Lumbar radiculopathy (also known as sciatica or radiculitis) is a condition that occurs when a nerve in your low back is injured, pinched, or compressed, causing pain or other symptoms that can extend from the low back to the hip, leg, or foot. Lumbar radiculopathy can be caused by sudden trauma or by long-term stress affecting structures in the back. It most often affects people aged 30 to 50 years. Risk factors for lumbar radiculopathy include repeated lifting, participating in weight-bearing sports, obesity, smoking, sedentary lifestyles, and poor posture. The majority of lumbar radiculopathy and sciatica cases recover without surgery, and respond well to physical therapy. Physical therapists design individualized treatment programs to help people with lumbar radiculopathy reduce their pain, regain normal movement, and get back to their normal activities.
The spine is made up of 33 vertebrae (bones) stacked on top of each other. On the side of each vertebra are openings in the bone through which nerve roots and nerves exit the spinal canal and travel out to the hips, legs, and feet. Between each vertebra is a piece of cartilage called an “intervertebral disc” that acts like a cushion between the vertebrae.
Injuries close to the spine can cause pressure or injury to the nerves and nerve roots. These injuries may include:
Conditions that can cause lumbar radiculopathy to develop over time include:
Sudden injury can occur with a fall, when a person lifts an object awkwardly, or through trauma such as a car accident. Structures surrounding the spine, such as ligaments or nerves, can also be injured.
A slow onset of lumbar radiculopathy can occur from sitting or standing with poor posture (slumped forward) for weeks, months, or years. Poor posture can slowly overstretch ligaments in the back, allowing pressure to occur on a spinal nerve. As that pressure increases, the pain can travel farther out along the path of the nerve, causing discomfort in the hip, leg, or foot.
Lumbar radiculopathy can cause pain, muscle tightness and weakness, or other symptoms. The pain usually starts in the low back, and can travel to the hip, leg, or foot. The location of the pain can vary depending on which nerve in the back is affected and how much it is irritated. Greater irritation causes the pain to spread farther. Spreading pain usually affects 1 leg, but may affect both legs. Pain and other symptoms can be constant or come and go, and can vary in intensity.
If a nerve or nerve root is severely pinched or compressed it can cause severe pain, muscle weakness, or extreme movement problems. Surgery may be recommended in more severe cases. On rare occasions, nerve compression can cause bladder control or bowel function problems, in which case immediate surgery is recommended.
Your physical therapist can help determine the details of your condition and whether consultation with a surgeon is necessary. Your physical therapist will work with your physician or surgeon to determine your best treatment.
Lumbar radiculopathy can cause a variety of symptoms. The type and location of your symptoms will depend on the amount of pressure being placed on the affected nerve(s). Symptoms may include:
The pain or other symptoms can occur in 1 limb or both. They can be in different locations at different times, and can change depending on your activity or body positioning. For example, pain can lessen or worsen when walking versus sitting, or lying down versus standing up.
Your physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist also will ask you detailed questions about your injury, such as:
Your physical therapist will perform tests on your body to identify problems, such as:
If your physical therapist finds any of the above problems, physical therapy treatment may begin right away, to help get you on the road to recovery and back to your normal activities.
If testing indicates any concerns, your physical therapist will consult your physician or surgeon regarding the need for special diagnostic testing, such as magnetic resonance imaging (MRI). Physical therapists work closely with physicians and other health care providers to ensure you receive an accurate diagnosis, treatment, and the care you need.
In all but the most extreme cases of lumbar radiculopathy, conservative care (such as physical therapy) often results in better and faster results than surgery or pain medication (such as opioid medication).
Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies, but improvement may be achieved in 4 to 8 weeks, when a proper posture, pain reduction, stretching, and strengthening program is implemented.
During the first 24 to 48 hours following your diagnosis of lumbar radiculopathy, your physical therapist may advise you to:
Some exercises are better for individuals with lumbar radiculopathy. Your physical therapist will educate you about them. For example:
Your physical therapist will work with you to:
Reduce pain and other symptoms. Your physical therapist will help you understand how to avoid or modify the activities that caused the injury, so healing can begin. Your therapist may use different types of treatments and technologies to control and reduce your pain and symptoms. Your treatment, based on your condition, may include specific motion exercises, mechanical traction, the application of cold or heat packs, and gentle electrotherapy such as transcutaneous electrical nerve stimulation (TENS).
Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in any stiff joints. These might begin with “passive” motions that the physical therapist performs for you to move your spine, and progress to active exercises and stretches that you do yourself. You can perform these motions at home and in your workplace to help hasten healing and pain relief.
Improve flexibility. Your physical therapist will determine if any of the involved muscles are tight, start helping you to stretch them, and teach you how to stretch them at home.
Improve strength. If your physical therapist finds any weak or injured muscles, the therapist will teach you the correct exercises to steadily restore your strength and agility. “Core strengthening” exercises are commonly used to restore the strength and coordination of muscles around your back, hips, abdomen, and pelvis.
Improve endurance. Restoring muscular endurance is important after an injury. Your physical therapist will develop a program of activities to help you regain the endurance you had before the injury, and improve it.
Improve posture. Your physical therapist will teach you how to improve your posture so that pressure is reduced in the injured area, and healing can begin and progress as rapidly as possible.
Learn a home program. Your physical therapist will teach you strengthening, stretching, and pain reduction exercises to perform at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.
Return to activities. Your physical therapist will discuss your activity levels with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. For spine and leg pain from lumbar radiculopathy, your physical therapist may teach you correct ways to lift objects (called “body mechanics”) that will help protect your spine from aggravating symptoms.
Once your pain is under control or gone, it will be important for you to continue your new posture and movement habits to keep your back healthy and pain free.
In some cases, surgery is necessary to prevent further damage. If you undergo surgery for your lumbar radiculopathy, your physical therapist will work closely with you and your surgeon to help you regain motion and strength more quickly than you could on your own, and help you get back to your normal lifestyle as quickly as possible.
Lumbar radiculopathy may be preventable. To reduce the likelihood of developing this condition:
To help prevent recurrence of lumbar radiculopathy, follow the above advice, and: