Understanding Lumbar Radiculopathy

Low back pain is a common issue that affects up to 85% of people at some points in their lives. It is so prevalent, in fact, that it is the leading cause of disability in the world, affecting both the general and athletic population. If you have experienced low back pain before, you may have heard of the terms radicular pain, sciatica and lumbar radiculopathy used interchangeably by your friends, family or health practitioner.

With so many definitions relating to the topic, it can be a real pain in the back to work out how they fit together and most importantly, how they relate to you.

Back Pain Definitions

Radiculopathy occurs when a nerve root is compressed or inflamed, and the nerve signals are blocked from travelling through the nerve. Unlike radicular pain (below), radiculopathy can result in sensation changes (i.e. pins and needles, tingling or numbness), weakened reflexes, motor loss, or a combination of these. This can occur with or without pain.

Radicular pain specifically applies to a single symptom – pain. This pain arises from the irritation of a nerve root, whether that be a sciatic nerve root, or a nerve root elsewhere in the body. Radicular pain is often described as ‘sharp’ or ‘shooting’ and travels into the lower limb along a narrow band, no more than 2-3 inches wide.

Radicular pain is commonly termed sciatica, although this term is used inconsistently by clinicians and patients for different types of leg or back pain. It has therefore become less meaningful and is used less often.

The term lumbar radicular pain or radiculopathy simply mean that these symptoms occur in the low back!

What causes Lumbar Radiculopathy?

In people under 50, the most common cause of lumbar radiculopathy is a disc herniation. Disc herniations occur when a disc becomes degenerative or injured and the nucleus – the soft inner part – starts to move beyond it’s tough outer margins. This material contacts or exerts pressure on the lumbar nerve roots.

After the age of 50, degenerative changes in the spine are a more common cause. This can include, but is not limited to, spinal stenosis (abnormal narrowing of the spinal canal) or spondylolisthesis (displacement of one spinal vertebra compared to another).

Who is affected?

Although low back pain is very common among the general population, lumbar radiculopathy has only been reported to affect 3 to 5% of all people!

Disc herniations are also more common in females than males and usually occur between the age of 20 to 50 years.

How long does it last?

It is important to remember that although it can be quite painful, lumbar radiculopathy is not a serious disease and that disc herniations generally resolve spontaneously. This means that symptoms will improve with the passage of time!

By 4 to 6 weeks, between 70 to 80% of patients will see a significant improvement in pain and disability with relative rest. What’s more, complete resolution of symptoms is expected to occur over a 3 to 6 month period. In a small number of cases, pain can persist beyond these usual timeframes and may require further medical evaluation.

How is it diagnosed?

In most cases, scans are not required to diagnose lumbar radiculopathy as your health practitioner can make the diagnosis based on your clinical history and physical examination. Considering this, imaging may be useful if symptoms do not settle in the usual time frames or the pain pattern is atypical. In this case, magnetic resonance imaging (MRI) is recommended as the most appropriate test.

How is it treated?

Treatment options for lumbar radiculopathy include surgery, injections and also non-surgical management. The consensus is that in the first 6 to 8 weeks, conservative (non-surgical treatment) is recommended, and may continue for longer if good progress is being made.  If there is no significant change after this time, a referral to a surgeon may be indicated.

Early non-surgical management:

  • Adopt positions of maximum comfort when pain is severe
  • Pain relief and anti-inflammatories as advised by your doctor
  • Avoid bed rest, minimise sitting and stay active with gentle activities, including walking
  • Commence gentle spine mobility exercises for pain relief
  • Gentle spinal manipulation for pain relief
  • Structured exercise with a physiotherapist

Ongoing non-surgical management:

In later stages, a physiotherapist can help you to restore pain free movement with localised mobilisation and gentle stretches. They can also help you to improve your motor control patterns and adjust your sporting technique to optimise the stress placed on spinal structures and prevent the injury from reoccurring.

Transforaminal epidural steroid injections (TESI):

TESI’s have been shown to provide short-term (2 to 4 weeks) pain relief in some patients. This option may be considered if there is no significant improvement in signs and symptoms with rest, and pain levels are distressing. As with surgery, the risks of having an invasive treatment  (such as infection) need to be considered against the potential benefits.

Spinal surgery:

Spinal surgery is only considered when nerve root compression results in persistent bladder or bowel symptoms or where symptoms have progressed or not changed despite adequate non-surgical management. It is important to note that the 2-year outcomes for surgical compared to non-surgical treatments are usually the same however.

 

We hope this blog has helped you understand the different types of back pain and Lumbar Radiculopathy. If you have any questions or would like to see our Physiotherapy team for an assessment, please get in touch.

 

References

Bogduk, N 2009, ‘On the definitions and physiology of back pain, referred pain, and radicular pain’, Pain, vol. 147, no. 1-3, pp. 17–19.

Brukner, P & Khan, K 2012, Clinical Sports Medicine, 4th edition,  McGraw-Hill, North Ryde.

Devillé, WL, Van Der Windt, DA, Dzaferagic, A, Bezemer, PD and Bouter, LM 2000, ‘The test of Lasegue: systematic review of the accuracy in diagnosing herniated discs,’ Spine, vol. 5, no. 9, pp.1140-1147.

Kreiner, DS, Hwang, SW, Easa, JE, Resnick, DK, Baisden, JL, Bess, S & Ghiselli, G 2014, ‘An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy,’ The Spine Journal, vol. 14, no. 1, pp. 180-191.

Urits, I, Burshtein, A, Sharma, M, Testa, L, Gold, P, Orhurhu, A, Viswanath, V, Jones, O, Sidransky, M, Spektor, R & Kaye, M 2019, ‘Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment’, Current Pain and Headache Reports, vol. 23, no. 3, pp. 1–10.

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