Lumbar Radiculopathy

What is lumbar radiculopathy?

This occurs when one or more nerves in the lower back are irritated or compressed, generally causing pain that radiates down the leg.

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What is a nerve?

Nerves are like electrical wires that run through our body. The lumbar nerves start in the lower back and go down the legs to the toes. They allow us to feel our legs when we touch them, and they provide electrical signals to our leg muscles so we can move.

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What are the symptoms of lumbar radiculopathy?

The main symptoms are:

• Pain in the lower back and pain in the leg.
• The leg pain is often felt along a specific path, like a line going down the leg. The pain may be in the buttock, thigh, calf, and even the foot.
• There may be burning, numbness, or tingling in the leg.
• You may feel weakness in the leg.

Generally, there are two "types of symptoms" for lumbar radiculopathy:

• "Lumbar radiculopathy with symptoms in lumbar flexion (rounded back)" 
• "Lumbar radiculopathy with symptoms in lumbar extension (arched back)"

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Here are the positions or movements that increase pain depending on the type of lumbar radiculopathy:

For lumbar radiculopathy with symptoms in lumbar flexion (rounded back), the pain is increased by one or more of the following:

• Sitting for long periods
• Driving for a long time
• Bending over
• Putting on socks, pants, underwear, shoes
• Sneezing or coughing

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For lumbar radiculopathy with symptoms related to lumbar extension (swayback), the pain is increased by one or more of the following:

• Walking for a long time (worse if walking slowly, better if walking faster)
• Standing for a long time (grocery shopping, cooking, waiting in line, or watching a show while standing still)
• Lying on your stomach or on your back with your legs extended
• Reaching to put objects on high shelves, such as in kitchen cabinets

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It is possible to have both types of lumbar radiculopathy at the same time, and therefore have symptoms that fall into both categories. However, one category is often worse.

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What are the serious symptoms of lumbar radiculopathy to watch out for?

The presence of certain signs and symptoms should prompt you to seek immediate medical attention at the emergency room or from a doctor. These include:

• Severe weakness or paralysis of one or both legs
• Significant or even complete loss of sensation in one or both legs
• Recent loss of balance when walking
• Significant and new incoordination
• New difficulties with bladder or bowel control
• Loss of sensation in the genital area or when wiping after a bowel movement

Serious symptoms are only present in less than 1% of lower back pain cases. Most of the time, although the pain can be very unpleasant, the condition improves.

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When to consult a physiotherapist for lumbar radiculopathy?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

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You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

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What are the causes of lumbar radiculopathy?

Lumbar radiculopathy can be caused by different things. Sometimes, the pain appears without any trigger. Other times, the pain is caused by a specific event. Here are some examples of possible causes:

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• Overloading the back compared to what you are used to. For example:

• Doing spring or fall cleaning
• Gardening all weekend
• Driving for 10 hours in a single day

• Decreased level of physical activity (if you have become less active than before, you may develop lower back pain)
• New job, new sport, or new activity that works your back in a new way
• Car accident, fall, or sudden awkward movement

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How is lumbar radiculopathy diagnosed?

The diagnosis is made based on the history of symptoms and the clinical examination.
It is important to know that medical imaging (X-ray, MRI, etc.) is not relevant in 99% of cases.

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What are the physiotherapy treatments for lumbar radiculopathy?

Your physiotherapist will perform an assessment to determine your limitations by evaluating the following elements:

• The mobility of your spine
• The gliding of your nerves
• Your postural habits
• The quality of your movements
• Your strength and stability

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Based on the assessment results, your physiotherapist will:

• Will mobilize the joints in your back and your nerves to reduce pain and improve movement.
• Will give you specific exercises to do at home to address the cause of the problem and reduce pain.
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Will give you advice for your postural habits and movements.

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What to do at home for lumbar radiculopathy?

Temporarily stop doing the movements that cause too much pain, and then gradually start doing them again.
Do not remain completely still for long periods, as you will be stiffer and experience more pain afterward.

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Here are some tips that may help depending on the type of symptoms:

For lumbar radiculopathy with symptoms in lumbar flexion (rounded back):

• Limit the time spent sitting (get up every 20 minutes to walk a little).
• When you are sitting, straighten your lower back a little by sticking your buttocks out. Place a rolled-up towel in your lower back to remind you to sit up straighter.
• Go for frequent walks for a duration that is comfortable. Running might even be good for you (it depends on the person).
• In the car, sit well back in the seat and tilt the backrest slightly backward. Move the seat slightly closer to the steering wheel.
• Stick your buttocks out slightly to lean forward.
• When the pain is present, spend a few minutes on your stomach or on your back with your legs extended. This should relieve you.

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For lumbar radiculopathy with symptoms in lumbar extension (hollow back):

• Limit the time spent standing (sit down every 20 minutes while the pain decreases).
• If you are standing still, place one foot in front of the other and make small weight transfers forward and backward.
• When cooking, place one foot inside the cabinet in front of you.
• When the pain is present, spend a few minutes lying on your side with a pillow between your knees. This should relieve you.

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If you don't see any improvement after 10 days, you should consult a physiotherapist.

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Did you know?

• 90% of lower back pain episodes heal in 6 to 12 weeks
• 50% of lower back pain episodes heal in 1-2 weeks

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To learn more...

You can listen to the podcast "Parle-moi de santé" produced by one of our physiotherapists, Alexis Gougeon. Episode #7 discusses the topic of lower back pain.

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Episode #7 lower back pain

Find the episode on YouTube :

Click below to listen to episodes on podcast platforms:

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Sources

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

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