A significant number of people experience low back pain at one stage in their life. Some of these will be unlucky enough to get pain running down their leg at the same time. One specific diagnosis of this pain is lumbar radiculopathy. Simply put, it is pain that originates from the lower back and is referred down the leg. There are many other names for this including sciatica, nerve pain, and referred pain. Sciatica is commonly used as a generic term for leg pain, as the sciatic nerve is the largest nerve in the body. However, for it to be classed a true radiculopathy it must fulfil the following criteria:
- The pain must travel below the knee in a specific pathway associated with a specific nerve
- There must be deficits in one or more of sensation, strength, or reflexes again associated with a specific nerve
If these criteria are not fulfilled than the cause of the leg pain is something other than a radiculopathy.
Causes
The main causes for lumbar radiculopathy are disc herniation or a disc bulge. When this occurs, there is an increase in pressure around the nerve. The increase in pressure can cause an irritation of the nerve resulting in pain. However, it is also important to note that disc herniations and bulges are commonly found in people with no pain or symptoms at all. Clinical guidelines now encourage a more clinical assessment and discourage the use of excessive imaging in people with low back pain with and without leg pain. If imaging is done the findings need to be considered in relation to each individual’s history and assessment findings.
Symptoms
When discussing the symptoms of a lumbar radiculopathy you may hear about dermatomes and myotomes.
A dermatome is an area of skin supplied by a single spinal nerve. A myotome is a group of muscles innervated by a single spinal nerve. For instance, the second nerve in your lower back supplies the skin at the front and side of your hip and is responsible for bending your hip. Dermatomes and myotomes are the reason that certain areas of the leg become affected in lumbar radiculopathies depending on which nerve is affected. Classic symptoms in these specific pathways include pain, pins and needles, numbness, muscle weakness, altered sensation, and altered reflexes. The severity of the symptoms and response to treatment will help determine recovery time. However, it is generally accepted that majority of people will have a full recovery and those that seek early treatment recover quicker.
Treatment
Lumbar radiculopathy sounds pretty scary. Fortunately, it certainly doesn’t have to be. There are loads of options for treatment, and most of these don’t involve surgery. Simply knowing this can be considered the first step of treatment. We know for a fact that if people are less fearful of their condition or pain, they will simply move around more and recover quicker. Other treatment options are discussed in detail below.
Education
The more you know about what is going on, why this is happening, and what you can do to help the better. Education and knowledge will give you more control over what is happening. Again, we know this results in better outcomes. So, don’t be afraid to ask your physiotherapist questions.
Load Management
We want you too to be strong and mobile. How do we do this? We get you too move. Movement is good as it allows you too maintain your strength and flexibility. As soon as you stop moving for long periods of time you become weaker and stiffer. In saying this some movements are better than others, and the amount you move needs to be considered in relation to your pain. Your physiotherapist will be able to advise you on these things and provide a progressive loading program so that you remain strong and mobile. Your program may include some basic exercises that can be progressed as able, or it may be as simple as to continue to walk. Each case is different so each individual’s program will be different.
Manual Therapy
There are a number of different techniques physiotherapists can use too loosen up stiff joints and tight muscles, or reduce the irritation or pain. Soft tissue therapy, joint mobilisation, dry needling or traction are the most common forms. Depending upon each individual’s presentation will determine which technique is appropriate. The aim of manual therapy is to decrease pain and put your body in a better environment to move and function better.
Cortisone Injections
Currently there is insufficient and conflicting evidence regarding the appropriateness and effectiveness of cortisone injections as a treatment option for lumbar radiculopathy. The idea is by injecting a strong local anti-inflammatory, symptoms will settle. Cortisone may be considered as an adjunct treatment option is symptoms are severe or other conservative treatment has failed.
Surgery
The most common type of surgery for lumbar radiculopathy is spinal decompression. This is when a piece of bone or disc is removed from the spine to allow pressure to be released from the surrounding nerve. In severe cases multiple levels may be fused together to improve stability of the spine, this is called a spinal fusion. Surgery for lumbar radiculopathy is only based on relatively weak evidence, and only must be considered if conservative treatment such as physiotherapy has failed. If you have any questions, please discuss them with your physiotherapist.
See a Physiotherapist
The world of low back and leg pain is a pretty complex thing. Lumbar radiculopathy is just one possible cause. As always it is important that you seek personal and professional advice as each case is unique. So if you are having any issues with low back and leg pain book in to see your physiotherapist today to help you get back on track.