Lumbar Radiculopathy

Lumbar Radiculopathy: a complete guide to understanding and treating nerve irritation

Lumbar radiculopathy is a condition that affects the nerves in the lower back, often causing pain that extends into the leg. While this condition can be very painful and limiting, the good news is that it generally responds well to conservative physiotherapy treatment. Understanding this condition and knowing how to manage it can help you quickly return to your normal activities.

What is lumbar radiculopathy?

Lumbar radiculopathy occurs when one or more nerves in the lower back become irritated or compressed. This nerve irritation typically causes pain that radiates down the leg, following the path of the affected nerve. The term radiculopathy comes from the Latin word "radix," meaning root, referring to the nerve root that emerges from the spine.

This condition is also known by other names depending on the specific nerve affected. Sciatica involves the sciatic nerve and causes pain in the back of the leg, while femoral neuralgia affects the femoral nerve and causes pain in the front of the thigh.

What is a nerve?

To better understand radiculopathy, it's helpful to know what a nerve is. Nerves are like electrical wires running through our bodies, transmitting signals between the brain and different body parts. Lumbar nerves originate in the lower back and extend down into the legs, all the way to the toes. They allow us to feel our legs when touched and provide the electrical signals to our muscles so we can move.

When a nerve is irritated or compressed, it doesn't function normally. This can cause pain, numbness, tingling, or weakness in the area supplied by that nerve.

What are the symptoms of lumbar radiculopathy?

The main symptoms of lumbar radiculopathy include lower back pain accompanied by leg pain. The leg pain is often felt along a specific path, like a line running down the limb. This pain can affect the buttock, thigh, calf, and even the foot, depending on the nerve involved.

There may also be burning, numbness, or tingling sensations in the leg, which reflect nerve irritation. Weakness in the leg can also be experienced, especially when the nerve irritation is more significant.

Generally, two types of lumbar radiculopathy symptoms can be distinguished, based on the movement or position that worsens them. This classification is important because it guides the choice of exercises and postural advice.

Lumbar radiculopathy with symptoms in lumbar flexion (rounded back)

This type of radiculopathy occurs when pain is increased by positions or movements that round the lower back. Sitting for long periods typically worsens symptoms, as this position flexes the lumbar spine. Driving for extended periods has the same effect. Bending forward, putting on socks, pants, underwear, or shoes can trigger or increase pain. Sneezing or coughing, movements that increase pressure in the spinal canal, can also provoke symptoms.

Lumbar radiculopathy with symptoms in lumbar extension (arched back)

This type of radiculopathy appears when pain is increased by positions or movements that arch the lower back. Walking for long periods can worsen symptoms, especially if walking slowly. Paradoxically, walking faster can sometimes improve the situation because it slightly changes the lumbar mechanics. Standing for extended periods, whether for grocery shopping, cooking, waiting in line, or standing at a show, generally worsens symptoms.

Lying on your stomach or on your back with legs extended can also cause pain. Reaching for objects overhead, such as in kitchen cabinets, is another activity that can trigger extension-related symptoms.

It is possible to have both types of lumbar radiculopathy simultaneously and thus experience symptoms from both categories. However, one category is often more pronounced than the other, which helps guide treatment.

What are the serious symptoms to watch out for?

The presence of certain signs and symptoms should prompt you to seek immediate medical attention at the emergency room or with a doctor. These "red flags" are rare but important to recognize as they can indicate serious nerve compression requiring quick intervention.

Severe weakness or paralysis in one or both legs is a medical emergency. Similarly, a significant or complete loss of sensation in one or both legs requires immediate evaluation. A recent loss of balance while walking or new, significant incoordination are also concerning signs.

New difficulties holding urine or stool, as well as a loss of sensation in the genital areas or when wiping after a bowel movement, can indicate cauda equina syndrome. This condition is a surgical emergency because prompt intervention can prevent permanent damage.

It is reassuring to know that these severe symptoms are present in less than 1% of lower back pain cases. Most of the time, although the pain can be very unpleasant, the condition improves favorably with appropriate treatment.

What causes lumbar radiculopathy?

Lumbar radiculopathy can be caused by various factors. Sometimes, pain appears without any obvious trigger. Other times, it's caused by a specific event. Here are some examples of possible causes.

Overloading your back beyond its usual capacity is a common cause. Examples include doing spring or fall cleaning, gardening all weekend with a bent back, or driving for 10 hours in one day. These activities put more strain on your back than it's accustomed to.

Paradoxically, a decrease in physical activity can lead to pain. If you've become less active than before, you might develop lower back pain because your back muscles and structures lose their ability to support daily loads.

A new job, sport, or activity that works your back in a new way can also trigger radiculopathy. The body needs time to adapt to new demands, and progressing too quickly can irritate the nerves.

A car accident, a fall, or a sudden awkward movement can traumatize the lumbar structures and irritate the nerves. These events can cause a lumbar disc herniation, which then compresses a nerve root.

How is lumbar radiculopathy diagnosed?

