What is a painful radiculopathy?
Low back pain is one of the most common musculoskeletal complaints encountered in a physiotherapist’s clinical practice. Painful lumbar radiculopathy is a type of back pain that is associated with symptoms of shooting or burning pain travelling down the leg, weakness and numbness. Previously it has been referred to as ‘Sciatica’. It has an incidence of 5-12% amongst the general population. Radicular lower back pain is a debilitating and frustrating condition; however, it can be managed together with your physiotherapist.
The nerves in our body transport messages from the body to the brain, and from the brain back, to initiate and control movement and sensation. The nerves enter and exit via the spine and travel along the spinal chord. Painful radiculopathy occurs when there is impaired nerve insulation which disrupts the transporting of function from the nerves to the body parts. It can occur due to compression, damaging the nerve root which can cause loss of nerve function (leading to weakness or numbness), or due to a chemical irritation within the spine, leading to inflammation (causing pain). Radiculopathy can happen at any portion of the spine, but it is most commonly seen in the lower back (lumbar) region.
Signs and symptoms of painful lumbar radiculopathy include back pain with unilateral leg pain. The leg pain can be dull, piercing, shooting, tingling or burning sensation radiating down as far as the knee or towards the ankle. It usually occurs in the area that the affected nerve supplies (dermatome). It can often be much worse that the lower back pain itself, and can occur both at rest and during activity. Patients often report numbness or weakness in the leg and can sometimes present with an altered gait pattern, depending on the severity of symptoms.
Why does painful radioculopahty happen?
There are many reasons for the onset of this type of pain. Predisposing factors are obesity, smoking, heavy manual labour, extended periods of sitting e.g. while driving and job dissatisfaction. More acute factors that contribute to radicular low back pain (usually triggered by trauma of twisting or straining the back or wear and tear) include
- A disc bulge: where over 25% of the disc (cushioning between the vertebrae) extends beyond its normal margin impinging on surrounding structures including the nerve root.
- A disc herniation: where under 25% of the disc herniates beyond its normal margins margin impinging on surrounding structures including the nerve root.
- Spinal stenosis: narrowing of the joint spaces within the spine due to degenerative changes of the spine.
- Spondylolisthesis: when one of the vertebrae slip forward onto the bone directly beneath.
- Spinal tumours or infections.
In cases under 50 years old, a herniated disc is the most frequent cause, while for those aged over 50 years old it can be caused by stenosis or degenerative changes in the spine. It is important to note, that often, people can have these findings on an MRI and experience no symptoms as well.
What is the treatment for painful radiculopathy?
Overall, the majority of cases of painful lumbar radiculopathy are not severe, and will resolve with time, and thus conservative management is the first line of treatment, however approximately 30% of cases will continue for a year or longer. Treatment is varied and includes a combination of physiotherapy and medical management.
Contacting your local physiotherapy clinic can be the first step. After a detailed assessment with the physiotherapist, we can guide you towards a program of manual and exercise therapy that suits your personal needs and goals. There is much evidence to show that staying active with a structured routine of guided exercises is an effective form of management. In certain cases, we may refer you onward for further medical management.
At The Moving Body, our physiotherapists are well equipped to manage your radicular lower back pain whether you are in the acute stages of pain, or if this has been an ongoing issue for months or years. We utilize a wide variety of treatment techniques including Pilates and modified resistance training to manage pain and optimize lumbo-pelvic strength. In severe cases, we may refer you onwards for an X-ray or MRI. We work hand in hand with GPs and orthopaedic consultants to ensure that you recover as soon as possible. While it is never too late to start, the sooner this issue is addressed, the better the outlook is. Contact us today to arrange your physiotherapy consultation.
Image credit: Unsplash, Toa Heftiba