (PCP, orthopedist, neurologist, etc) you will be instructed in treatment options and need for further assessment as stated above.
Physical therapy can help with the pain and weakness associated with lumbar radiculopathy by improving mechanics around the nerve interface (foramen) and strengthening areas of weakness or muscle imbalance to prevent further compromise to the nerve. At Results Physiotherapy a highly skilled PT will perform a thorough examination to establish an individualized treatment plan specific to your impairments and functional needs.
This will include hands on manual therapy to your spinal joints, muscles or nerve to reduce inflammation to nerve root by restoring normal mechanics aroun the nerve. Once the nerve root inflammation is reduced, you will begin exercises to strengthen the muscles around the nerve root to help maintain normal mechanics around the nerve. Finally you will be trained how to perform activities with good ergonomics to safely return to activities of daily living or activities that have been limited due to this condition.
Triggerpoint Dry Needling is an adjunct tool to hands on manual therapy treatment for Lumbar Radiculopathy. If appropriate for you, your PT may recommend this course of treatment to get you better faster. In the case of lumbar radiculopathy the solid filament needle may be placed in the muscles surrounding the nerve root or pathway (i.e. buttocks or down the leg) to directly release pressure placed on the nerve by the structures.
Upon discharge from Physical Therapy, you will have instructions to continue a maintenance home exercise program to prevent the condition from occuring again as well as when to contact your PT if symptoms recur or do not continue to improve as expected.
Prolonged sitting is one of the common triggers for low back pain, especially for those who work at a computer. Sitting with hips and knees at a right angle, and feet flat on the floor, will keep the spine in a neutral position. For those whose feet cannot reach the floor without sitting on the edge of the chair, placing the feet on a book or stool will help. Also, take frequent breaks to stand up and move around. Standing without the knees locked out will reduce the compression through the joints. When lifting heavy items, use the legs and not the back and arms and avoid lifting and twisting at the same time. Ice or heat can reduce the pain and muscle guarding, if it does occur.
Motion is Lotion! Keeping an active lifestyle is one factor in improving low back health. The American College of Sports Medicine suggests getting at least 20 minutes of physical activity every day which can be as simple as walking 10 minutes twice a day. Use good ergonomics with sitting, standing, driving, stooping, and lifting. Avoid prolonged postures without taking rest breaks. Whether it is sitting, standing or stooping, make sure to take a rest break every hour or so. Take a quick lap around the office or do some repetitive stretches.
Maintain a healthy weight. For every pound over your healthy weight it puts an added 5 pounds of pressure on your joints. Quit smoking! Smokers are 600x more likely to have spinal pain than non-smokers.
Don't ignore low back pain. Early intervention is the best prevention. Many of the common causes of Lumbar Radiculopathy are treatable prior to progressing to nerve root irritation (degenerative disc disease, stenosis, muscle spasm, disc herniation.) The newest research is demonstrating the cost savings (i.e. loss of work hours, surgical intervention, expensive imaging) of early intervention with Physical Therapy.