The diagnosis of lumbar radiculopathy is based on your symptom history and a clinical examination. Your physiotherapist or doctor will ask you about when your pain started, what makes it worse or better, and how it affects your daily activities.

It's important to know that medical imaging, whether X-rays or MRI, is not relevant in 99% of cases. Studies show that changes visible on imaging are often present in people without any pain and do not necessarily predict the cause of your symptoms. A clinical diagnosis is usually sufficient to guide treatment.

When to consult a physiotherapist for lumbar radiculopathy?

You should consult a physiotherapist if you experience symptoms as described above, or if your doctor has already ruled out any other potential causes for your pain. Physiotherapy for lower back pain offers an effective approach to treating radiculopathy.

You do not need to see a doctor before consulting a physiotherapist. Physiotherapists are primary care professionals who can assess your condition and refer you to other healthcare professionals if necessary. If your condition requires seeing a doctor, your physiotherapist will be able to inform you and provide an appropriate referral.

What are the physiotherapy treatments for lumbar radiculopathy?

Your physiotherapist will first conduct a comprehensive evaluation to determine your limitations. This assessment examines several essential elements. The mobility of your spine will be tested to identify segments that move less effectively. The gliding of your nerves will be assessed to check if they are irritated or compressed.

Your postural habits will be observed to identify positions that might contribute to your pain. The quality of your movements will be analyzed to pinpoint inefficient movement patterns. Your strength and stability will be measured to assess your muscles' ability to support your spine.

Based on the results of this evaluation, your physiotherapist will use different therapeutic approaches. Joint mobilizations and manipulations of your back and nerve joints help reduce pain and improve movement. These manual techniques are safe and effective when applied by a qualified professional.

Specific exercises will be prescribed for you to do at home to address the root cause of the problem and reduce pain. The McKenzie approach is often used to identify your directional preference, which is the movement that centralizes or reduces your symptoms. Stabilizing muscle exercises strengthen the deep muscles that support your spine.

Your physiotherapist will also teach you how to properly pace your daily activities and hobbies to optimize healing. You will receive personalized advice for your posture and movements.

What to do at home for lumbar radiculopathy?

The first recommendation is to temporarily stop movements that cause too much pain, then gradually resume them later. It's also important not to remain completely immobile for long periods, as you will feel stiffer and more pain afterwards.

For Symptoms with Lumbar Flexion (Rounded Back)

Limit the time you spend sitting and get up every 20 minutes to walk around a bit. Prolonged sitting increases pressure on the intervertebral discs and can worsen nerve irritation.

When sitting, slightly straighten your lower back by tilting your pelvis forward. Place a rolled towel in the small of your back to remind you to sit more upright. This lumbar support helps maintain the natural curve of your spine.

Walk often for a comfortable duration. Running might even be beneficial for you, though this depends on the individual. Walking is generally an excellent exercise because it keeps your back in a neutral position.

In the car, sit back fully in the seat and recline the backrest slightly. Move the seat closer to the steering wheel a bit to avoid stretching. Stick your buttocks out slightly when leaning forward, using your hips rather than your spine.

When pain is present, spend a few minutes lying on your stomach or on your back with your legs extended. These positions should provide relief.

For Symptoms with Lumbar Extension (Arched Back)

Limit time spent standing and sit down every 20 minutes until the pain subsides. If you must stand statically, place one foot in front of the other and make small weight shifts forward and backward. This slight movement reduces the load on your lumbar structures.

When cooking, place one foot inside the cabinet in front of you. This position slightly reduces the lumbar curve and relieves pressure on the posterior joints. When pain is present, lie on your side for a few minutes with a pillow between your knees. This position maintains your spinal alignment and should provide relief.

If you don't see any improvement after 10 days of home care, you should consult a physiotherapist for a professional evaluation and personalized treatment.

The prognosis for lumbar radiculopathy

Statistics regarding lower back pain are encouraging. Approximately 90% of lower back pain episodes resolve within 6 to 12 weeks, and 50% resolve within 1 to 2 weeks. These figures also apply to radiculopathies, with the majority responding well to conservative treatment.

Conditions associated with lumbar radiculopathy

Lumbar radiculopathy can be associated with other conditions affecting the spine. Lumbar disc herniation is one of the most common causes of nerve irritation. Lumbar facet syndrome can coexist with radiculopathy. Spinal stenosis can cause nerve compression, particularly in older individuals.

Lower back pain is a general condition that often accompanies radiculopathy. Treatment aims to reduce both local back pain and pain radiating into the leg.

Get help for your lumbar radiculopathy

If you are experiencing back pain that radiates into your leg, our physiotherapists can help you understand your condition and regain your mobility. A comprehensive assessment will identify the factors contributing to your pain and help develop a personalized treatment plan.

Don't wait for the pain to become chronic before seeking help. The sooner you act, the better the results usually are. Book an appointment today to start your journey towards relief.

Sources

Alexander CE, Varacallo M. Lumbosacral Radiculopathy. InStatPearls [Internet] 2019 Mar 23. StatPearls Publishing.