SCIATICA OR LUMBAR RADICULOPATHY
Lumbar radiculopathy (also known as sciatica or lumbar 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 Physiotherapy. Physiotherapists design individualized treatment programs to help people with lumbar radiculopathy reduce their pain, regain normal movement, and get back to their normal activities.
What is Sciatica?
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:
- Bulging intervertebral discs (“herniated or prolapsed disc”)
- Overstretching of a nerve or nerve root
- Tight piriformis muscle
Conditions that can cause lumbar radiculopathy to develop over time include:
- Bone spurs
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.
How Does it Feel?
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 Physiotherapist at Alton Pain Clinic in Alton, Hampshire can help determine the details of your condition and whether consultation with a surgeon is necessary. Your Physiotherapist will work with your physician or surgeon to determine your best treatment.
Signs and Symptoms
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:
- Pain and/or pressure in the back, hip, leg(s), foot/feet
- Pain that can be throbbing, aching, shooting, sharp, dull, or burning
- Inability to bend or rotate the back
- Numbness or tingling in the back, hip(s), leg(s), or feet
- Weakness in the leg(s)
- Increased pain when coughing, sneezing, reaching, or sitting
- Inability to stand up straight; being “stuck” in a position such as stooped forward
- Difficulty getting up from a chair
- Inability to remain in 1 position for a long period of time, such as sitting or standing, due to pain
- Pain that is worse in the morning
- Limping when walking
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 physiotherapist at Alton Pain clinic, Alton Hampshire will conduct a thorough evaluation that includes taking your health history. Your physiotherapist also will ask you detailed questions about your injury, such as:
- Do you have loss of control of your bladder or bowel? CAUTION: Contact a medical professional immediately if you experience this condition.
- How and when did the pain start?
- At what time of day is it worse?
- What type of discomfort do you feel, and where do you feel it?
- What are you unable to do right now in your daily life due to the pain?
Your physiotherapist will perform tests on your body to identify problems, such as:
- Difficulty moving
- Muscle weakness or tightness
- Changes in skin sensation (numbness)
- Changes in reflexes
- Joint stiffness
- Changes in posture
- Difficulty walking or balancing
If your physiotherapist at Alton Pain clinic, Alton Hampshire finds any of the above problems, physiotherapy 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 physiotherapist will consult your physician or surgeon regarding the need for special diagnostic testing, such as magnetic resonance imaging (MRI). Physiotherapists work closely with physicians and other health care providers to ensure you receive an accurate diagnosis, treatment, and the care you need.
How Can a Physiotherapist Help?
In all but the most extreme cases of lumbar radiculopathy, conservative care (such as Physiotherapy) often results in better and faster results than surgery or pain medication (such as opioid medication).
Your Physiotherapist at Alton Pain Clinic, Alton Hampshire 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. Physiotherapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies, but on average improvement may be achieved in 8-12 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 physiotherapist may advise you to:
- Protect the area by avoiding activity that causes worsening symptoms, such as heavy lifting.
- Avoid too much bed rest.
- Stay active around the house, and go on short walks several times per day. Movement will decrease your pain and stiffness, and help you feel better.
- Apply ice packs to the affected area for 15 to 20 minutes every 2 hours.
- Sit in firm chairs. Soft couches and easy chairs may make your problems worse.
- Consult with a physician for further services, such as medication or diagnostic tests.
Some exercises are better for individuals with lumbar radiculopathy. Your Physiotherapist will educate you about them.
At Alton Pain Clinic, Alton Hampshire we offer Spinal Decompression Therapy using mechanical traction which involves stretching the spine along its long axis, using a motorized device, with the goal of relieving back pain and/or leg pain. This technique is called non-surgical decompression therapy (as contrasting to surgical spinal decompression, such as laminectomy and microdiscectomy) and is very effective in treatment of lower back pain, neck pain, herniated discs and/or pain originating from nerve compression like sciatica.
Concept of Spinal Decompression
Both traction and decompression therapy are applied with the goals of relieving pain and promoting an optimal healing environment for bulging, degenerating, or herniated discs and compressed or pinched nerves due to narrowing of their spinal passages by:
- Creating a negative intra-discal pressure to promote retraction or repositioning of the herniated or bulging disc material.
- Distraction of vertebral bodies and facet joints creating space between adjacent levels.
- Widening of inter-vertebral foramen allowing more space for exiting nerve roots.
- Stretching of spinal ligaments and musculature.
- Creating a lower pressure in the disc that will cause an influx of healing nutrients and other substances into the disc.
Your physiotherapist at Alton Pain Clinic, Alton Hampshire will also work with you to:
Reduce pain and other symptoms Your Physiotherapist 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 Physiotherapist will choose specific activities and treatments to help restore normal movement in any stiff joints. These might begin with “passive” motions that the Physiotherapist 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 Physiotherapist 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 Physiotherapist 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 Physiotherapist will develop a program of activities to help you regain the endurance you had before the injury, and improve it.
Improve posture Your Physiotherapist 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 Physiotherapist 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 Physiotherapist, you can speed your recovery.
Return to activities Your Physiotherapist at Alton Pain Clinic, Alton Hampshire 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 Physiotherapist 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.