Anatomy of the lumbosacral spine
The lumbar and sacral spine (lower back) are made up of 5 adjacent vertebrae. Between each adjacent lumbar vertebrae, and the last lumbar and first sacral vertebrae, there is an intervertebral disc. On either side, extending outward, the vertebral column has bony projections, referred to as articular processes. Adjacent articular processes form facet joints. The spinal cord is protected by the vertebral column and travels down the spinal canal. The spinal cord gives rise to nerve roots that supply messages to the rest of the body. These nerve roots exit via openings referred to as the intervertebral foramen.
Description
Lumbar radiculopathy is a disorder that results in lower back pain referring to the lower limb(s). The pathway of referral sometime depends on where the injury occurred in the spine (1,2,8). When going down the back of the leg, this pain or paraesthesia is referred to as Sciatica.
Why do you experience pain or odd sensations (paraesthesia) in your lower limb?
Spinal nerve roots may be affected by injury/irritation to the lumbar spine/lower back and because lumbar spinal nerve roots supply messages to the lower limbs, compression or irritation of the nerve may lead to pain or paraesthesia experienced along the nerve pathway (8). Injury or irritation to the nerve root may also result in weakness and impaired reflexes in the leg (1,7).
What are the commonly experienced paraesthesia symptoms in the lower limb?
These symptoms often vary between individuals but some of the most common symptoms include the following: Sharp, shooting pain in the leg, numbness, burning, tingling, pins and needles (1,3,7)
Structures that may affect the nerve.
Nerves may be impinged by a variety of structures. It is thus essential that a comprehensive assessment is carried out to determine the exact cause of pain. Some common causes of lower back pain referring into the lower limb(s) include lumbar disc herniation (1,3,8) (lower back intervertebral disc is out of position and places pressure on a nearby nerve root), lumbar spinal stenosis – narrowing of the canal where the spinal cord passes through and bone spurs/growths (3,8).
Management
The first line of treatment advised for most individuals is conservative, non-surgical management (5&7).
Physiotherapy consultations at Floyd Lebatie Physiotherapy will include the following:
Education on how to protect your back and prevent further injury or reoccurrence and Joint mobilization to provide relief from pain and/or stiffness (2,6). Soft tissue manipulation/massage to release the tension of tight muscles (6). Traction to relieve pressure on your spine (7). Neural mobilization to ensure your nerves can move freely to transmit signals (3). Strengthening exercises to provide support and stability of the spine (2,6). If needed, we may also provide you with a referral to a doctor to do an Injection to reduce pain(6,8).References
1.Iversen, T., Solberg, T., Romner, B., Wilsgaard, T., Nygaard, O., Waterloo, K., . . . Ingebrigtsen, T. (2013). Accuracy of physical examination for chronic lumbar radiculopathy. MBC Musculoskeletal Disorders, 14(206).
2.Karlsson, M., Bergenheim, A., Larsson, M., Norderman, L., van Tulder, M., & Bernhardsson, S. (2020). Effects of exercise therapy in patients with acute low back pain: a systematic review of systematic reviews. Systematic Reviews, 9(182).
3.Lynch, R. (2019). Physical Therapy Rehabilitation for Lumbar Radiculopathy: A Case Report. North Dakota: University of North Dakota Scholarly Commons.
4.Murphy DR, Hurwitz EL, Gerrard JK, Clary R. Pain patterns and descriptions in patients with radicular pain: Does the pain necessarily follow a specific dermatome?. Chiropractic & Osteopathy. 2009 Dec 1;17(1):9.
5.Perolat, R., Kastler, A., Nicot, B., Pellat, J.-M., Tahon, F., Attye, A., . . . Krainik, A. (2018). Facet joint syndrome: from diagnosis to interventional management. Insights Imaging, 9(5), 773-789.
6.Shipton, E. (2018). Physical Therapy Approaches in the Treatment of Low Back Pain. Pain and Therapy, 7, 127-137.
7.Vanti, C., Turone, L., Panizzolo, A., Guccione, A., Bertozzi, L., & Pillastrini, P. (2021). Vertical traction for lumbar radiculopathy: a systematic review. Archives of Physiotherapy, 11(7).
8.Zhang, X., Zhang, Z., Wen, J., Lu, J., Sun, Y., & Sang, D. (2018). The effectiveness of therapeutic strategies for patients with radiculopathy: A network meta-analysis. Molecular pain, 14.
